Causes & Symptoms

There are no readily apparent symptoms that indicate high LDL or triglycerides, or low HDL. The only way to diagnose a problem is through a simple blood test. However, one general indication of high cholesterol is obesity. Another is a high-fat diet. In 2001, new research involving twins demonstrated that both genetic factors and diet contribute to cholesterol levels.

Diagnosis

High cholesterol often is diagnosed and treated by general practitioners or family practice physicians. In some cases, the condition is treated by an endocrinologist or cardiologist. Total cholesterol, LDL, HDL, and triglyceride levels as well as the cholesterol to HDL ratio are measured by a blood test called a lipid panel. The cost of a lipid panel is generally $40-100 and is covered by most health insurance and HMO plans, including Medicare, providing there is an appropriate reason for the test. Home cholesterol testing kits are available over the counter but test only for total cholesterol. The results should only be used as a guide and if the total cholesterol level is high or low, a lipid panel should be performed by a physician. In most adults the recommended levels, measured by milligrams per deciliter (mg/dL) of blood, are: total cholesterol, less than 200; LDL, less than 130; HDL, more than 35; triglycerides, 30-200; and cholesterol to HDL ratio, four to one. However, the recommended cholesterol levels may vary, depending on other risk factors such as hypertension, a family history of heart disease, diabetes, age, alcoholism, and smoking.

Doctors have always been puzzled by why some people develop heart disease while others with identical HDL and LDL levels do not. New studies indicate it may be due to the size of the cholesterol particles in the

TYPES OF CHOLESTEROL
Types	Levels
Total cholesterol:
Desirable	<200
Borderline	200 to 240
Undesirable	>240
HDL cholesterol:
Desirable	>45
Borderline	35 to 45
Undesirable	<35
LDL cholesterol:
Desirable	<130
Borderline	130 to 160
Undesirable	>160
Ratio of total cholesterol to HDL cholesterol:
Desirable	<3
Borderline	3 to 4
Undesirable	>4

bloodstream. A test called a nuclear magnetic resonance (NMR) LipoProfile exposes a blood sample to a magnetic field to determine the size of the cholesterol particles. Particle size also can be determined by a centrifugation test, where blood samples are spun very quickly to allow particles to separate and move at different distances. The smaller the particles, the greater the chance of developing heart disease. It allows physicians to treat patients who have normal or close to normal results from a lipid panel but abnormal particle size.