My Doctor Online The Permanente Medical Group

Screening and Diagnosis

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Screening for cholesterol is generally done by a blood test obtained after you’ve fasted for 12 hours. When you fast, you have nothing to eat or drink except water and any medication you take. If you have diabetes, check with us before fasting.

The blood test for screening your cholesterol will be more complete if you fast, but if you are not fasting, you can get the total cholesterol, HDL, and LDL, without the triglycerides, done at any time.

Target ranges for healthy levels of cholesterol are:

• Total cholesterol. Less than 200. Your total cholesterol profile is actually more important than just this number.
• LDL cholesterol. Less than 130 for those in good health. However, the goal is less than 100 (or even as low as 70) if you have certain medical conditions such as diabetes, CAD (heart disease), stroke, chronic kidney disease, or peripheral arterial disease.
• HDL cholesterol. More than 50.
• Triglycerides. Less than 150.

A healthy range for you may vary depending on your risk factors and total cholesterol profile.

Causes and Prevention

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Blood levels of cholesterol and triglycerides are influenced by family genetics as well as by your lifestyle.

Making healthy lifestyle choices helps prevent high LDL and triglyceride levels, and raises HDL levels. These good choices include:

• Maintaining a healthy weight
• Eating a healthy diet
• Getting plenty of exercise
• Not smoking

Medications may also be used to manage your cholesterol.

Why Treatment Is Important

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The goal of treatment is to lower your levels of LDL and triglycerides as well as increase your HDL to prevent damage to blood vessels over time. When you are treated for high cholesterol, you can avoid many of its damaging effects on your body.

Without treatment, high levels of bad cholesterol cause cholesterol particles to stick to the artery walls and form plaque. Over time, this condition can significantly narrow the arteries and harden the walls of the blood vessels. This process is called atherosclerosis.

The best treatment plan for you needs to address your risk factors as well as your cholesterol levels. The goal is to prevent damage to your heart or blood vessels and to lower your blood fats.

Risk for Heart Attack and Stroke

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A lack of blood and oxygen reaching the heart can cause chest pain (angina) or a heart attack. 

More often, accumulated fat deposits become unstable and break loose. When this happens, a blood clot forms in the damaged area, blocking the blood flow. If the artery bringing blood to the brain is blocked, a stroke occurs.

Even when your total cholesterol is normal, low levels of HDL (good cholesterol) put you at increased risk for heart attacks and hardening of the arteries. This is because good cholesterol is also necessary to prevent the harmful buildup of fatty deposits. 

High levels of triglycerides may increase the risk of heart disease, especially when the levels of LDL, or bad cholesterol, are high, or the levels of HDL, or good cholesterol, are too low. 

Lifestyle Changes

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Lifestyle changes such as losing weight, changing your diet, and getting regular physical activity can help keep your cholesterol in a healthy range. Medications may also be necessary, if you are at high risk for a heart attack or other blood vessel problems.

To help control your cholesterol, you will need to:

• Maintain a healthy weight by eating a low-fat, high-fiber diet and exercising.
• Stop smoking.
• Limit your alcohol and sugar intake.

If you need medication in addition to making changes in your lifestyle, take medication exactly as directed and do not stop taking it until you discuss it with us first.

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Maintain a Healthy Weight and Exercise

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Maintain a healthy weight. Losing as little as 10 pounds can help increase your good cholesterol levels.

Exercise regularly. When you exercise, your body burns more calories and builds more muscle. Muscle, in turn, burns more calories than fat. So, the more muscle you have, the more calories your body uses all day, every day, helping you to maintain or reach a healthy weight.

When you start an exercise program, start slowly and build up gradually:

• Start with 10 minutes of daily physical activity like walking, bicycling, or swimming.
• Gradually increase your exercise sessions to at least 30 to 60 minutes of exercise on most days.

Eat a Healthy Diet

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• Choose foods low in fat and high in fiber. Whole-grain foods, fruits, and vegetables provide fiber. Oatmeal, whole-wheat bread, bran cereals, brown rice, and corn tortillas are good examples of low-fat, high-fiber foods.
• Read food labels. Compare the nutrition information of similar food products when you shop. Foods with less than 3 grams of fat in a serving are considered low-fat.
• Limit your intake of meat, eggs, full-fat cheese, and whole milk. Low-fat or nonfat milk and dairy products are fine.
• Eat fish twice a week. Studies show that a diet rich in omega-3s, which can be found in fish, may help increase good cholesterol. Omega-3s may also prevent blood from clotting. (Pregnant and nursing mothers should eat no more than 6 ounces of fish per week.)
• Cook with mono-unsaturated fats. These fats are found in olive oil, canola oil, peanut oil, avocados, and many nuts. Use in moderation, since fat is very high in calories and using too much (even of healthy fats) will make you gain weight.
• Limit foods with saturated fats, trans fats, and cholesterol. Trans fats are manufactured fats that appear in many processed foods and stick margarine. Trans fats also increase your risk for heart disease because they lower good (HDL) cholesterol.

