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What is cholesterol?

Cholesterol is a waxy, fat-like substance that's found in all the cells in your body. Your liver makes cholesterol, and it is also in some foods, such as meat and dairy products. Your body needs some cholesterol to work properly. But if you have too much cholesterol in your blood, you have a higher risk of coronary artery disease.

How do you measure cholesterol levels?

A blood test called a lipoprotein panel can measure your cholesterol levels. Before the test, you'll need to fast (not eat or drink anything but water) for 9 to 12 hours. The test gives information about your:

• Total cholesterol - a measure of the total amount of cholesterol in your blood. It includes both low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol.
• LDL (bad) cholesterol - the main source of cholesterol buildup and blockage in the arteries
• HDL (good) cholesterol - HDL helps remove cholesterol from your arteries
• Non-HDL - this number is your total cholesterol minus your HDL. Your non-HDL includes LDL and other types of cholesterol such as VLDL (very-low-density lipoprotein).
• Triglycerides - another form of fat in your blood that can raise your risk for heart disease, especially in women

What do my cholesterol numbers mean?

Cholesterol numbers are measured in milligrams per deciliter (mg/dL). Here are the healthy levels of cholesterol, based on your age and gender:

Anyone age 19 or younger:

Type of CholesterolHealthy LevelTotal CholesterolLess than 170mg/dLNon-HDLLess than 120mg/dLLDLLess than 100mg/dLHDLMore than 45mg/dL

Men age 20 or older:

Type of CholesterolHealthy LevelTotal Cholesterol125 to 200mg/dLNon-HDLLess than 130mg/dLLDLLess than 100mg/dLHDL40mg/dL or higher

Women age 20 or older:

Type of CholesterolHealthy LevelTotal Cholesterol125 to 200mg/dLNon-HDLLess than 130mg/dLLDLLess than 100mg/dLHDL50mg/dL or higher

Triglycerides are not a type of cholesterol, but they are part of a lipoprotein panel (the test that measures cholesterol levels). A normal triglyceride level is below 150 mg/dL. You might need treatment if you have triglyceride levels that are borderline high (150-199 mg/dL) or high (200 mg/dL or more).

How often should I get a cholesterol test?

When and how often you should get a cholesterol test depends on your age, risk factors, and family history. The general recommendations are:

For people who are age 19 or younger:

• The first test should be between ages 9 to 11
• Children should have the test again every 5 years
• Some children may have this test starting at age 2 if there is a family history of high blood cholesterol, heart attack, or stroke

For people who are age 20 or older:

• Younger adults should have the test every 5 years
• Men ages 45 to 65 and women ages 55 to 65 should have it every 1 to 2 years

What affects my cholesterol levels?

A variety of things can affect cholesterol levels. These are some things you can do to lower your cholesterol levels:

• Diet. Saturated fat and cholesterol in the food you eat make your blood cholesterol level rise. Saturated fat is the main problem, but cholesterol in foods also matters. Reducing the amount of saturated fat in your diet helps lower your blood cholesterol level. Foods that have high levels of saturated fats include some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods.
• Weight. Being overweight is a risk factor for heart disease. It also tends to increase your cholesterol. Losing weight can help lower your LDL (bad) cholesterol, total cholesterol, and triglyceride levels. It also raises your HDL (good) cholesterol level.
• Physical Activity. Not being physically active is a risk factor for heart disease. Regular physical activity can help lower LDL (bad) cholesterol and raise HDL (good) cholesterol levels. It also helps you lose weight. You should try to be physically active for 30 minutes on most, if not all, days.
• Smoking.Cigarette smoking lowers your HDL (good) cholesterol. HDL helps to remove bad cholesterol from your arteries. So a lower HDL can contribute to a higher level of bad cholesterol.

Things outside of your control that can also affect cholesterol levels include:

• Age and Sex. As women and men get older, their cholesterol levels rise. Before the age of menopause, women have lower total cholesterol levels than men of the same age. After the age of menopause, women's LDL (bad) cholesterol levels tend to rise.
• Heredity. Your genes partly determine how much cholesterol your body makes. High blood cholesterol can run in families.
• Race. Certain races may have an increased risk of high blood cholesterol. For example, African Americans typically have higher HDL and LDL cholesterol levels than whites.

