Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

Former AHRQ Director Carolyn Clancy, M.D., prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan.

If you're older than 45, there's a good chance that you or someone you know has high cholesterol. It's so common that treating high cholesterol led to 44 million doctor visits in 2006.

High cholesterol may be widespread, but understanding how to treat it can be confusing. However, lowering high cholesterol can prevent heart attacks and strokes. It could even save your life.

That's why my agency, the Agency for Healthcare Research and Quality (AHRQ), offers a guide called Treating High Cholesterol. The guide explains in plain English how this common medical condition is treated and the pros and cons of different cholesterol medicines.

Cholesterol is vital to your body. Your liver makes cholesterol, which is found in your blood. We all need some cholesterol, but too much is harmful. Your diet and family history affect your cholesterol levels.

There are two main types of cholesterol—good (HDL) and bad (LDL) cholesterol. When your cholesterol is too high, that refers to your bad cholesterol, or your LDL level. When bad cholesterol builds up and leaves deposits (called plaque) in the walls of your arteries, it can limit blood flow and cause a heart attack or stroke.

A simple blood test can determine your cholesterol level and your risk for heart disease. The more risk factors you have, the higher the chance you have high cholesterol. Risk factors include:

  • Age (being 45 or older for men or 55 or older for women).
  • Family history of early heart disease.
  • Smoking.
  • High blood pressure.
  • Low levels of good (HDL) cholesterol.
  • Diabetes or certain other conditions.

Your doctor can help you determine your level of risk. The first step in controlling your cholesterol is a balanced diet and more exercise. Your doctor or nurse may recommend a diet that includes fresh fruits, vegetables, and whole grains, while limiting foods that are high in fat. However, even with a good diet and exercise habits, you may need medicine to lower your cholesterol.

Different kinds of medicines work in different ways to improve cholesterol levels. Some block the liver from making cholesterol, while others decrease the amount of fat absorbed from food.

Most people start with a medicine called a statin, which works to lower bad (LDL) cholesterol. If your bad cholesterol remains high, your doctor or nurse may increase your statin dose or add a different kind of medicine to help you reach healthy levels.

Our guide Treating High Cholesterol, based on a review of more than 100 research studies of cholesterol medicines, shows that all such medicines can cause minor side effects. These side effects include heartburn, upset stomach, and diarrhea. These problems often go away and are not usually serious. But you should tell your doctor if any symptoms do not disappear.

It's important to talk with your doctor or nurse about your high cholesterol. Good topics include:

  • Diet and exercise. Everyone with high cholesterol should be on a cholesterol-lowering diet. Exercise helps, too. Ask if diet and exercise alone can help meet your cholesterol goals.
  • Medicines. Talk to your doctor about how and when to take cholesterol medicines. Once you start taking medicine to lower cholesterol levels, you will probably need to continue.
  • Cost. Some medicines are available as generics, which cost less than brand-name drugs. Check with your health insurance plan about the cost. Our guide offers resources if you need help paying for your medicines or have other questions.
  • Other steps for a healthy heart. Lowering high cholesterol is vital. But it's also important to control other health problems, like diabetes and high blood pressure. Stopping smoking will also help.

AHRQ's guides can help make complex decisions—including how to treat high cholesterol—easier to understand. By understanding the benefits and risks of treatments, you can work with your doctor to make decisions that are right for you.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

More Information

Agency for Healthcare Research and Quality
Treating High Cholesterol: A Guide for Adults
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=351&returnpage

Effective Health Care Program
http://effectivehealthcare.ahrq.gov

American Heart Association
Control Cholesterol
http://www.heart.org/HEARTORG/Conditions/Cholesterol/CholestrolATH_UCM_001089_SubHomePage.jsp

Page last reviewed August 2010
Internet Citation: Treating High Cholesterol. August 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/080310.html