Stop Smoking

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If you smoke, becoming a nonsmoker may be the most important thing you can do for your health. Smoking lowers HDL, or good cholesterol, and raises triglycerides. 

There are many ways to stop smoking. Visit or call your local Health Education Center for more information on smoking cessation programs.

Lower your Triglycerides

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Follow the guidelines for improving cholesterol. In addition:

Limit your alcohol intake to 2 drinks per week.

• One drink is equal to 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of liquor.
• If your triglycerides are above 500, avoid alcohol entirely.

Limit your sugar intake.

• Avoid sodas with sugar.
• Limit drinking fruit juice to 4 ounces per day.
• Avoid baked goods such as cookies and pastries, including fat-free versions.
• If you have diabetes, keep your blood sugar levels in a healthy range.

Medications

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The decision to recommend medications depends on both your cholesterol levels and your risk factors for heart disease and atherosclerosis. We will work with you to find the medications that will work best for you. Making lifestyle changes is still very important, even if you take medications.

Statin Medications

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A class of medicines called statins work to lower bad, or LDL, cholesterol, which builds up in your artery walls and makes them narrower. Statins also increase your good, or HDL, cholesterol and are very helpful medications for your heart and blood vessels.

Although it is an important part of your medical treatment, taking a statin medication by itself is not enough to prevent heart attacks and strokes. It's common to take other medications to keep your heart healthy and prevent heart attack and stroke in addition to a statin drug. We will work with you to help determine which medications will work best in your individual case.

Statin medications and pregnancy

Statin medications should not be taken by women who are trying to get pregnant or are at risk for pregnancy because they can cause birth defects. If you have high cholesterol and want to get pregnant, please talk to us. It is best to be at a healthy weight and have your cholesterol under good control before trying to get pregnant. If you are a woman of childbearing age (15 to 49) and are not planning to get pregnant, use an effective form of birth control. You must be using a highly reliable method of birth control if you are taking certain medications for high cholesterol.

Side effects

Most people who take this medication have few or no side effects. Some people experience mild muscle aches, upset stomach, gas, constipation, abdominal pain, or cramps. Severe muscle pain is a very rare side effect. If you experience severe muscle pain or severe weakness, contact us immediately.

Blood tests are done periodically to monitor your liver function, although most people who take statins do not develop liver problems. 

To reduce your chances of experiencing side effects:

• Avoid eating grapefruit or drinking grapefruit juice.
• Drink alcohol in moderation – 2 or fewer drinks a day for men, and 1 or fewer for women, with 1 drink being equal to 12 ounces of beer, 4 ounces of wine, or 1½ ounces of liquor.
• Do not take statins if you are pregnant or may become pregnant in the near future. Women aged 15 to 49 should use a highly reliable birth control method if they are taking statins. 
• Avoid taking statins if you have severe liver or kidney damage.

Other cholesterol-lowering medications

Depending on your situation, we may prescribe other cholesterol- or triglyceride-lowering medications.

Your Care with Me

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I can order a cholesterol screening test for you at the appropriate time, based on your risk factors.

If your cholesterol is higher than the recommended target for your risk factors, I will work with you to help improve it. We will discuss changes in your lifestyle to help you achieve the target. I recommend that you review our related health tools and classes for programs that may help you learn about your cholesterol, increase physical activity, eat healthier, quit smoking, and maintain a healthy weight.

If necessary, I will prescribe medication. If you are taking medication for high cholesterol, we recommend that you get a blood test at least once a year. Clinical pharmacists are available for added help with medication adjustments. As we continue to monitor your cholesterol and medication levels, we may send you for follow-up tests and make adjustments as needed.

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You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site. You can also book an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you. 

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If you need to talk with me after your visit or procedure, please call my office. If you are a Kaiser Permanente member, you can also send a secure e-mail message to me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing an emergency, call 911 or go to the nearest Emergency Room.

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How We Coordinate Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization.  We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures we will schedule an appointment with the radiology department. When the results are ready I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

If you are due for preventive screenings or tests

As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test.  We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.

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Convenient Resources for You

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My goal is to provide high quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions and schedule appointments.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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