How can I lower my cholesterol?

There are two main ways to lower your cholesterol:

• Heart-healthy lifestyle changes, which include:
• Heart-healthy eating. A heart-healthy eating plan limits the amount of saturated and trans fats that you eat. Examples include the Therapeutic Lifestyle Changes diet and the DASH Eating Plan.
• Weight Management. If you are overweight, losing weight can help lower your LDL (bad) cholesterol.
• Physical Activity. Everyone should get regular physical activity (30 minutes on most, if not all, days).
• Managing stress. Research has shown that chronic stress can sometimes raise your LDL cholesterol and lower your HDL cholesterol.
• Quitting smoking.Quitting smoking can raise your HDL cholesterol. Since HDL helps to remove LDL cholesterol from your arteries, having more HDL can help to lower your LDL cholesterol.
• Drug Treatment. If lifestyle changes alone do not lower your cholesterol enough, you may also need to take medicines. There are several types of cholesterol medicines available, including statins. The medicines work in different ways and can have different side effects. Talk to your health care provider about which one is right for you. While you are taking medicines to lower your cholesterol, you should continue with the lifestyle changes.

NIH: National Heart, Lung, and Blood Institute

What is metabolic syndrome?

Metabolic syndrome is the name for a group of risk factors for heart disease, diabetes, and other health problems. You can have just one risk factor, but people often have several of them together. When you have at least three of them, it is called metabolic syndrome. These risk factors include:

• A large waistline, also called abdominal obesity or "having an apple shape." Too much fat around the stomach is a greater risk factor for heart disease than too much fat in other parts of the body.
• Having a high triglyceride level. Triglycerides are a type of fat found in the blood.
• Having a low HDL cholesterol level. HDL is sometimes called the "good" cholesterol because it helps remove cholesterol from your arteries.
• Having high blood pressure. If your blood pressure stays high over time, it can damage your heart and lead to other health problems.
• Having a high fasting blood sugar. Mildly high blood sugar may be an early sign of diabetes.

The more factors you have, the higher your risk for heart disease, diabetes, and stroke is.

What causes metabolic syndrome?

Metabolic syndrome has several causes that act together:

• Overweight and obesity
• An inactive lifestyle
• Insulin resistance, a condition in which the body can't use insulin properly. Insulin is a hormone that helps move blood sugar into your cells to give them energy. Insulin resistance can lead to high blood sugar levels.
• Age - your risk goes up as get older
• Genetics - ethnicity and family history

People who have metabolic syndrome often also have excessive blood clotting and inflammation throughout the body. Researchers don't know whether these conditions cause metabolic syndrome or worsen it.

Who is at risk for metabolic syndrome?

The most important risk factors for metabolic syndrome are:

• Abdominal obesity (a large waistline)
• An inactive lifestyle
• Insulin resistance

There are certain groups of people who have an increased risk of metabolic syndrome:

• Some racial and ethnic groups. Mexican Americans have the highest rate of metabolic syndrome, followed by whites and blacks.
• People who have diabetes
• People who have a sibling or parent who has diabetes
• Women with polycystic ovary syndrome (PCOS)
• People who take medicines that cause weight gain or changes in blood pressure, blood cholesterol, and blood sugar levels

What are the symptoms of metabolic syndrome?

Most of the metabolic risk factors have no obvious signs or symptoms, except for a large waistline.

How is metabolic syndrome diagnosed?

Your health care provider will diagnose metabolic syndrome based on the results of a physical exam and blood tests. You must have at least three of the risk factors to be diagnosed with metabolic syndrome:

• A large waistline, which means a waist measurement of
  • 35 inches or more for women
  • 40 inches or more for men
• A high triglyceride level, which is 150 mg/dL or higher
• A low HDL cholesterol level, which is
  • Less than 50 mg/dL for women
  • Less than 40 mg/dL for men
• High blood pressure, which is a reading of 130/85 mmHg or higher.
• A high fasting blood sugar, which is 100 mg/dL or higher

What are the treatments for metabolic syndrome?

