High cholesterol and high triglycerides: tests and treatment by video in Puerto Rico

Cholesterol is a fat your body needs, but when LDL (the "bad" cholesterol) is high, plaque builds up in your arteries. That plaque narrows blood flow and, over time, can cause a heart attack or a stroke. Plaque also reduces blood flow to the penis, which is why erection problems are sometimes an early sign of artery disease. If you are prescribed an erection medicine, read about sildenafil and tadalafil.

Having high blood pressure or type 2 diabetes as well raises the risk, so it makes sense to follow them up together.

Booking a cholesterol visit is simple:

A doctor visit has the same price for every age, with no membership and no insurance needed. You are charged when you request the visit, and you get a full refund if the clinic can’t see you. The lab order is part of the visit; the lab charges for the tests and the pharmacy for the medicine. A doctor's note after your visit is included at no extra charge. See all prices.

If you only need a refill of the cholesterol medicine you already take (non-controlled), choose the follow-up visit; anyone can book it. A review of lab results is also a follow-up visit, for existing patients. If a follow-up or forms visit turns out to need a full visit, the doctor explains why and, with your consent, you pay the difference.

High cholesterol usually causes no symptoms. Plaque builds up in the arteries silently until it narrows blood flow, and then it can cause chest pain once complications develop, a heart attack or a stroke. That is why it is checked with regular tests even when you feel fine.

A lipid panel is a blood test that measures several fats. You don’t need an office visit first: the doctor gives you a lab order for a lab near you, then goes over the results with you by video. These are the healthy values for adults 20 and older, according to MedlinePlus (NIH):

• Total cholesterol: less than 200 mg/dL.
• LDL, the "bad" cholesterol: less than 100 mg/dL.
• HDL, the "good" cholesterol: higher is better; 60 mg/dL or more is best.
• Non-HDL cholesterol: less than 130 mg/dL.
• Triglycerides: another blood fat; high levels may raise your risk of heart disease.

The doctor gives you a lab order on these general MedlinePlus intervals, or more often if you already have high cholesterol or take medication: adults 20 and older without other risks, every 5 years; men 45 to 65 and women 55 to 65, every 1 to 2 years; over 65, every year. You may be asked to fast for 9 to 12 hours before the test.

Eating less cholesterol and saturated fat, being more active, keeping a healthy weight and not smoking all help lower cholesterol and heart risk. According to the CDC, smoking damages blood vessels, lowers "good" (HDL) cholesterol, raises triglycerides and adds to plaque buildup; if you want to quit smoking, the doctor helps you with a plan. If losing weight has been hard, see how we help with medically supervised weight loss. Under its FDA label, Wegovy (semaglutide) also lowers the risk of heart attack and stroke in adults with heart disease and overweight or obesity; see GLP-1 medicines compared.

When medication is needed, treatment may include a statin, the most commonly used group; other groups exist for specific situations. Statins are explained below, under “Statins: atorvastatin, rosuvastatin and others.” According to MedlinePlus, you keep taking them even when you feel well, because high cholesterol causes no symptoms.

Never stop a statin on your own, or change the dose or the pill without talking to the doctor; if you have a side effect, tell her: there is almost always another option. The exception is pregnancy, covered below. If you already take a statin and are running low, see prescription refills.

Statins are the most commonly used cholesterol medicine. Atorvastatin (brand name Lipitor) and rosuvastatin (brand name Crestor) are two of the best known. According to MedlinePlus, they slow the body’s production of cholesterol and lower the risk of heart attack and stroke. The doctor decides whether a medicine is right for you based on your lipid panel and your heart risk.

Muscle aches: according to MedlinePlus, if you have muscle pain, tenderness or weakness while taking atorvastatin or rosuvastatin, especially with fever, unusual tiredness or flu-like symptoms, call your doctor right away or get emergency care. See also muscle cramps, a related but different symptom.

Lab tests: the doctor may order a lipid panel to see how much your cholesterol comes down, and liver tests, because according to MedlinePlus the doctor orders liver function tests with these medicines. We give you an order for those tests at a lab near you and go over the results with you by video.

Pregnancy and breastfeeding: if you become pregnant while taking a statin, call the doctor right away. For atorvastatin, MedlinePlus says to stop it and call your doctor, because it can harm the baby; according to the FDA, most patients should stop a statin once they learn they are pregnant, and the doctor advises you on your situation. Breastfeeding is not recommended while taking a statin. If you are pregnant, planning a pregnancy or breastfeeding, tell the doctor.

High triglycerides means too much of another blood fat, measured in the same lipid panel as cholesterol. According to MedlinePlus and the NHLBI (NIH), these are the triglyceride levels for adults:

• Normal (healthy): less than 150 mg/dL.
• Borderline high: 150 to 199 mg/dL.
• High: 200 to 499 mg/dL.
• Very high: 500 mg/dL or more.

Causes. According to MedlinePlus, triglycerides go up when you regularly eat more calories than you burn, especially with a lot of sugar and refined carbohydrates, and with heavy drinking, excess weight or obesity, smoking and too little exercise. They are also raised by poorly controlled type 2 diabetes, thyroid disease such as hypothyroidism, liver or kidney disease, some inherited conditions, and certain medicines, such as diuretics and some breast cancer or HIV treatments. If you take one of those medicines, do not stop it on your own: tell the doctor.

The pancreatitis risk. According to MedlinePlus and the NHLBI, very high triglycerides raise the risk of acute pancreatitis, a sudden swelling of the pancreas. That is why a level of 500 mg/dL or more is dealt with promptly.

Treatment. According to MedlinePlus and the NHLBI, these help lower triglycerides: reaching a healthy weight, regular physical activity, not smoking, limiting sugar and refined foods, switching from saturated fats to healthier fats, getting enough sleep and limiting alcohol; with very high levels, a provider may recommend stopping alcohol completely. Some people also need medicine: the NHLBI lists statins, fibrates and prescription omega-3 fatty acids, and notes that over-the-counter omega-3 supplements are not FDA-approved for this. The doctor goes over your lipid panel with you, looks for what is raising your triglycerides and decides with you whether a medicine is appropriate.

The test sometimes requires 9 to 12 hours of fasting; follow the instructions you are given. Book an evaluation; the doctor decides whether a treatment is right for you. She gives you a lab order for your lipid panel and goes over the results with you by video. Book your visit.

We see adults and children of all ages. MedlinePlus says children should have a first cholesterol test between ages 9 and 11, repeated every 5 years. If your family has very high cholesterol or early heart disease, the doctor can give you a lab order for your child sooner.

For your safety, call 911 or go to the emergency room if you have any of these signs. See also when to go to the ER.

• Chest pain, pressure or tightness, especially if it spreads to the arm, jaw or back
• Sudden shortness of breath
• Weakness or numbness on one side of the body, a drooping face or trouble speaking
• Sudden loss of vision, or severe dizziness with trouble walking