Subject Contents


A soft, waxy substance that is present in all parts of the body including the nervous system, skin, muscle , liver, intestines, and heart. It is made by the body and obtained from animal products in the diet.
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Alternative Names
Diet - cholesterol
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Cholesterol is manufactured in the liver for normal body functions including the production of hormones, bile acid, and Vitamin D . It is transported in the blood to be used by all parts of the body.
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Food Sources
Dietary cholesterol is present only in foods of animal origin (not in foods of plant origin). Cholesterol is found in eggs, dairy products, meat, poultry, fish, and shellfish . Egg yolks and organ meats (liver, kidney, sweetbread, and brain) are high in dietary cholesterol. Fish generally contains less cholesterol than other meats, but some shellfish is high in cholesterol content. Foods of plant origin (vegetables, fruits, grains, cereals, nuts, and seeds) contain no cholesterol. Fat content is not a good measurement of cholesterol content. For example, liver and other organ meats are low in fat but very high in cholesterol.
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Side Effects
Excessive cholesterol contributes to atherosclerosis and subsequent heart disease . The risk of developing heart disease or atherosclerosis increases as the level of blood cholesterol increases.
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Approximately 25% of the adult population in the U.S. has elevated blood cholesterol levels . More than half of the adult population has blood cholesterol levels that are higher than the "desirable" range, as specified by the medical community. Elevated cholesterol levels often begin in childhood. Some children may be at higher risk than others secondary to family history. The level for total cholesterol has been lowered in the past few years. Depending on the laboratory levels either less than 200 or 190 milligrams per deciliter (mg/dl) are considered "desirable" because they carry the least risk of heart disease . When the level is above 200 mg/dl the risk for coronary heart disease increases. It is also important to know the levels for High Density Lipoprotein (HDL, also known as the "good cholesterol") and Low Density Lipoprotein (LDL, or "bad cholesterol"). You must consult your health care provider to measure and discuss your cholesterol profile. To lower high cholesterol levels, eat less than 30% of the total daily calories from fat . Of that 30%, less than one-third should be from saturated fat and not more than one-third should be from polyunsaturated fat . At least one-third of the total fat calories should be from monounsaturated fat . Less than 300 milligrams (mg) of dietary cholesterol per day should be consumed. Recommendations for children's diets are similar to those of adults. It is imperative that children's caloric intake be adequate to support growth, activity level and that the child achieve and maintain a desirable body weight The following two sample menus provide examples of an average American diet and a low-fat diet. The nutrient analysis shows that, for the same number of calories, a low-fat diet provides 190 mg of dietary cholesterol versus the 510 mg of dietary cholesterol of an average American diet. AVERAGE AMERICAN DIET
  • breakfast
  • 1 egg scrambled in 1 teaspoon of butter
  • 2 slices of white toast
  • 1 teaspoon of butter
  • 1/2 cup of apple juice
  • snack
  • 1 cake donut
  • lunch
  • 1 ham and cheese sandwich (2 ounces of meat, 1 ounce of cheese)
  • white bread
  • 1 teaspoon of mayonnaise
  • 1-ounce bag potato chips
  • 12-ounce soft drink
  • 2 chocolate chip cookies
  • snack
  • 8 wheat thins
  • dinner
  • 3 ounces of broiled sirloin
  • 1 medium baked potato
  • 1 tablespoon of sour cream
  • 1 teaspoon of butter
  • 1/2 cup of peas, 1/2 teaspoon of butter
  • LOW fat DIET
  • breakfast
  • 1 cup of toasted oat ring cereal
  • 1 cup of skim milk
  • 1 slice of whole-wheat bread
  • 1 teaspoon of margarine
  • 1 banana
  • snack
  • 1 cinnamon raisin bagel, 1/2 ounce light cream cheese
  • lunch
  • turkey sandwich (3 ounces of turkey)
  • rye bread
  • lettuce
  • 1 orange
  • 3 fig newtons
  • 1 cup skim milk
  • snack
  • non fat yogurt with fruit
  • dinner
  • 3 ounces of broiled chicken breast
  • 1 medium baked potato
  • 1 tablespoon of nonfat yogurt
  • 1 teaspoon of margarine
  • 1/2 cup of broccoli
  • 1 dinner roll
  • 1 cup skim milk
  • TOTALS Average American diet:
  • 2,000 Calories, 84 grams fat, 34 grams saturated fat, 425 milligrams cholesterol
  • 38% total fat
  • 15% saturated fat
  • Low fat diet:
  • 2,000 Calories, 38 grams fat, 9.5 grams saturated fat, 91 milligrams cholesterol
  • 17% fat
  • 4% saturated fat
  • The sample menus demonstrate that because the fat is high in calories, the low-fat diet has a greater quantity of food than the typical American diet for the same 2,000 Calories. The low fat diet example is too low in fat for small children to promote good growth. In addition, it may be difficult for them to consume such a large volume of food. Children should have a diet that is closer to thirty per cent of the calories from fat. Lower fat diets may be appropriate in some cases but require careful follow-up from a physician and dietitian.