The most important treatment for metabolic syndrome is a heart-healthy lifestyle, which includes:

• A heart-healthy eating plan, which limits the amount of saturated and trans fats that you eat. It encourages you to choose a variety of nutritious foods, including fruits, vegetables, whole grains, and lean meats.
• Aiming for a healthy weight
• Managing stress
• Getting regular physical activity
• Quitting smoking (or not starting if you don't already smoke)

If making lifestyle changes is not enough, you may need to take medicines. For example, you may need medicines to lower cholesterol or blood pressure.

Can metabolic syndrome be prevented?

The best way to prevent metabolic syndrome is through the heart-healthy lifestyle changes.

NIH: National Heart, Lung, and Blood Institute

What are triglycerides?

Triglycerides are a type of fat. They are the most common type of fat in your body. They come from foods, especially butter, oils, and other fats you eat. Triglycerides also come from extra calories. These are the calories that you eat, but your body does not need right away. Your body changes these extra calories into triglycerides and stores them in fat cells. When your body needs energy, it releases the triglycerides. Your VLDL cholesterol particles carry the triglycerides to your tissues.

Having a high level of triglycerides can raise your risk of heart diseases, such as coronary artery disease.

What causes high triglycerides?

Factors that can raise your triglyceride level include:

• Regularly eating more calories than you burn off, especially if you eat a lot of sugar
• Being overweight or having obesity
• Cigarette smoking
• Excessive alcohol use
• Certain medicines
• Some genetic disorders
• Thyroid diseases
• Poorly controlled type 2 diabetes
• Liver or kidney diseases

How are high triglycerides diagnosed?

There is a blood test that measures your triglycerides, along with your cholesterol. Triglyceride levels are measured in milligrams per deciliter (mg/dL). The guidelines for triglyceride levels are

CategoryTriglyceride LevelNormalLess than 150mg/dLBorderline high150 to 199 mg/dLHigh200 to 499 mg/dLVery high500 mg/dL and above

Levels above 150mg/dl may raise your risk for heart disease. A triglyceride level of 150 mg/dL or higher is also a risk factor for metabolic syndrome.

What are the treatments for high triglycerides?

You may be able to lower your triglyceride levels with lifestyle changes:

• Controlling your weight
• Regular physical activity
• Not smoking
• Limiting sugar and refined foods
• Limiting alcohol
• Switching from saturated fats to healthier fats

Some people will also need to take cholesterol medicines to lower their triglycerides.

What is blood glucose?

Blood glucose, or blood sugar, is the main sugar found in your blood. It is your body's primary source of energy. It comes from the food you eat. Your body breaks down most of that food into glucose and releases it into your bloodstream. When your blood glucose goes up, it signals your pancreas to release insulin. Insulin is a hormone that helps the glucose get into your cells to be used for energy.

What is diabetes?

Diabetes is a disease in which your blood glucose levels are too high. When you have diabetes, your body doesn't make enough insulin, can't use it as well as it should, or both. Too much glucose stays in your blood and doesn't reach your cells. Over time, having too much glucose in your blood can cause serious health problems (diabetes complications). So if you have diabetes, it's important to keep your blood glucose levels within your target range.What are blood glucose targets?

If you have diabetes, your blood glucose target is the range you try to reach as much as possible. The typical targets are:

• Before a meal: 80 to 130 mg/dL
• Two hours after the start of a meal: Less than 180 mg/dL

Your blood glucose targets may be different, depending on your age, any additional health problems you have, and other factors. Talk with your health care team about the best target range for you.

When and how should I check my blood glucose?

If you have diabetes, you'll likely need to check your blood glucose every day to make sure that your blood glucose numbers are in your target range. Some people may need to check their blood glucose several times a day. Ask your health care team how often you need to check it.

The most common way to check your blood glucose level at home is with a blood glucose meter. A blood glucose meter measures the amount of glucose in a small sample of blood, usually from your fingertip.

Continuous glucose monitoring (CGM) is another way to check your glucose levels. Most CGM systems use a tiny sensor that is inserted under your skin. The sensor measures your glucose level every few minutes. It can show changes in your glucose level throughout the day and night. A CGM system is especially useful for people who take insulin and have problems with low blood glucose.

