Cholesterol maintains proper fluidity and permeability in cell membranes in the body, and aids in the synthesis of fat-soluable vitamins, steroid hormones, and sex hormones. Low-density lipoprotein (LDL) is known as “bad” cholesterol, while high-density lipoprotein (HDL) is known as “good” cholesterol. LDL, HDL, triglycerides, and other lipid components make up total cholesterol.
Excessive amounts of cholesterol in the bloodstream are associated with atherosclerosis—a waxy build-up of plaque in the blood vessels that can lead to heart attack or stroke. Low HDL cholesterol levels are also a major factor for heart disease. Adults should aim for total cholesterol levels below 200 mg/dL (LDL<100 mg/dL; HDL>40 mg/dL for men and >50 mg/dL for women; triglycerides <150 mg/dL.)
The American Heart Association (AHA) recommends individuals aged 20 years or older get their cholesterol levels tested every 5 years. OTC testing kits for cholesterol have been on the market since 1993, and are up to 95% accurate when used properly. These tests may be an attractive option for patients who are uninsured or underinsured compared with laboratory blood tests; the average retail price for a simple testing kit starts at $12.99. Some OTC tests measure only total cholesterol, while others offer more specific readings of HDL cholesterol or triglycerides. Patients who use OTC cholesterol tests should be counseled to choose the test that best fits their needs and to follow the instructions carefully—particularly when fasting—to avoid inaccurate results.
To reduce the risks of atherosclerosis, heart disease, and stroke, pharmacists should counsel individuals to avoid smoking and alcohol, get regular aerobic exercise, and avoid or reduce obesity. Identifying and treating diabetes and hypertension will also help reduce the risks of cardiovascular problems.
Patients may have questions about the relationship between diet and cholesterol levels. The AHA recommends that individuals with elevated cholesterol levels eat a heart-healthy diet rich in fiber, fruits and vegetables, and lean proteins. There is also a variety of supplements on the market that are indicated for reducing cholesterol. Patients should report the use of any supplements to their pharmacist to reduce the possibility of potentially dangerous drug interactions.
Patients with elevated cholesterol levels may be able to control their condition with careful monitoring and lifestyle modifications, including a healthy diet, exercise, and OTC dietary supplements. Those individuals who still have elevated cholesterol after making lifestyle changes should be referred to their physician.