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    Cholesterol test

    A test that measures the amount of cholesterol and triglycerides in serum (part of the blood).
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    Alternative Names
    Total cholesterol; Lipid test; Lipoprotein test
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    How the test is performed
    Blood is drawn from a vein ( venipuncture ), usually from the inside of the elbow or the back of the hand. The puncture site is cleaned with antiseptic, and a tourniquet (an elastic band) or blood pressure cuff is placed around the upper arm to apply pressure and restrict blood flow through the vein. This causes veins below the tourniquet to distend (fill with blood). A needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe. During the procedure, the tourniquet is removed to restore circulation and prevent a hematoma (bruising). Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding . Note that veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others. Infant or young child: The area is cleansed with antiseptic and punctured with a sharp needle or a lancet. The blood may be collected in a pipette (small glass tube), on a slide, onto a test strip, or into a small container. Cotton or a bandage may be applied to the puncture site if there is any continued bleeding.
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    How to prepare for the test
    To get accurate results, you should fast for 9 to 12 hours before the test. The health care provider may advise you to discontinue drugs that can affect the test. (See "Special considerations.") You may drink water during the fast, but other beverages such as coffee, tea or soda may affect results. Infants and children: The physical and psychological preparation you can provide for this or any test or procedure depends on your child's age, interests, previous experiences, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child's age:
  • infant test or procedure preparation
  • (birth to 1 year)
  • toddler test or procedure preparation
  • (1 to 3 years)
  • preschooler test or procedure preparation
  • (3 to 6 years)
  • schoolage test or procedure preparation
  • (6 to 12 years)
  • adolescent test or procedure preparation
  • (12 to 18 years)
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    How the test will feel
    When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.
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    Why the test is performed
    This test is often performed to evaluate risks for heart disease . Cholesterol is an important normal body constituent, used in the structure of cell membranes, synthesis of bile acids, and synthesis of steroid hormones. Since Cholesterol '>Cholesterol is water insoluble, most serum (the noncellular portion of blood) Cholesterol '>Cholesterol is carried by lipoproteins (chylomicrons, LDL '>LDL '>VLDL '>LDL '>LDL '>LDL '>VLDL '>LDL , LDL '>LDL , and HDL '>HDL ). The term "LDL" usually means LDL-Cholesterol '>Cholesterol and "HDL" means HDL-cholesterol. The term "cholesterol" usually means total Cholesterol '>Cholesterol (LDL '>LDL '>VLDL '>LDL '>LDL '>LDL '>VLDL '>LDL + LDL '>LDL + HDL). However, as will be discussed shortly, total Cholesterol '>Cholesterol measurements are not being used as much these days to determine risk for heart disease. Chylomicrons are lipoproteins that are present shortly after a meal but disappear within about 2 hours in "normal" individuals. Triglycerides are another component commonly measured in a lipid or Cholesterol '>Cholesterol test. Triglycerides are compounds used by the body to move fatty acids (formed when fats or oils are consumed) through the blood. These fatty acids may be used by the body for energy or stored (as fat) for later use. Excess Cholesterol '>Cholesterol in the blood has been correlated with cardiovascular disease. High triglycerides are now associated with heart disease as well. LDL '>LDL is sometimes referred to as "bad" cholesterol, because elevated levels of LDL '>LDL correlate most directly with coronary heart disease . HDL '>HDL is sometimes referred to as "good" Cholesterol '>Cholesterol since high levels of HDL '>HDL reduce risk for coronary heart disease. This is because one of the main functions of HDL '>HDL is to take excess Cholesterol '>Cholesterol to the liver for excretion in the bile. In fact, a high HDL '>HDL (defined below) will take away one risk factor you may have for coronary disease.
