|Also Listed As:
|| Cholesterol, High; High
Cholesterol is a soft waxy substance that is a natural component of the fats
in the bloodstream and in all the cells of the body. While cholesterol is an
essential part of a healthy body, high levels of cholesterol in the blood (known
as hypercholesterolemia) increase a person's risk for cardiovascular disease,
which can lead to stroke or heart attack. When there is too much cholesterol
circulating in the blood, it can create sticky deposits (called plaque) along
the artery walls. Plaque can eventually obstruct or even block the flow of blood
to the brain, heart, and other organs. A recent report indicates that more and
more Americans have high cholesterol—the condition is
most common among those living in Western cultures. While heredity may be a
factor for some people, increasingly sedentary lifestyles combined with diets
high in saturated fats appear to be the main culprits.
The normal range for total blood cholesterol is between 140 and 200 mg per
decilitre (mg/dL) of blood. Levels between 200 and 240 mg/dL indicate moderate
risk, and levels surpassing 240 mg/dL indicate high risk. While total
cholesterol level is important, it does not tell the whole story. There are two
main types of cholesterol: low density lipoproteins (LDL) and high density
lipoproteins (HDL). HDL is generally considered to be "good" cholesterol, while
LDL is considered "bad." Triglycerides are a third type of fatty material found
in the blood. While their role in heart disease is not entirely clear, it
appears that as triglyceride levels rise, levels of "good" cholesterol fall. It
is the complex interaction of these three types of lipids that is thrown off
when a person has hypercholesterolemia. High cholesterol is characterized by
elevated levels of LDL cholesterol, normal or low levels of HDL cholesterol, and
normal or elevated levels of triglycerides.
|Signs and Symptoms|
In its preliminary stages, high cholesterol generally occurs without any
symptoms. For this reason, screening through routine blood tests is crucial for
early detection. In its advanced state, however, high cholesterol may result in
any of the following:
- Fat deposits in the tendons and skin (called xanthomas)
- Enlarged liver and spleen (which the healthcare provider may feel on
- Severe abdominal pain as a result of pancreatitis (this happens if
triglycerides deposit in the pancreas, which may occur when triglyceride levels
are 800 mg/dL or higher)
- Chest pain and even a heart attack (this may occur when enough
cholesterol has built up in blood vessel walls to block the flow of blood in the
In some cases, abnormally high cholesterol may be related to an inherited
disorder. Certain genetic causes of abnormal cholesterol and triglycerides,
known as hereditary hyperlipidemias, are often very difficult to treat. High
cholesterol or triglycerides can also be associated with other diseases a person
may have, such as diabetes. In most cases, however, elevated cholesterol levels
are associated with an overly fatty diet coupled with an inactive lifestyle. It
is also more common in those who are obese, a condition that has now reached
epidemic proportions in the United States, affecting as much as half of the
Causes of high total and LDL cholesterol levels include:
- Hereditary hyperlipidemia (Types IIa or IIb)
- Diets high in saturated fats and cholesterol
- Liver disease
- Underactive thyroid
- Poorly controlled diabetes
- Overactive pituitary gland (a gland in the brain that helps control
hormones in the body)
- A kidney disorder called nephrotic syndrome characterized by elevated
cholesterol, loss of protein in the urine leading to low levels of protein in
the blood, and excessive fluid retention causing swelling
- Anorexia nervosa
- Medications such as progestogens, cyclosporins, and thiazide
Causes of low HDL cholesterol include:
- Cigarette smoking
- Certain medications such as beta blockers and anabolic
- Low levels of physical activity
- Polycystic ovarian syndrome (a hormonal disorder caused by multiple
cysts in the ovaries accompanied by irregular or no menstruation, acne, obesity,
and excessive facial hair)
Causes of high triglyceride levels include:
- Hereditary hyperlipidemia (Types I, IIb, III, IV, or V)
- Diets high in calories, especially from sugar and refined
- Poorly controlled diabetes
- Insulin resistance (decreased effectiveness of insulin, a hormone that
lowers blood sugar levels)
- Alcohol use
- Kidney failure
- Polycystic ovarian syndrome
- Multiple myeloma (a rare disease that occurs more frequently in men
than in women and is associated with anemia, bleeding, recurrent infections, and
- Lymphoma (tumor of the lymphoid tissue)
- Certain medications such as estrogens (available in either oral
contraceptives or as part of hormone replacement therapy for menopausal women),
corticosteroids, a class of cholesterol-lowering medications known as bile acid
binding resins (including cholestyramine, colestipol, colesevelam), and
isotretinoin (used to treat acne).
There are certain factors that put a person at increased risk of having high
cholesterol. While some factors cannot be altered by changes in lifestyle, many
can be changed. The most important risk factors for high cholesterol
- Diets high in saturated fat and trans fatty acids (found frequently in
processed foods, such as those that have been hydrogenated or fried)
- Low fiber in the diet
- Physical inactivity
- Smoking cigarettes
- Living in an industrialized country
- Underactive thyroid
- Polycystic ovary syndrome
Since most people have few if any symptoms of hypercholesterolemia (another
term for high cholesterol), blood screening is very important. An initial blood
test is done to check a "random" measurement of total and HDL cholesterols,
meaning that the test is performed at any time during the day, regardless of
what has been eaten. Those with abnormal levels (total cholesterol more than 200
mg/dL or HDL less than 40 mg/dL), will go on to have a test called fasting lipid
profile (in which the person being tested refrains from eating for 8 to 12
hours, usually overnight, prior to the test). The fasting test will indicate
whether or not total cholesterol levels fall within the normal range (between
140 and 200 mg/dL), are moderately high (between 200 and 240 mg/dL), or if they
are in the very high range (240 mg/dL or greater). This blood test also reveals
the levels of LDL, HDL, and triglycerides. According to guidelines released by
the National Cholesterol Education Program (NCEP), the optimal level for LDL
cholesterol depends on whether you have heart disease or not and whether there
are other risk factors present for heart disease (such as diabetes and high
blood pressure). The optimal level for HDL for all people (healthy or otherwise)
is a measurement higher than 60 mg/dL; low levels are 40 mg/dL and below.