Your provider will also check your blood glucose with a blood test called an A1C. It checks your average blood glucose level over the past three months. People with diabetes usually have an A1C test at least twice a year. But you may need the test more often if you aren't meeting your diabetes treatment goals.

What happens if my blood glucose level becomes too high?

High blood glucose is called hyperglycemia. Symptoms that your blood glucose levels may be too high include:

• Feeling thirsty
• Feeling tired or weak
• Headaches
• Urinating (peeing) often
• Blurred vision

If you often have high blood glucose levels or symptoms of high blood glucose, talk with your health care team. You may need a change in your diabetes meal plan, physical activity plan, or diabetes medicines.

High blood glucose may also be caused by other conditions that can affect insulin or glucose levels in your blood. These conditions include problems with your pancreas or adrenal glands.

What happens if my blood glucose level becomes low for me?

Hypoglycemia, also called low blood glucose, happens when your blood glucose level drops below what is healthy for you. For many people with diabetes, this means a blood glucose reading lower than 70 mg/dL. Your number might be different, so check with your health care team to find out what blood glucose level is low for you.

Symptoms of low blood glucose tend to come on quickly. The symptoms can be different for everyone, but they may include:

• Shaking
• Sweating
• Nervousness or anxiety
• Irritability or confusion
• Dizziness
• Hunger

Low blood glucose levels can be common in people with type 1 diabetes and people with type 2 diabetes who take certain diabetes medicines. If you think you may have low blood glucose, check your level, even if you don't have symptoms. Low blood glucose can be dangerous and should be treated as soon as possible.

Although it's rare, you can still get low blood glucose without having diabetes. The causes can include conditions such as liver disease, kidney disease, and hormone deficiencies (lack of certain hormones). Some medicines, such as certain heart medicines and antibiotics, can also cause it. See your provider to find out the cause of your low blood glucose and how to treat it.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

What is cholesterol?

Your body needs some cholesterol to work properly. But if you have too much in your blood, it can stick to the walls of your arteries and narrow or even block them. This puts you at risk for coronary artery disease and other heart diseases.

Cholesterol travels through the blood on proteins called lipoproteins. One type, LDL, is sometimes called the "bad" cholesterol. A high LDL level leads to a buildup of cholesterol in your arteries. Another type, HDL, is sometimes called the "good" cholesterol. It carries cholesterol from other parts of your body back to your liver. Then your liver removes the cholesterol from your body.

What are the treatments for high cholesterol?

If you have high cholesterol, lifestyle changes can help you to lower your cholesterol level. But sometimes the lifestyle changes are not enough, and you need to take cholesterol medicines. You should still continue with the lifestyle changes even though you are taking medicines.

Who needs cholesterol medicines?

Your health care provider may prescribe medicine if:

• You have already had a heart attack or stroke, or you have peripheral arterial disease
• Your LDL (bad) cholesterol level is 190 mg/dL or higher
• You are 40-75 years old, you have diabetes, and your LDL cholesterol level is 70 mg/dL or higher
• You are 40-75 years old, you have a high risk of developing heart disease or stroke, and your LDL cholesterol level is 70 mg/dL or higher

What are the different types of medicines for cholesterol?

There are several types of cholesterol-lowering drugs available, including:

• Statins, which block the liver from making cholesterol
• Bile acid sequestrants, which decrease the amount of fat absorbed from food
• Cholesterol absorption inhibitors, which decrease the amount of cholesterol absorbed from food and lower triglycerides.
• Nicotinic acid (niacin), which lowers LDL (bad) cholesterol and triglycerides and raises HDL (good) cholesterol. Even though you can buy niacin without a prescription, you should talk to your health care provider before taking it to lower your cholesterol. High doses of niacin can cause serious side effects.
• PCSK9 inhibitors, which block a protein called PCSK9. This helps your liver remove and clear LDL cholesterol from your blood.
• Fibrates, which lower triglycerides. They may also raise HDL (good) cholesterol. If you take them with statins, they may increase the risk of muscle problems.
• Combination medicines, which include more than one type of cholesterol-lowering medicine

There are also a few other cholesterol medicines (lomitapide and mipomersen) that are only for people who have familial hypercholesterolemia (FH). FH is an inherited disorder that causes high LDL cholesterol.

