Treatment of elevated cholesterol.

As we age, cholesterol builds up in the arteries of the heart and neck, placing us at risk for heart attacks, strokes, and premature death. Treatment that lowers cholesterol in the blood has therefore become the cornerstone of prevention of future heart attack, stroke, and death, both in persons who definitely have heart disease and in those who are at risk of developing it in the future. Evidence suggests that millions of people who could benefit from cholesterollowering medicines are currently untreated. According to the American Heart Association, nearly 38 million patients in the United States would benefit from the combination of diet and drug therapy, and an additional 30 million should follow diet and exercise programs to reduce cholesterol levels.1 Given that there are 290 million adults in the Unites States, this issue affects 1 of every 3 to 5 adults. Unfortunately, cholesterol-lowering treatment is widely underutilized because of the lack of awareness, fear of side effects, reluctance of otherwise healthy people to take medication, and cost. We hope this overview of the treatment of elevated cholesterol for patients (and persons who are not “patients”) will help ensure that all affected people will get their elevated cholesterol treated. What Is Cholesterol? Cholesterol is a fatty substance that circulates in the blood and is an important structural component of all human cells. The body obtains cholesterol through 2 methods: via the liver, which produces about 75% of cholesterol, and through food, which accounts for 25%. Cholesterol comes in several forms, notably a “good” and a “bad” cholesterol. High levels of low-density lipoprotein (LDL) cholesterol, the “bad” cholesterol, are associated with an increased risk of heart attacks and strokes. By contrast, increased levels of high-density lipoprotein (HDL) cholesterol, the “good” cholesterol, offer protection against heart attacks and strokes. (See the Cardiology Patient Page on HDL at http://circ. ahajournals.org/cgi/reprint/111/5/e89.2) The total cholesterol value you receive after a blood test is the sum of all types of cholesterol, as discussed in a previous Cardiology Patient Page (http://circ. ahajournals.org/cgi/content/full/110/11/ e296).3 Triglycerides are another form of circulating fatty substance that, when elevated, are also associated with heart attacks and strokes.