Cholesterol is a soft, waxy substance found among the lipids (fats) in your bloodstream and in all cells. Cholesterol comes in several forms, most notable of which are “good” and “bad” cholesterol.
High levels of low-density lipoprotein (LDL), aka “the bad cholesterol,” can increase your risk of heart attacks or stroke (thus, the cholesterol-diabetes link). LDL is the major cholesterol carrier in the blood and it can form a plaque on the inside of arteries, which is a condition known as atherosclerosis. If a clot forms and blocks blood from flowing to the heart muscle, a heart attack can occur. If a clot blocks the flow of blood to the brain, the result is a stroke. Keeping your LDL low helps to protect your heart.
High-density lipoprotein (HDL), on the other hand, is considered “the good cholesterol” because high levels seem to protect against heart attacks. About one-fourth to one-third of blood cholesterol is carried by HDL. It helps remove plaque deposits from the walls of the blood vessels, preventing blockages.
Triglycerides are another type of fat that circulates in the bloodstream. High triglycerides raise your risk of a heart attack or stroke.
The American Diabetes Association recommends that people get their cholesterol levels checked once when they are first diagnosed with diabetes, and then every five years after that, unless your doctor recommends more frequent testing. Although you should talk to your healthcare team about your cholesterol goals, the U.S. Centers for Disease Control and Prevention (CDC) generally recommends that people maintain cholesterol levels of:
||LDL (“bad” cholesterol”
||HDL (“good” cholesterol)
|Less than 200 mg/dL
||Less than 100 mg/dL
||60 mg/dL or higher
||Less than 150 mg/dl
Treatment of Elevated Cholesterol
High cholesterol levels are a major risk factor for heart disease, which is an increased concern for people with diabetes. What can you do if you have high cholesterol? Here are some lifestyle changes you can implement to help lower your cholesterol:
- First and foremost, keep your blood glucose levelsunder control.
- Work with your medical team to develop a meal plan that you can stick with.
- Eat more healthy fats (from fish and plant foods) and avoid trans fat (found in processed foods).
- Eat more fruits and vegetables.
- Choose whole grains for cereals and breads.
- Get at least 30 minutes of moderate intensity exercise per day.
- If you smoke—quit!
- Maintain a healthy weight.
- If you have elevated triglycerides, take fish oil supplements (under a physician’s care).
When it comes to cholesterol, careful monitoring and healthy lifestyle changes are key. However, sometimes changing your diet or your weight isn’t enough. There are times when drug therapy is prescribed to achieve results.
There are several drug therapies that can help you lower your cholesterol and/or triglyceride levels.
- Statins are the most common front-line treatment. They reduce LDL cholesterol by slowing down the production of cholesterol in the liver. They also increase the body’s ability to remove LDL from the blood.
- Bile acid sequestrants may be used if statins are not producing the desired results.
- Medication to lower their triglycerides is sometimes prescribed. There are several drug choices to lower triglycerides, such as fibrates and nicotinic acid or niacin.
Your doctor can tell you what treatment is right for you. All drugs have potential side effects, so talking to your healthcare team on a regular basis is important. Always consult your medical team before making any changes to your diabetes management.
For a list of approved cholesterol medications, visit the FDA’s Guide to Cholesterol Medications.
Updated by Julia Telfer, 3/17.