How does my health care provider decide which cholesterol medicine I should take?

When deciding which medicine you should take and which dose you need, your health care provider will consider:

• Your cholesterol levels
• Your risk for heart disease and stroke
• Your age
• Any other health problems you have
• Possible side effects of the medicines. Higher doses are more likely to cause side effects, especially over time.

Medicines can help control your cholesterol, but they don't cure it. You need to keep taking your medicines and get regular cholesterol checks to make sure that you cholesterol levels are in a healthy range.

What is cholesterol?

Cholesterol is a waxy, fat-like substance that's found in all the cells in the body. The liver makes cholesterol, and it is also in some foods, such as meat and dairy products. The body needs some cholesterol to work properly. But if your child or teen has high cholesterol (too much cholesterol in the blood), he or she has a higher risk of coronary artery disease and other heart diseases.

What causes high cholesterol in children and teens?

Three main factors contribute to high cholesterol in children and teens:

• An unhealthy diet, especially one that is high in fats
• A family history of high cholesterol, especially when one or both parents have high cholesterol
• Obesity

Some diseases, such as diabetes, kidney disease, and certain thyroid diseases, can also cause high cholesterol in children and teens.

What are the symptoms of high cholesterol in children and teens?

There are usually no signs or symptoms that your child or teen has high cholesterol.

How do I know if my child or teen has high cholesterol?

There is a blood test to measure cholesterol levels. The test gives information about:

• Total cholesterol - a measure of the total amount of cholesterol in your blood. It includes both low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol.
• LDL (bad) cholesterol - the main source of cholesterol buildup and blockage in the arteries
• HDL (good) cholesterol - HDL helps remove cholesterol from your arteries
• Non-HDL - this number is your total cholesterol minus your HDL. Your non-HDL includes LDL and other types of cholesterol such as VLDL (very-low-density lipoprotein).
• Triglycerides - another form of fat in your blood that can raise your risk for heart disease

For anyone aged 19 or younger, the healthy levels of cholesterol are

Type of CholesterolHealthy LevelTotal CholesterolLess than 170mg/dLNon-HDLLess than 120mg/dLLDLLess than 100mg/dLHDLMore than 45mg/dL

When and how often your child or teen should get this test depends on his or her age, risk factors, and family history. The general recommendations are:

• The first test should be between ages 9 to 11
• Children should have the test again every 5 years
• Some children may have this test starting at age 2 if there is a family history of high blood cholesterol, heart attack, or stroke

What are the treatments for high cholesterol in children and teens?

Lifestyle changes are the main treatment for high cholesterol in children and teens. These changes include:

• Being more active. This includes getting regular exercise and spending less time sitting (in front of a television, at a computer, on a phone or tablet, etc.)
• Healthy eating. A diet to lower cholesterol includes limiting foods that are high in saturated fat, sugar, and trans fat. It is also important to eat plenty of fresh fruits, vegetables, and whole grains.
• Losing weight, if your child or teen is overweight or has obesity

If everyone in the family makes these changes, it will be easier for your child or teen to stick to them. It is also an opportunity to improve your health, and the health of the rest of your family.

Sometimes these lifestyle changes are not enough to lower your child or teen's cholesterol. Your health care provider may consider giving your child or teen cholesterol medicines if he or she:

• Is at least 10 years old
• Has an LDL (bad) cholesterol level that is higher than 190 mg/dL, even after six months of diet and exercise changes
• Has an LDL (bad) cholesterol level that is higher than 160 mg/dL AND is at high risk for heart disease
• Has an inherited type of high cholesterol

What is blood glucose?

Blood glucose, or blood sugar, is the main sugar found in your blood. It is your body's primary source of energy. It comes from the food you eat. Your body breaks down most of that food into glucose and releases it into your bloodstream. When your blood glucose goes up, it signals your pancreas to release insulin. Insulin is a hormone that helps the glucose get into your cells to be used for energy.

For people with diabetes, your body doesn't make enough insulin, can't use it as well as it should, or both. Too much glucose stays in your blood and doesn't reach your cells.

What is hypoglycemia?

