has high blood cholesterol in the United States. All
persons, including children, can develop high blood
cholesterol. It has been shown to represent a major
risk factor for heart disease, the leading cause of death
in the country. In 2004, there were 6.5 million visits to
doctors’ offices that included a cholesterol test being
done or ordered. Among African Americans, about
16.6% of women and 12.5% of men have high total
cholesterol. Among Mexican Americans, about
12.7% of women and 17.6% of men have high total
cholesterol. Among whites, 17.4% of women and
17.0% of men have high cholesterol. In 2005, 73% of
adults reported that that they had their cholesterol
checked within the previous 5 years, according to
data from CDC’s Behavioral Risk Factor Surveillance
System. Some 23% reported that they never had their
cholesterol checked.Symptoms
Hyperlipidemia by itself does not cause symp-
toms, so people are generally not aware that their
lipid levels are too high.Diagnosis
Simple blood tests are done to check blood lipid
levels. The National Cholesterol Education Program
recommends that people be tested every 5 years after
age 20. A lipoprotein test, also called a fasting lipid
test, is commonly performed as part of a routine med-
ical examination. The test measures lipid levels and
usually reports on four groups:
Total cholesterol (normal: 100–199 mg/dL)
LDL (normal: less than 100 mg/dL)
HDL (normal: 40–59 mg/dL)
Triglycerides (normal: less than 150 mg/dL)
A total cholesterol value greater than 200 mg/dL
is indicative of a greater risk for heart disease. How-
ever, LDL levels are a better predictor of heart disease,
and they determine how your high cholesterol should
be treated.Treatment
Treatment depends on lipid levels, the presence of
risk factors for heart disease, and general health.
When lipid levels are not balanced, the goal is to
bring them under control and this is done with chang-
ing dietary habits. Hyperlipidemia is accordingly first
treated by modifying eating habits:
Reducing saturated fat intake to 7% of the daily
intake of calories.Reducing total fat intake to 25–35% of the daily
intake of calories.
Limiting the dietary cholesterol to less than 200 mg
per day.
Ensuring the intake of 20–30 g a day of soluble fiber.
Ensuring the intake of plant sterols to 2–3 g daily.
If dietary changes do not correct the hyperlipide-
mia, a course of drug therapy may be indicated. In the
Unites States, men older than age 35 and post–meno-
pausal women are generally candidates for lipid–low-
ering medications.Nutrition/Dietetic concernsTo treat hyperlipidemia, a diet low in total fat,
saturated fat, and cholesterol is recommended, along
with reducing or avoiding alcohol intake. The Amer-
ican Heart Association (AHA) endorses the following
dietary recommendations for people with high blood
cholesterol:
Total fat: 25% of total calories
Saturated fat: less than 7% total calories
Polyunsaturated fat: up to 10% total calories
Monounsaturated fat: up to 20% total calories
Carbohydrates: 50–60% total calories
Protein:15% total calories
Cholesterol: less than 200 mg/dL
Plant sterols: 2 g
Soluble fiber such as psyllium: 10– 25g
Categories of appropriate foods include:
Lean meat/fish: less than 5 oz/day
Eggs: less than 2 yolks per week (whites unlimited)
Low fat dairy products (<1% fat): 2–3 servings/day
Grains, especially whole grains: 6–8 tsp/day
Vegetables: less than 6 servings per day
Fruits: 2–5 servings per day
These recommendations translate into the follow-
ing practicaldietary guidelines:
Select only the leanest meats, poultry, fish and shell-
fish. Choose chicken and turkey without skin or
remove skin before eating. Some fish, like cod, have
less saturated fat than either chicken or meat.
Limit goose and duck. They are high in saturated fat,
even with the skin removed.
Some chicken and turkey hot dogs are lower in satu-
rated fat and total fat than pork and beef hot dogs.
There are also lean beef hot dogs and vegetarian
(tofu) franks that are low in fat and saturated fat.Hyperlipidemia