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    Normal Values
    Your results will contain a few different components that will be outlined here. In the past, a lipid test would initially be conducted without prior fasting and would test total cholesterol and HDL. If these were abnormal, a fasting test would be done measuring total cholesterol, HDL, LDL and triglycerides. In 2001, guidelines from the National Cholesterol Education Panel recommended that all lipid tests be performed fasting and should measure all four components. The total cholesterol measurement, as with all lipid measurements, will be listed as milligrams per deciliter (mg/dL). All laboratories will list your cholesterol with these measurements. In most cases, the higher your total cholesterol, the more at risk you are for heart disease. A value of less than 200 mg/dL is a "desirable" level and places you in a group at less risk for heart disease. Levels over 240 mg/dL may put someone at almost twice the risk of heart disease as compared to someone with a level less than 200 mg/dL. High LDL cholesterol levels may be the best predictor of risk of heart disease. If you have known heart disease, peripheral vascular disease (blockages in the blood vessels of the extremities), or diabetes, your LDL cholesterol should be below 100 mg/dL. If you have 2 or more risk factors (smoking, high blood pressure, low HDL, a family history of heart disease, are a man over 45 or woman over 55) for heart disease, your LDL should be below 130 mg/dL. Finally, if you have none or one of the 5 risk factors from the above list, your LDL cholesterol should be below 160. HDL cholesterol levels more than or equal to 60 mg/dL will take away the increased risk from one risk factor and decrease your risk of heart disease. Levels below 40 mg/dL add a risk factor. Triglyceride levels are also becoming an important predictor of risk for heart disease. Even if you have low LDL and high HDL cholesterol, high triglyceride levels may put you at risk. Normal triglyceride levels are less than 150 mg/dL and can be incorrectly elevated if a 9-12 hour fast was not completed. It is important you discuss your results with your physician to determine the best therapy given your risk factors and lifestyle.
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    What abnormal results mean
    High LDL, low HDL, and or high triglyceride levels may put you at increased risk for heart disease. By depositing in blood vessels, including the coronary arteries, these components may cause blockages (atherosclerosis) leading to a myocardial infarction (heart attack) or necrosis (death of cells in) of legs or toes requiring amputation. Elevated cholesterol levels may be caused by:
  • biliary
  • cirrhosis
  • familial hyperlipidemias
  • high-cholesterol diet
  • hypothyroidism
  • nephrotic syndrome
  • uncontrolled
  • diabetes Low cholesterol levels may be caused by:
  • hyperthyroidism
  • liver disease
  • malabsorption
  • (inadequate absorption of nutrients from the intestinal tract)
  • malnutrition
  • pernicious anemia
  • sepsis
  • Additional conditions under which the test may be performed:
  • arteriosclerosis of the extremities
  • familial dysbetalipoproteinemia
  • familial hypercholesterolemia
  • hypothyroidism; primary
  • hypothyroidism; secondary
  • Type I or Type II diabetes
  • primary biliary cirrhosis
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    What the risks are
  • excessive
  • bleeding
  • fainting
  • or feeling light-headed
  • hematoma (blood accumulating under the skin)
  • infection (a slight risk any time the skin is broken)
  • multiple punctures to locate veins
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    Special considerations
    Pregnancy is usually associated with elevated cholesterol . Oophorectomy (removal of the ovaries) may increase cholesterol levels. Drugs that may increase cholesterol measurements include ACTH '>ACTH , anabolic steroids, beta-adrenergic blocking agents, corticosteroids, epinephrine, oral contraceptives, phenytoin, sulfonamides, thiazide diuretics, and Vitamin D . Drugs that may decrease cholesterol measurements include allopurinol, androgens, captopril, chlorpropamide, clofibrate, colchicine, colestipol, erythromycin, isoniazid, lovastatin, MAO inhibitors, neomycin, niacin , and nitrates.
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