Adults with normal total and HDL cholesterol levels should have their
cholesterol checked every 5 years. Those being treated for hypercholesterolemia
should have their cholesterol levels measured every 2 to 6 months and have liver
function tests as well if they are on cholesterol-lowering medication.
Changing eating habits is key in preventing high cholesterol. Other lifestyle
changes that can reduce the risk of developing high cholesterol and
cardiovascular disease include maintaining a normal weight and increasing
The best ways to lower cholesterol through diet include the
- Reducing the amounts of saturated fat and cholesterol consumed each
- Increasing daily consumption of fruits, vegetables, fish, and whole
- Supplementing the diet with other protective components such as fiber
There are a number of diets designed to keep cholesterol levels in check
including the American Heart Association (AHA) diet, the Mediterranean diet, and
the Ornish diet. While these three diets vary in some ways, they all emphasize
whole grains and include fiber, fresh fruits and vegetables, lean protein,
particularly soy and fish, and avoidance of saturated fats and trans fatty
acids. These diets are outlined below.
The AHA Step I Diet is considered appropriate for the general
population, including those who have normal cholesterol levels and want to
prevent the development of high cholesterol. This diet calls for up to 55% of
daily calories from carbohydrates, 15% from protein, and no more than 30% from
fat. The diet also outlines quite specific of types of fat and the proportions
- Between 8% and 10% of fat from saturated fatty acids (saturated fats
are found mainly in foods that come from animals such as butter, cheese, milk,
cream, and ice cream)
- Up to 10% from polyunsaturated fatty acids (polyunsaturated fat is
highly unsaturated fat that is found in large amounts in foods from plants,
including safflower, sunflower, corn, and soybean oils)
- Up to 15% from monounsaturated fatty acids (monounsaturated fat is a
slightly unsaturated fat found in large amounts in foods from plants, including
peanut, avocado, canola, and olive oils)
- Less than 300 mg per day of dietary
This diet also specifies the level of calories that helps people achieve and
maintain a healthy weight, and it is ideal for those who currently include a lot
of fat in their diets and have not previously attempted to lower their
cholesterol levels through dietary changes.
The AHA Step II Diet is designed for patients who require
greater LDL lowering, and includes the Step I guidelines (above) with two
- Less than 7% of calories from saturated fat (instead of 8% to
- Less than 200 mg per day of dietary cholesterol (instead of less than
300 mg per day)
The Mediterranean Diet is comprised of whole grains, fresh
fruits and vegetables, fish, olive oil, garlic, and moderate, daily consumption
of red wine. Although this diet is not low in fat, it is high in monounsaturated
fatty acids and has been shown to increase HDL cholesterol levels and to inhibit
the process whereby LDL cholesterol adheres to artery walls. One large,
well-designed study found that people who had had at least one heart attack were
between 50% and 70% less likely to suffer a another heart attack if they
followed the Mediterranean diet. This diet puts a great emphasis on bread, root
and green vegetables, and the daily consumption of fruit, fish, and poultry.
Only olive and rapeseed (canola) oils are used in this eating plan and margarine
(with alpha-linolenic acid) is used instead of butter. Eating beef and lamb is
discouraged. This diet is naturally rich in fiber, antioxidants, and omega-3
fatty acids. It contains the same amount of protein as the AHA diet, but the
source of protein is primarily fish. The Mediterranean diet has less
carbohydrates than the AHA or Ornish diets, but places the same emphasis on
consuming fruits, vegetables, nuts, legumes, and beans.
The Ornish Diet is a completely vegetarian diet that has been
shown to dramatically reduce cholesterol levels and to actually reverse the risk
of heart disease. No oils or animal products are allowed in the Ornish diet,
except nonfat dairy products and egg whites. In this diet, total fat is limited
to 10% of daily calories, saturated fats are significantly limited, and
carbohydrates generally make up 75% of calories. Complex carbohydrates from
whole grains and other high-fiber foods and from fresh fruits and vegetables are
Being overweight increases risk of high cholesterol and heart disease. Even
small degrees of weight loss can make nutritional changes more effective in
lowering LDL—a 5 to 10 pound weight loss can double the
LDL reduction achieved by dietary adjustment alone. Weight loss is often
accompanied by lowered triglycerides and increased HDL levels as well. The goal
for weight loss should be a realistic one, rather than a rapid or dramatic loss.
Very low calorie diets (500 to 800 calories) can be dangerous and are not
recommended. A reasonable caloric restriction is considered a reduction of 250
to 500 calories per day in the usual diet aimed at achieving a gradual, weekly
weight loss of one-half to one pound.
