High cholesterol affects many Americans and can lead to serious problems like heart attack or stroke. Cardiologist Bukola Olubi, MD, of Piedmont Healthcare, discusses the most common questions her patients have about lowering their cholesterol levels. 1. Q: What is cholesterol? A: Cholesterol is a fat-like substance that’s found in the blood and in all the cells of the body. Really, your body makes all the cholesterol it needs. And my patients are usually surprised when I tell them cholesterol is needed for good health. It only becomes a problem when there’s too much cholesterol in the blood. 2. Q: What are you looking for when measuring cholesterol levels? A: When we measure cholesterol levels, we measure your LDL, HDL and triglyceride levels. LDL, or low-density cholesterol, is often referred to as the “bad” cholesterol because too much LDL cholesterol contributes to plaque formation that can clog your arteries. We know LDL cholesterol can actually increase your risks for heart attacks, stroke, and other health problems. That’s why it’s called the bad cholesterol, and why you definitely want to take all necessary precautions to decrease LDL cholesterol. Then we have HDL, or high-density, cholesterol. We usually refer to that as the “good” cholesterol because it removes the bad cholesterol from where it’s not supposed to be in the body. And we also know that when you have high HDL levels, this actually helps to lower your risk for heart attack, strokes, and other health problems. Triglycerides are also part of the equation. Usually when you have high triglycerides, you get that from your food. And high triglyceride levels have been shown to increase your risk for heart attacks and strokes. 3. Q: What causes high cholesterol? A: It can be caused by a variety of sources, including your family history, but primarily it comes from what you eat. Your body makes all the cholesterol it needs, so any extra cholesterol you have comes from what you eat. And if you eat too much saturated fat, then you’re likely to have elevated cholesterol levels. Primarily, foods like saturated fats, butter, cheeses, animal fats, packaged foods, some types of oils, and margarine cause high cholesterol levels. Some people have familial hypercholesterolemia, which is genetic high cholesterol, so we’ll tackle that differently than diet-caused high cholesterol. 4. Q: How is high cholesterol treated? A: High cholesterol can almost always be lowered with a combination of lifestyle changes and medication. Usually, when I see someone with high cholesterol, I counsel them on lifestyle changes like diet, weight loss, and exercise. And then, of course, we have a number of medications we can use for high cholesterol. The most common ones we have out there are what we call statins. We also have other medications called cholesterol absorption inhibitors, and sometimes we use bile acid binding resins as well as fibrates and niacin. Some new cholesterol medications have come to the market in the last few months that have gotten a lot of buzz lately. They are injectables called PCSK9 inhibitors. They can be helpful for people who can’t tolerate statins or other drugs. For people who have familial hypercholesterolemia, we treat with a combination of aggressive lifestyle modifications like diet and exercise, plus pharmacological therapy using more than one of the available medications. 5. Q: What’s the hardest part for you about treating high cholesterol? A: I think the hardest part is patients coming in and telling me they read something online or heard something on the news, and they believe their medicine is going to kill them or have really serious side effects. I think we’ve seen a lot of negative information from the press about cholesterol medication. So unfortunately, the hardest part is trying to convince patients to take their cholesterol medicine, that the benefits far outweigh the risks. I spend some time trying to explain to patients that, yes, there’s a small risk of what they heard or read, but the benefits far, far outweigh the risks. And the side effects are not as common as they might believe. It’s much more important for them to lower their cholesterol with these medications—the bigger risk is their risk of cardiovascular disease and other health problems.