Hypoglycemia means low glucose. It happens when the level of glucose in your blood drops below what is healthy for you:

• For many people with diabetes, this means a blood glucose level lower than 70 mg/dL. Your number might be different, so check with your health care team to find out what blood glucose level is too low for you.
• For people who don't have diabetes, hypoglycemia is typically a blood glucose level lower than 55 mg/dL.

What causes hypoglycemia?

Hypoglycemia is common in people who have diabetes type 1 or who have diabetes type 2 and take insulin or other diabetes medicines. It can happen:

• As a side effect of insulin or some other medicines that help your pancreas release insulin into your blood. These medicines can lower your blood glucose level.
• If you don't eat or drink enough carbohydrates (carbs). Carbs are the main source of glucose for your body.
• If you get a lot more physical activity than usual.
• If you drink too much alcohol without enough food.
• When you are sick and can't eat enough food or keep food down.

Although it's rare, you can still get low blood glucose without having diabetes. The causes can include conditions such as liver disease, kidney disease, and hormone deficiencies (lack of certain hormones). It can also happen in people who have had certain types of weight loss surgery. Some medicines, such as certain heart medicines and antibiotics, can also cause it. See your health care provider to find out the cause of your low blood glucose and how to treat it.

What are the symptoms of hypoglycemia?

The symptoms of low blood glucose tend to come on quickly. The symptoms can be different for everyone, but they may include:

• Shaking
• Sweating
• Nervousness or anxiety
• Irritability or confusion
• Dizziness
• Hunger

How is hypoglycemia diagnosed?

If you have diabetes, you'll most likely need to check your blood glucose every day and make sure that it's not too low. You can do this with a blood glucose meter or continuous glucose monitoring (CGM) system.

There are also blood tests that providers can use to check if your blood glucose is too low.

If you don't have diabetes and you have hypoglycemia, your provider will likely order other tests to try to figure out the cause.

What are the treatments for hypoglycemia?

If you have mild or moderate hypoglycemia, eating or drinking something with carbohydrates can help. But severe hypoglycemia can cause serious complications, including passing out, coma, or even death. Severe hypoglycemia can be treated with glucagon, a hormone that raises blood glucose levels. It can be given as nasal spray or injection. If you have diabetes, your provider can prescribe you a glucagon kit for use in case of an emergency.

If you have diabetes and you often have mild or moderate low blood glucose, your health care team may make changes to your diabetes meal plan, physical activity plan, and/or diabetes medicines.

If you don't have diabetes and you keep having low blood glucose, the treatment will depend on what is causing it to happen.

Can hypoglycemia be prevented?

If you have diabetes and you take insulin or other medicines that lower blood glucose, you can help prevent hypoglycemia if you:

• Follow your diabetes meal plan. Eat and drink enough carbs to keep your blood glucose in your target range. Also carry a source of fast-acting carbohydrate, such as glucose tablets or a juice box, with you in case your blood glucose gets too low.
• Be safe during physical activity. Check your blood glucose before and afterwards. You may need to eat a snack before your physical activity.
• If you take diabetes medicines, make sure to take them correctly.

What is cholesterol?

Cholesterol is a waxy, fat-like substance that's found in all the cells in your body. Your liver makes cholesterol, and it is also in some foods, such as meat and dairy products. Your body needs some cholesterol to work properly. But having too much cholesterol in your blood raises your risk of coronary artery disease.

What are LDL and HDL?

LDL and HDL are two types of lipoproteins. They are a combination of fat (lipid) and protein. The lipids need to be attached to the proteins so they can move through the blood. LDL and HDL have different purposes:

• LDL stands for low-density lipoproteins. It is sometimes called the "bad" cholesterol because a high LDL level leads to a buildup of cholesterol in your arteries.
• HDL stands for high-density lipoproteins. It is sometimes called the "good" cholesterol because it carries cholesterol from other parts of your body back to your liver. Your liver then removes the cholesterol from your body.

How can a high LDL level raise my risk of coronary artery disease and other diseases?

If you have a high LDL level, this means that you have too much LDL cholesterol in your blood. This extra LDL, along with other substances, forms plaque. The plaque builds up in your arteries; this is a condition called atherosclerosis.