Regular physical activity by itself both reduces the risk of death from heart
disease and enhances the effects of diet on LDL cholesterol levels. In a study
of 377 people who were divided into four groups (aerobic exercise, the AHA Step
II diet, the Step II diet plus exercise, or no intervention), those who only
made dietary changes did not show reduced LDL while the group on the Step II
diet plus exercise had a significant reduction in LDL cholesterol. Moderate
exercise three to five times per week (the equivalent of walking 7 to 14 miles
per week) can help promote weight loss in overweight individuals, reduce LDL and
triglyceride levels, and produce favorable levels of HDL. Exercise may also
lower blood pressure. For these reasons, everyone with risk factors for heart
disease should consider starting a program of regular, aerobic physical
activity, individualized to suit physical fitness level, heart health, and
The main goal of treatment is to reduce the risk of cardiovascular diseases,
such as heart disease and stroke, by lowering blood cholesterol levels. Studies
have shown that for every 1% reduction in cholesterol levels there is a 2%
reduction in the rate of heart disease. People who benefit most from lowering
their cholesterol are those who already have heart disease or who have multiple
risk factors for the disease. In addition to lifestyle changes, specific
medications are often prescribed.
lifestyle are the most effective means of
both preventing and, in less severe cases, treating elevated LDL cholesterol
levels. The cornerstone of this treatment strategy is
dietary modification and exercise. In
addition to little fat and cholesterol, lean protein (such as soy and fish), and
lots of fruits and vegetables, diets should include:
- Soluble fibers, such as psyllium, which have a cholesterol lowering
- Soy, which reduces total cholesterol
- Antioxidants, which when consumed in high amounts, have been
associated with lowered risk of cardiovascular disease. (Vitamin E appears to be
of particular value).
- Omega-3 fatty acids, such as docosahexaenoic acid (DHA) and
eicosapentaenoic acid (EPA), which may lower the chance of recurrent heart
attacks and death from heart disease.
- Folic acid supplements, which may improve the function of the blood
vessels in those with high cholesterol and reduce the risk of heart
supplements may help lower
cholesterol levels. The most promising include:
The following changes in life habits have been shown to both
prevent high cholesterol and to
lower high levels of cholesterol and triglyceride:
- Dietary changes
- Weight reduction
- Increased physical activity
- Stress reduction
- Quitting smoking (because tobacco use lowers HDL
According to the National Cholesterol Education Program (NCEP) guidelines,
healthcare practitioners should prescribe cholesterol-lowering medication
- LDL cholesterol is higher than 190 mg/dL and the person has no known
risk factors for heart disease
- LDL cholesterol is higher than 160 mg/dL and the person has two or
more risk factors for heart disease
- LDL cholesterol exceeds 130 mg/dL and the person has heart
The following are commonly prescribed medications for high
- Statin drugs or HMG-CoA reductase inhibitors (lovastatin, pravastatin,
simvastatin, atorvastatin, and fluvastatin). This class of medications is used
to treat elevated LDL and triglyceride levels, and also to raise HDL levels.
Taking statins reduces the risk of death in those with heart disease and slows
the rate of development of both heart disease and stroke when used by those with
high cholesterol. Healthcare practitioners prefer statin drugs because they are
the most effective cholesterol-lowering medication. Side effects include
myositis (inflammation of the muscles), joint pain, stomach upset, and liver
- Niacin (nicotinic acid). This is used to treat elevated LDL and
triglyceride levels and is more effective in increasing HDL levels than other
cholesterol-lowering medications. Side effects may include redness or flushing
of the skin (which can be reduced by taking aspirin 30 minutes before the
niacin), stomach upset (which usually subsides in a few weeks), headache,
dizziness, blurred vision, and liver damage. Starting with low doses of niacin
and increasing very gradually helps to reduce the likelihood and severity of
side effects. Niacin should be avoided by people who have gout, diabetes, low
blood pressure, or a history of peptic ulcer.
- Bile acid sequestrants (cholestyramine, colestipol, and colesevelam).
These are used to treat elevated LDL levels. Common side effects include
bloating, constipation, heartburn, and elevated triglycerides. These medications
may also lead to a deficiency of fat-soluble vitamins and loss of calcium in the
- Fibric acid derivatives (gemfibrozil, fenofibrate, and clofibrate).
These medications are used to treat elevated triglycerides and low HDL in people
who cannot tolerate niacin. Side effects include myositis, stomach upset, sun
sensitivity, gallstones, irregular heartbeat, and liver
- Probuchol lowers both LDL and HDL. Its use is therefore generally
limited to certain types of hereditary high cholesterol and/or to cases in which
other cholesterol-lowering medications have been ineffective. Side effects
include diarrhea, bloating, nausea, and
|Nutrition and Dietary Supplements|
There is considerable evidence that dietary antioxidants, particularly
vitamin E, as well as folic acid, fiber, and soy can help to prevent the
development of heart disease. Substances that have shown promise in lowering
cholesterol specifically or that have demonstrated benefit in preventing heart
disease in people with high cholesterol are discussed below.
Fiber and Fiber Sources
The American Heart Association (AHA) recommends increased intake of dietary
fiber in the form of whole grains, vegetables, fruits, legumes, and nuts because
they have been shown to do the following:
- Reduce total and LDL cholesterol more effectively than a diet low in
saturated fat and cholesterol alone
- Help control weight and intake of calories by promoting a sense of
- Improve cholesterol and triglyceride levels as well as blood sugar in
people with diabetes
Soluble fibers such as those in psyllium husk, guar gum, and oat bran have a
cholesterol-lowering effect when added to a low-fat, cholesterol-lowering diet.
Studies have shown psyllium, in particular, to be quite effective in lowering
total as well as LDL cholesterol levels. Oat bran (3 g per day) has also been
shown to lower total cholesterol.
Many studies have shown that replacing some animal protein with soy protein
in the diet results in lower blood cholesterol levels, especially when soy is
consumed as part of a general low-fat
diet. One study has shown that as
little as 20 g of soy protein per day is effective in reducing total
cholesterol, but that 40 to 50 g shows faster effects (in 3 weeks instead of 6).
This evidence suggests that soy protein should be included in a healthy diet. In
fact, since October of 1999, the FDA has allowed the labels of foods containing
6.25 g or more of soy protein to carry the claim that these foods reduce the
risk of heart disease. Moreover, the AHA recommends that people with elevated
total and LDL cholesterol add soy to their daily diet. Ethanol-washed soy
preparations should be avoided because this procedure causes the soy to lose its
isoflavones (the substances likely responsible for its cholesterol-lowering
effects) in the process.
Omega-3 fatty Acids
EPA and DHA
Numerous studies have reported the benefits of consuming fish oils, rich in
the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid
(EPA), at doses ranging from 850 mg to 4 g per day for those with heart disease.
Supplementation with DHA, for example, has been shown to reduce triglycerides
and LDL levels and raise HDL levels.
Walnuts are one of the best sources of the omega-3 fatty acid alpha-linolenic
acid. Replacing a major portion (35%) of the monounsaturated fat in the
Mediterranean diet with walnuts appears to significantly improve cholesterol and
triglyceride levels in people with high cholesterol. Almonds, although not as
well studied as walnuts, appear to have similar effects when used as a
substitute for a portion of monounsaturated fats in low-fat diets.
A number of studies conducted over the last 10 years have reported beneficial
results from the use of vitamin E supplements for the treatment and prevention
of heart disease including for those with elevated cholesterol levels.
Preliminary evidence suggests that vitamin C (3 glasses of orange juice per
day or up to 3 g per day as a supplement) may help decrease total and LDL
cholesterol and triglycerides, and increase HDL levels.
Coenzyme Q10 (CoQ10)
Coenzyme Q10 (CoQ10), also known as ubiquinone, is an antioxidant that is
essential for energy production. Levels of CoQ10 have been found to be lower in
people with high cholesterol when they were compared to healthy individuals of
the same age. Furthermore, when person with high cholesterol take statin drugs,
CoQ10 levels appear to decline in direct proportion to the level of decrease in
cholesterol. This is particularly important to bear this in mind when statin
drugs are used for long periods of time. Taking CoQ10 supplements, however, can
correct the deficiency caused by statin medications without affecting the
medication's positive effects on cholesterol levels.
Folic Acid (Vitamin B9)
High blood levels of homocysteine (an amino acid produced by the body) have
been shown to increase the risk of heart attacks. Evidence suggests that high
homocysteine levels are also related to low folate levels. This means that an
adequate supply of folate and other B vitamins may be important, particularly
for those with heart disease.
Plant sterols (fats present in fruits, vegetables, seeds, and nuts) appear to
interfere with the absorption of cholesterol, thereby lowering the level of
cholesterol in the blood. A daily intake of 1.6 g of margarine containing plant
sterols has been shown to reduce total and LDL cholesterol, with larger intakes
not necessarily providing any additional benefit. Questions have been raised,
however, regarding the possibility that plant sterols interfere with the
absorption of certain antioxidants such as alpha- and beta-carotenes,
alpha-tocopherol, and lycopene. While the significance of this is still unclear,
it warrants further investigation, and these micronutrients must be carefully
monitored in the blood of those using plant sterols.
L-carnitine is produced in the liver and kidneys from the amino acids lysine
and methionine. It is stored in skeletal muscles and the heart and may be
beneficial in treating conditions such as chest pain, heart attack, heart
failure, diabetes, and abnormal cholesterol. In several human studies,
supplementation with 2 to 3 g per day of L-carnitine led to a significant
reduction in total cholesterol and triglycerides, and to increases in HDL
Red wine contains flavonoids, which inhibit LDL oxidation (the process
whereby LDL cholesterol adheres to artery walls). Studies have demonstrated a
relationship between flavonoid consumption (from food) and reduced risk of death
from coronary heart disease.
Although nonalcoholic grape products contain flavonoids, red wine contains
much higher concentrations of flavonoids. However, the use of alcohol is not
advocated by the AHA and other organizations because of the potential for
addiction and the other serious repercussions such as motor vehicle accidents
and the development of hypertension, liver disease, breast cancer, weight gain.
If red wine is consumed, it is recommended that men have no more than 2 glasses
(20 g ethanol) per day and women, no more than 1 glass (15 g ethanol).
Red Yeast Rice
Red yeast rice, the fermented product of rice and red yeast, has been used in
China since at least 800 AD to make wine and preserve food, and for its
medicinal properties, which are believed to include, among other things,
improvement in blood circulation. Recent well-designed studies have shown that
red yeast rice significantly reduces total cholesterol, LDL cholesterol, and
Brewer's yeast is an important source of chromium. Ninety percent of
Americans are deficient in this important mineral. Chromium has demonstrated the
ability to lower LDL levels in the blood and raise HDL levels.
Preliminary studies in animals and people suggest that calcium supplements,
in the range of 1,500 to 2,000 mg per day, may help to lower cholesterol. The
information available thus far suggests that keeping cholesterol levels normal
or even low by using calcium supplements (along with many other measures such as
changing your diet and exercising) is likely to be more beneficial than trying
to treat it by adding calcium once you already have elevated cholesterol. More
research in this area is needed.
Vitamin B5 (Pantothenic Acid)
Research has shown that vitamin B5 lowers cholesterol. Studies are currently
underway to determine if this vitamin helps prevent heart
Hawthorn (Crataegus oxyacantha and monogyna)
The flowers and berries of the hawthorn plant have been used in traditional
herbal and homeopathic remedies to protect against stroke and to treat chest
pain, irregular heartbeat, and heart failure. In addition, studies using rats
suggest that the tincture of Crataegus (made from the berries) may be a
powerful agent for the removal of LDL from the blood stream. The tincture of
hawthorn berries also reduced the production of cholesterol in the liver of rats
who were being fed a high-cholesterol diet. Studies to determine if hawthorn
will confer the same effects in humans are needed.