Coronary artery disease happens when the plaque buildup is in the arteries of your heart. It causes the arteries to become hardened and narrowed, which slows down or blocks the blood flow to your heart. Because your blood carries oxygen to your heart, this means that your heart may not be able to get enough oxygen. This can cause angina (chest pain), or if the blood flow is completely blocked, a heart attack.

How do I know what my LDL level is?

A blood test can measure your cholesterol levels, including LDL. When and how often you should get this test depends on your age, risk factors, and family history. The general recommendations are:

For people who are age 19 or younger::

• The first test should be between ages 9 to 11
• Children should have the test again every 5 years
• Some children may have this test starting at age 2 if there is a family history of high blood cholesterol, heart attack, or stroke

For people who are age 20 or older::

• Younger adults should have the test every 5 years
• Men ages 45 to 65 and women ages 55 to 65 should have it every 1 to 2 years

For people who are older than 65:

• They should have the test every year.

You may need to get your cholesterol checked more often if you have heart disease, diabetes, or a family history of high cholesterol.

What can affect my LDL level?

Things that can affect your LDL level include:

• Diet. Saturated fat and cholesterol in the food you eat make your LDL level rise
• Weight. Being overweight tends to raise your LDL level, lower your HDL level, and increase your total cholesterol level
• Physical Activity. A lack of physical activity can lead to weight gain, which can raise your LDL level
• Smoking.Cigarette smoking lowers your HDL cholesterol. Since HDL helps to remove LDL from your arteries, if you have less HDL, that can contribute to you having a higher LDL level.
• Age and Sex. As women and men get older, their cholesterol levels rise. Before the age of menopause, women have lower total cholesterol levels than men of the same age. After the age of menopause, women's LDL levels tend to rise.
• Genetics. Your genes partly determine how much cholesterol your body makes. High cholesterol can run in families. For example, familial hypercholesterolemia (FH) is an inherited form of high blood cholesterol.
• Medicines. Certain medicines, including steroids, some blood pressure medicines, and HIV medicines, can raise your LDL level.
• Other medical conditions. Diseases such as chronic kidney disease, diabetes, and HIV can cause a higher LDL level.
• Race or ethnicity. People from certain racial or ethnic groups may have an increased risk of high blood cholesterol. For example, African Americans typically have higher HDL and LDL cholesterol levels than White Americans. Asian Americans are more likely to have higher LDL levels than other groups.

What should my LDL level be?

With LDL cholesterol, lower numbers are better, because a high LDL level can raise your risk for coronary artery disease and related problems. The general ranges for healthy adults are:

LDL (Bad) Cholesterol LevelLDL Cholesterol CategoryLess than 100 mg/dLOptimal100-129 mg/dLNear optimal/above optimal130-159 mg/dLBorderline high160-189 mg/dLHigh190 mg/dL and aboveVery High

If you have coronary artery disease or are at high risk for it, your health care provider may have different goals for your LDL level.

How can I lower my LDL level?

There are two main ways to lower your LDL cholesterol level:

• Heart-healthy lifestyle changes, which include:
• Heart-healthy eating. A heart-healthy eating plan limits the amount of saturated and trans fats that you eat. Examples of eating plans that can lower your LDL level include the Therapeutic Lifestyle Changes diet and the DASH eating plan.
• Weight management. If you are overweight, losing weight can help lower your LDL level.
• Physical Activity. Everyone should get regular physical activity.
• Drug Treatment. If lifestyle changes alone do not lower your LDL level enough, you may also need to take medicines. There are several types of cholesterol-lowering drugs available, including statins. The medicines work in different ways and can have different side effects. Talk to your provider about which one is right for you. While you are taking medicines to lower your LDL level, you still should continue with the lifestyle changes.

Some people with familial hypercholesterolemia (FH) may receive a treatment called lipoprotein apheresis. This treatment uses a filtering machine to remove LDL cholesterol from the blood. Then the machine returns the rest of the blood back to the person.

NIH: National Heart, Lung, and Blood Institute

What is prediabetes?

Prediabetes means that your blood glucose, or blood sugar, levels are higher than normal but not high enough to be called diabetes. Glucose comes from the foods you eat. Too much glucose in your blood can damage your body over time.

If you have prediabetes, you are more likely to develop type 2 diabetes, heart disease, and stroke. But if you make some lifestyle changes now, you may be able to delay or prevent type 2 diabetes.