Green Tea (Camellia sinensis)
Green tea has been observed to have a variety of beneficial effects,
including anticancer and antioxidant effects. The tea has also demonstrated an
ability to lower total cholesterol and raise HDL cholesterol in both animals and
people. Although an animal study conducted to determine how green tea effects
these changes was not conclusive, results from the study suggest that the
catechins in green tea may block intestinal absorption of cholesterol and
promote its excretion from the body.
Garlic (Allium sativum)
Long hailed for its beneficial effects, a number of studies have found that
garlic reduces elevated total cholesterol levels more effectively than placebo.
However, the size of the effect in these studies was small, and study
limitations make it difficult to draw any firm conclusions. More research with
better-designed studies is warranted in order to assess the safety and
effectiveness of garlic and to determine the most appropriate dose and form
(fresh garlic vs. supplements).
Red clover (Trifolium pratense)
Preliminary studies suggest that chemicals in red clover known as isoflavones
may raise HDL levels, especially in menopausal women. Not all studies, however,
have shown such positive effects. Further studies are needed before a definitive
conclusion can be made.
Bilberry (Vaccinium myrtillus)
Animal studies suggest that bilberry may prevent the oxidation of LDL
cholesterol, thereby lessening the risk of this bad form of cholesterol
contributing to the development of atherosclerotic plaque in the arteries.
Research in people is needed.
|Massage and Physical Therapy|
While no studies have examined the effect of massage on cholesterol levels,
massage has been shown to reduce cortisol (stress-related hormone) levels and to
induce relaxation. Massage may therefore have an indirect effect on risk factors
that result from or are worsened by stress, such as poor eating habits and
obesity, cigarette smoking, or lack of exercise. Lowering cortisol levels may
also have a positive effect on cholesterol levels.
Emotional and social stress increases the risk for heart disease. Stress is
thought to promote hardening of the arteries and effective stress reduction
techniques can help to reduce high cholesterol levels and other risk factors. In
several studies of Transcendental Meditation (TM), significant reductions in
total cholesterol levels as well as reductions in blood pressure, obesity, and
cigarette smoking were seen after 3 to 11 months of practice. Although TM
appears to be one of the more effective methods for relaxation, other methods
that may be considered include:
- Progressive muscle relaxation (PMR)
- Stress management classes
Guggulipid (Commiphora mukul)
Guggulipid, a traditional Ayurvedic medication used to treat high
cholesterol, is widely used in India and was first recommended as a
treatment for hardening of the arteries in 600 BC. It appears to be an effective
cholesterol-lowering agent and its healthful effects are thought to be due to
its ability to block the production of cholesterol in the liver. In a 4-week
study of 61 people who were on a fruit and vegetable-rich diet, half were given
guggul supplements of 400 mg three times and the other half received placebo.
The guggulipid group had reductions of total cholesterol, LDL, and triglycerides
comparable to that seen with conventional cholesterol-lowering drugs while the
placebo group had no improvement.
Fenugreek (Trigonella foenum graecum)
Fenugreek is a legume sold as a dried seed. It is cultivated in India and the
Middle East, and used as a condiment in foods like curry and in baked goods. In
Ayurvedic medicine, spices and herbs are traditionally used to treat a variety
of chronic diseases. Fenugreek seeds have been shown to decrease LDL cholesterol
and triglycerides, and increase HDL cholesterol levels. These effects appear to
result from reduced intestinal absorption of cholesterol, and may be related to
the high fiber content of the seed. Consumption of fenugreek may therefore be
beneficial in the management of high cholesterol levels.
Cholesterol-lowering medications should be avoided during pregnancy.
|Prognosis and Complications|
A number of complications may occur if high cholesterol is left untreated.
- Heart disease—the leading cause of death in
the United States, and elevated cholesterol levels more than doubles the risk of
heart attack. Lowering cholesterol by 1% reduces the risk of coronary artery
disease by 2%.
- Stroke—low levels of HDL cholesterol have
been associated with an increased risk of stroke
- Insulin resistance—88% of people with low HDL
and 84% with high triglycerides also have insulin resistance (that is, their
bodies are not responsive to insulin, which leads to high blood sugar levels).
Many people with insulin resistance go on to develop
It is also important to note that lowering cholesterol too rapidly may
contribute to the development of depression, which may be related to low levels
of omega-3 fatty acids.
Maintaining an appropriate weight, eating a low-fat diet, and exercising can
have a significant impact on cholesterol levels and improve long-term prognosis.
Ackermann RT, Mulrow CD, Ramirez G, Gardner CD, Morbidoni L, Lawrence VA.
Garlic shows promise for improving some cardiovascular risk factors. Arch
Intern Med. 2001;161:813-824.
Al-Habori M, Raman A. Antidiabetic and hypocholesterolemic effects of
fenugreek. Phyto Res. 1998;12:233-242.
Anderson JW, Davidson MH, Blonde L, et al. Long-term cholesterol-lowering
effects on Psyllium as an adjunct to diet therapy in the treatment of
hypercholesterolemia. Am J Clin Nutr. 2000a;71:1433-1438.
Anderson JW, Allgood LD, Lawrence A, et al. Cholesterol-lowering effects of
psyllium intake adjunctive to diet therapy in men and women with
hypercholesterolemia: meta-analysis of 8 controlled trials. Am J Clin Nutr.
Anderson JW, Johnstone BM, Cook-Newell ME. Meta-analysis of the effects of
soy protein intake on serum lipids. New Engl J Med. 1995;
Arsenian, MA. Carnitine and its derivatives in cardiovascular disease.
Progr in Cardiovasc Dis. 1997;40:3:265-286.
Baber R, Bligh PC, Fulcher G, Lieberman D, Nery L, Moreton T. The effect of
an Isoflavone dietary supplement (P-081) on serum lipids, forearm bone density
& endometrial thickness in post menopausal women [abstract].