What causes prediabetes?

Prediabetes usually happens when your body has a problem with insulin. Insulin is a hormone that helps the glucose get into your cells to give them energy. A problem with insulin could be:

• Insulin resistance, a condition in which the body can't use its insulin properly. It makes it hard for your cells to get glucose from your blood. This can cause your blood sugar levels to rise.
• Your body can't make enough insulin to keep your blood sugar levels at a healthy level

Researchers think that being overweight and not getting regular physical activity are major factors in causing prediabetes.

Who is at risk for prediabetes?

About 1 out of every 3 adults has prediabetes. It is more common in people who:

• Are overweight or have obesity
• Are age 45 or older
• Have a parent, brother, or sister with diabetes
• Are African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander American
• Are not physically active
• Have health conditions such as high blood pressure and high cholesterol
• Have had gestational diabetes (diabetes in pregnancy)
• Have a history of heart disease or stroke
• Have metabolic syndrome
• Have polycystic ovary syndrome (PCOS)

What are the symptoms of prediabetes?

Most people don't know they have prediabetes because usually there are no symptoms.

Some people with prediabetes may have darkened skin in the armpit or on the back and sides of the neck. They may also have many small skin growths in those same areas.

How is prediabetes diagnosed?

There are a few different blood tests that can diagnose prediabetes. The most common ones are:

• Fasting plasma glucose (FPG) test, which measures your blood sugar at a single point in time. You need to fast (not eat or drink) for at least 8 hours before the test. The results of the test are given in mg/dL (milligrams per deciliter):
  • A normal level is 99 or below
  • Prediabetes is 100 to 125
  • Type 2 diabetes is 126 and above
• A1C test, which measures your average blood sugar over the past 3 months. The results of an A1C test are given as a percentage. The higher the percentage, the higher your blood sugar levels have been.
  • A normal level is below 5.7%
  • Prediabetes is between 5.7 to 6.4%
  • Type 2 diabetes is above 6.5%

If I have prediabetes, will I get diabetes?

If you have prediabetes, you may be able to delay or prevent type 2 diabetes through lifestyle changes:

• Losing weight, if you are overweight
• Getting regular physical activity
• Following a healthy, reduced-calorie eating plan

In some cases, your health care provider may also recommend taking diabetes medicines.

Can prediabetes be prevented?

If you are at risk for prediabetes, those same lifestyle changes (losing weight, regular physical activity, and a healthy eating plan) may prevent you from getting it.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

What is cholesterol?

Cholesterol is a waxy, fat-like substance that's found in all the cells in your body. Your liver makes cholesterol, and it is also in some foods, such as meat and dairy products. Your body needs some cholesterol to work properly. But having too much cholesterol in your blood raises your risk of coronary artery disease.

What is VLDL cholesterol?

VLDL stands for very-low-density lipoprotein. Your liver makes VLDL and releases it into your bloodstream. The VLDL particles mainly carry triglycerides, another type of fat, to your tissues. VLDL is similar to LDL cholesterol, but LDL mainly carries cholesterol to your tissues instead of triglycerides.

VLDL and LDL are sometimes called "bad" cholesterols because they can contribute to the buildup of plaque in your arteries. This buildup is called atherosclerosis. The plaque that builds up is a sticky substance made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, the plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your body. It can lead to coronary artery disease and other heart diseases.

How do I know what my VLDL level is?

There isn't a way to directly measure your VLDL level. Instead, you will most likely get a blood test to measure your triglyceride level. The lab can use your triglyceride level to estimate what your VLDL level is. Your VLDL is about one-fifth of your triglyceride level. However, estimating your VLDL this way does not work if your triglyceride level is very high.

What should my VLDL level be?

Your VLDL level should be less than 30 mg/dL (milligrams per deciliter). Anything higher than that puts you at risk for heart disease and stroke.

How can I lower my VLDL level?

Since VLDL and triglycerides are linked, you can lower VLDL level by lowering your triglyceride level. You may be able to lower your triglycerides with a combination of losing weight, diet, and exercise. It is important to switch to healthy fats, and cut back on sugar and alcohol. Some people may also need to take medicines.