Binaghi P, Cellina G, Lo Cicero G, et al. Evaluation of the
cholesterol-lowering effectiveness of pantethine in women in perimenopausal age
[in Italian]. Minerva Med. 1990;81:475-479.
Birketvedt GS, Aaseth J, Florholmen JR, Ryttig K. Long-term effect of fibre
supplement and reduced energy intake on body weight and blood lipids in
overweight subjects. Acta Medica. 2000;43(4):129-132.
Bonovich K, Colfer H, Davidson M, et al. A multi-center, self-controlled
study of cholestin in subjects with elevated cholesterol. Paper presented at:
American Heart Association 39th Annual Conference on Cardiovascular Disease
Epidemiology and Prevention; March 1999; Orlando, Fla:Abstract.
Bordia A, Verma SK, Srivastava KC. Effect of ginger (Zingiber officinal)
and fenugreek (Trigonella foenumgraecum) on blood lipids, blood sugar
and platelet aggregation in patients with coronary artery disease.
Prostaglandins, Leukotrienes and Essential Fatty Acids.
Bostick RM, Fosdick L, Grandits GA, Grambsch P, Gross M, Louis TA. Effect of
calcium supplementation on serum cholesterol and blood pressure. Arch Fam
Calderon Jr. R, Schneider RH, Alexander CN, Myers HF, Nidich SI, Haney C.
Stress, stress reduction and hypercholesterolemia in African Americans: a
review. Ethn Dis. 1999;9:451-462.
Castillo-Richmond A, Schneider RH, Alexander CN, et al. Effects of stress
reduction on carotid atherosclerosis in hypertensive African Americans.
Clarke R, Frost C, Collins R, Appleby P, Peto R. Dietary lipids and blood
cholesterol: quantitative meta-analysis of metabolic ward studies. BMJ.
Clarkson P, Adams MR, Powe AJ, et al. Oral L-arginine improves
endothelium-dependent dilation in hypercholesterolemic young adults. J Clin
Davidson MH, Maki KC, Kalkowski J, Schaefer EJ, Torri SA, Drennan KB. Effects
of docosahexeaenoic acid on serum lipoproteins in patients with combined
hyperlipidemia. A randomized, double-blind, placebo-controlled trial. J Am
Coll Nutr. 1997;16:3:236-243.
de Logeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N.
Mediterranean diet, traditional risk factors, and the rate of cardiovascular
complications after myocardial infarction: final report of the Lyon Diet Heart
Study. Circulation. 1999;99(6):779-785.
Frei B. On the role of vitamin C and other antioxidants in atherogenesis and
vascular dysfunction. Proc Soc Exp Biol Med. 1999;222(3):196-204.
Ginsberg HN, Goldberg IJ. Disorders of Lipoprotein Metabolism. IN: Fauci A,
et al. eds. Harrison's Principles of Internal Medicine. New York, NY:
McGraw-Hill; 2000: 2138-2149.
Hallikainen MA, Sarkkinen ES, Uusitupa MIJ. Plant stanol esters affect serum
cholesterol concentrations of hypercholesterolemic men and women in a
dose-dependent manner. J Nutr. 2000a;130:767-776.
Hallikainen MA, Sarkkinen ES, Gylling H, Erkkila AT, Uusitupa MIJ. Comparison
of the effects of plant sterol ester and plant stanol ester-enriched margarines
in lowering serum cholesterol concentrations of hypercholesterolemic subjects on
a low-fat diet. Euro J Clin Nutr. 2000b;54:715-725.
HarrisWS. Omega-3 fatty acids and serum lipoproteins: human studies. Am J
Clin Nutr. 1997;65:1645S-1654S.
Havel R. Dietary supplement or drug? The case of cholestin. Am J Clin
Heber D, Yip I, Ashley JM, Elashoff DA, Elashoff RM, Go VLW.
Cholesterol-lowering effects of a proprietary Chinese red-yeast rice dietary
supplement. Am J Clin Nutr. 1999;69:231-236.
Hosobuchi C, Rutanassee L, Bassin SL, Wong ND. Efficacy of acacia, pectin,
and guar gum-based fiber supplementation in the control of hypercholesterolemia.
Nutr Res. 1999;19(5):643-649.
Howes JB, Sullivan D, Lai N. The effects of dietary supplementation with
isoflavones from red clover on the lipoprotein profiles of postmenopausal women
with mild to moderate hypercholesterolemia. Atherosclerosis.
Human JA, Ubbink JB, Jerling JJ, et al. The effect of simvastatin on the
plasma antioxidant concentrations in patients with hypercholesterolemia. Clin
Chim Acta. 1997;263(1):67-77.
Jenkins D, Kendall C, Vidgen E, Agarwal S, Rao AV, Rosenberg RS et al. health
aspects of partially defatted flaxseed, including effects on serum lipids,
oxidative measures, and ex vivo androgen and progestin activity: a controlled
crossover trial. Am J Clin Nutr. 1999;69:395-402.
Keenan JM, Wenz JB, Myers S, Ribsin C, Huang ZQ. Randomized, controlled,
crossover trial of oat bran in hypercholesterolemic subjects. J Fam
Knopp RH, Superko R, Davidson M, et al. Long-term blood cholesterol-lowering
effects of a dietary fiber supplement. Am J Prev Med.
Kokkinos PF, Fernhall B. Physical activity and high density lipoprotein
cholesterol levels. Sports Med. 1999;28(5):307-314.
Kontush A, Schippling S, Spranger T, Beisiegel U. Plasma ubiquinol-10 as a
marker for disease: is the assay worthwhile? Biofactors.
Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ, et al.
AHA Scientific Statement: AHA Dietary guidelines Revision 2000: A statement for
healthcare professionals from the nutrition committee of the American Heart
Association. Circulation. 2000;102(18):2284-2299.
Kris-Etherton P, Eckel RH, Howard BV, St. Jeor S, Bazzare TL. AHA Science
Advisory: Lyon Diet Heart Study. Benefits of a Mediterranean-style, National
Cholesterol Education Program/American Heart Association Step I Dietary Pattern
on Cardiovascular Disease. Circulation. 2001;103:1823.
Kurowska EM, Spence JD, Jordan J, Wetmore S, Freeman DJ, Piche LA, Serratore
P. HDL-cholesterol-raising effect of orange juice in subjects with
hypercholesterolemia. Am J Clin Nutr. 2000;72(5):1095-1100.
Laplaud PM, Lelubre A, Chapman MJ. Antioxidant action of Vaccinium myrtillus
extract on human low density lipoproteins in vitro: initial observations. Fundam
Clin Pharmacol. 1997;11(1):35-40.
Lopez-Miranda J, Gomez P, Castro P, et al. Mediterranean diet improves low
density lipoproteins' susceptibility to oxidative modifications. Med Clin
(Barc) [in Spanish]. 2000;115(10):361-365.
Marz W, Wieland H. HMG-CoA reducatse inhibition: anti-inflammatory effects
beyond lipid lowering. Herz. 2000;25(6):117-25.
Mensink RR, Katan MB. Effect of dietary fatty acids on serum lipids and
lipoproteins. A meta-analysis of 27 trials. Arterioscler Thromb.
Miller AL. Botanical influences on cardiovascular disease. Altern Med
Miyake Y, Shouza A, Nishikawa M, Yonemoto T, Shimizu H, Omoto S, Hayakawa T,
Inada M. Effect of treatment with 3-hydroxy-3methylglutaryl coenzyme A reductase
inhibitors on serum coenzyme Q10 in diabetic patients. Arzneimittelforschung.
Mortensen SA, Leth A, Agner E, Rohde M. Dose-related decrease of serum
coenzyme Q10 during treatment with HMG-CoA reductase inhibitors. Mol Aspects
National Cholesterol Education Program. Executive summary of the third report
of the National Cholesterol Education Program (NCEP) expert panel on detection,
evaluation, and treatment of high blood cholesterol in adults (Adult Treatment
Panel III). JAMA. 2001;285(19):2486-2497.
National Cholesterol Education Program. Second Report of the Expert Panel on
Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.
Circulation. 1994; 89:3:1333-1445.
Nestel PJ, Pomeroy S, Kay S, et al. Isoflavones from red clover improve
systemic arterial compliance but not plasma lipids in menopausal women. J
Clin Endocrinol Metab. 1999;84(3):895-898.
New promensil study - cholesterol benefit. 2000
(October 31). Novogen news and announcements page. Novogen website. Available
at: http://www.novogen.com. Accessed March
Nutrition Committee of the American Heart Association. AHA Dietary
Guidelines. Revision 2000: A Statement for Healthcare Professionals.
Circulation. 2000; 102:2284-2299.
Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merrit KL, et al.
Intensive lifestyle change for reversal of coronary heart disease. JAMA.
Plat J, van Onselen ENM, van Heugten MMA, Mensink RP. Effects on serum
lipids, lipoproteins, and fat soluble antioxidant concentrations of consumption
frequency of margarines and shortenings enriched with plant stanol esters.
Euro J Clin Nutr. 2000;54:671-677.
Qin S, Zhang W, Qi P, et al. Elderly patients with primary hyperlipidemia
benefited from treatment with a Monacus purpureus rice preparation: a
placebo-controlled, double-blind clinical trial. Paper presented at: American
Heart Association 39th Annual conference on Cardiovascular Disease Epidemiology
and Prevention; March 1999; Orlando, Fla. Abstract.
Raitakari OT, McCredie RJ, Witting P, Griffiths KA, Letter J, Sullivan D,
Stocker R, Celermajer DS. Coenzyme Q improves LDL resistance to ex vivo
oxidation but does not enhance endothelial function in hypercholesterolemic
young adults. Free Radic Biol Med. 2000;28(7):1100-1105.
Rajendran S, Deepalakshmi PD, Parasakthy K, Devaraj H., Devaraj SN. Effect of
tincture of Crataegus on the LDL-receptor activity of hepatic plasma
membrane of rats fed an atherogenic diet. Atherosclerosis.
Redlich CA, Chung JS, Cullen MR, Blaner WS, Van Benneken AM, Berglund L.
Effect of long-term beta-carotene and vitamin A on serum cholesterol and
triglyceride levels among participants in the Carotene and Retinol Efficacy
Trial (CARET). Atherosclerosis. 1999;143: 427-434.
Rimm EB, Stampfer MJ, Ascherio A, Giovannucci E, Colditz GA, Willett WC.
Vitamin E consumption and the risk of coronary heart disease in men. N Engl J
Ripsin CM, Keenan JM, Jacobs Jr. DR, et al. Oat products and lipid lowering:
a meta-analysis. JAMA. 1992;267:24:3317-3325.
Shintani TT, Beckham S, Brown AC, O'Connor HK. The Hawaii diet: ad libitum
high carbohydrate, low fat multi-cultural diet for the reduction of chronic
disease risk factors: obesity, hypertension, hypercholesterolemia, and
hyperglycemia. Hawaii Med J. 2991;60(3):69-73.
Singh RB, Niaz MA, Ghosh S. Hypolipidemic and antioxidant effects of
Commiphora mukul as an adjunct to dietary therapy in patients with
hypercholesterolemia. Cardiovasc Drugs and Therapy. 1994;8:659-664.
Sirtori CR, Pazzucconi F, Colombo L, Battistin P, Bondioli A, Descheemaeker
K. Double-blind study of high-protein soya milk v. cow's milk to the diet of
patients with severe hypercholesterolaemia and resistance to or intolerance of
statins. Brit J Nutr. 1999;82:91-96.
Spiller GA, Jenkins DAJ, Boselloo Gates JE, Cragen LN, Bruce B. Nuts and
plasma lipids: an almond-based diet lowers LDL-c while Preserving HDL-c.
J Am Coll Nutr. 1998;17(3):285-290.
Stampfer MJ, Hennekens CH, Manson JE, Colditz GA, Rosner B, Willett WC.
Vitamin E consumption and the risk of coronary disease in women. N Engl J Med.
Stefanick ML, Mackey S, Sheehan M, Ellsworth N, Haskell WL, Wood PD.
Effectsof diet and exercise in men and postmenopausal women with low levels of
HDL cholesterol and high levels of LDL cholesterol. New Engl J Med.
Stephens NG, Parsons A, Schofield PM, Kelly F, Cheeseman K, Mitchinson MJ.
Randomised controlled trial of vitamin E in patients with coronary disease:
Cambridge Heart Antioxidant Study (CHAOS). Lancet. 1996;
Stevinson C, Pittler MH, Ernst E. Garlic for treating hypercholesterolemia.
Ann Intern Med. 2000;133(6):420-429.
Sum CF, Winocour PH, Agius L, et al. Does oral L-carnitine alter plasma
triglyceride levels in hypertriglyceridemic subjects with or without non-insulin
dependent diabetes mellitus. Diabetes Nutr Metab Clin Exp.
Teixeira SR, Potter SM, Weigel R,Hannam S, Erdman Jr. JW, Hasler CM. Effects
of feeding 4 levels of soy Protein for 3 and 6 wk on blood lipids and
apolipoproteins in moderately hypercholesterolemic men. Am J Clin Nutr.
Tofler GH, Stec JJ, Stubbe I, Beadle J, Feng D, Lipinska I, Taylor A. The
effect of vitamin C supplementation on coagulability and lipid levels in healthy
male subjects. Thromb Res. 2000;100(1):35-41.
Van Golde PH, Sloots LM, Vermeulen WP, et al. The role of alcohol in the anti
low density lipoprotein oxidation activity of red wine. Atherosclerosis.
Verhaar MC, Wever RM, Kastelein JJ, et al. Effects of oral folic acid
supplementation on endothelial function in familial hypercholesterolemia.
Villalobos MA, De La Cruz JP, Martin-Romero M, Carmona JA, Smith-Agreda JM,
Sanchez de la Cueta F. Effect of dietary supplementation with evening primrose
oil on vascular thrombogenesis in hyperlipidemic rabbits. Thromb Haemost.
Williams JC, Forster LA, Tull SP, Wong M, Bevan RJ, Ferns GAA. Dietary
vitamin E supplementation inhibits thrombin-induced platelet aggregation, but
not monocyte adhesiveness, in patients with hypercholesterolaemia. M J Exp
Wang J, Lu Z, Chi J, et al. Multicenter clinical trial of serum
lipid-lowering effects of a Monascus purpureus (red yeast) rice preparation from
traditional Chinese medicine. Curr Ther Res. 1997;58(12):964-978.
Wong WW, Smith EO, Stuff JE, Hachey DL, Heird WC, Pownell HJ.
Cholesterol-lowering effect of soy protein in normocholesterolemic and
hypercholesterolemic men. Am J Clin Nutr. 1998;68(suppl):1385S-1389S.
Yang TTC, Koo MWI. Chinese green tea lowers cholesterol level through an
increase in fecal lipid excreiton. Life Sciences.
Yu-Poth S, Zhao G, Etherton T, Naglak M, Jonnalagadda S, Kris-Etherton PM.
Effects of the National Cholesterol Education Program's Step I and Step II
dietary intervention programs on cardiovascular disease risk factors: a
meta-analysis. Am J Clin Nutr. 1999;69:632-646.
Zambón D, Sabate J, Munoz S, et al. Substituting walnuts for monounsaturated
fat improves the serum lipid profile of hypercholesterolemic men and women.
Ann Intern Med. 2000;132:538-546.
|Review Date: June 2001|
|Reviewed By: Participants in the review process include: Robert A. Anderson, MD, President
, American Board of Holistic Medicine, East Wenatchee, WA; Ruth Debusk, RD, PhD,
Editor, Nutrition in Complementary Care, Tallahassee, FL; Jacqueline A. Hart,
MD, Department of Internal Medicine, Newton-Wellesley Hospital, Harvard
University and Senior Medical Editor Integrative Medicine, Boston, MA; R. Lynn
Shumake, PD, Director, Alternative Medicine Apothecary, Blue Mountain Apothecary
& Healing Arts, University of Maryland Medical Center, Glenwood,
Copyright © 2004 A.D.A.M., Inc
The publisher does not accept any responsibility for the accuracy of
the information or the consequences arising from the application, use, or misuse
of any of the information contained herein, including any injury and/or damage
to any person or property as a matter of product liability, negligence, or
otherwise. No warranty, expressed or implied, is made in regard to the contents
of this material. No claims or endorsements are made for any drugs or compounds
currently marketed or in investigative use. This material is not intended as a
guide to self-medication. The reader is advised to discuss the information
provided here with a doctor, pharmacist, nurse, or other authorized healthcare
practitioner and to check product information (including package inserts)
regarding dosage, precautions, warnings, interactions, and contraindications
before administering any drug, herb, or supplement discussed