LDL: The "Bad" Cholesterol

What is cholesterol?

Cholesterol is a waxy, fat-like substance that's found in all the cells in your body. Your liver makes cholesterol, and it is also in some foods, such as meat and dairy products. Your body needs some cholesterol to work properly. But having too much cholesterol in your blood raises your risk of coronary artery disease.

LDL and HDL are two types of lipoproteins. They are a combination of fat (lipid) and protein. The lipids need to be attached to the proteins so they can move through the blood. LDL and HDL have different purposes:

• LDL stands for low-density lipoproteins. It is sometimes called the "bad" cholesterol because a high LDL level leads to a buildup of cholesterol in your arteries.
• HDL stands for high-density lipoproteins. It is sometimes called the "good" cholesterol because it carries cholesterol from other parts of your body back to your liver. Your liver then removes the cholesterol from your body.

If you have a high LDL level, this means that you have too much LDL cholesterol in your blood. This extra LDL, along with other substances, forms plaque. The plaque builds up in your arteries; this is a condition called atherosclerosis.

Coronary artery disease happens when the plaque buildup is in the arteries of your heart. It causes the arteries to become hardened and narrowed, which slows down or blocks the blood flow to your heart. Because your blood carries oxygen to your heart, this means that your heart may not be able to get enough oxygen. This can cause angina (chest pain), or if the blood flow is completely blocked, a heart attack.

A blood test can measure your cholesterol levels, including LDL. When and how often you should get this test depends on your age, risk factors, and family history. The general recommendations are:

For people who are age 19 or younger::

• The first test should be between ages 9 to 11
• Children should have the test again every 5 years
• Some children may have this test starting at age 2 if there is a family history of high blood cholesterol, heart attack, or stroke

For people who are age 20 or older::

• Younger adults should have the test every 5 years
• Men ages 45 to 65 and women ages 55 to 65 should have it every 1 to 2 years

For people who are older than 65:

• They should have the test every year.

You may need to get your cholesterol checked more often if you have heart disease, diabetes, or a family history of high cholesterol.

Things that can affect your LDL level include:

• Diet. Saturated fat and cholesterol in the food you eat make your LDL level rise
• Weight. Being overweight tends to raise your LDL level, lower your HDL level, and increase your total cholesterol level
• Physical Activity. A lack of physical activity can lead to weight gain, which can raise your LDL level
• Smoking.Cigarette smoking lowers your HDL cholesterol. Since HDL helps to remove LDL from your arteries, if you have less HDL, that can contribute to you having a higher LDL level.
• Age and Sex. As women and men get older, their cholesterol levels rise. Before the age of menopause, women have lower total cholesterol levels than men of the same age. After the age of menopause, women's LDL levels tend to rise.
• Genetics. Your genes partly determine how much cholesterol your body makes. High cholesterol can run in families. For example, familial hypercholesterolemia (FH) is an inherited form of high blood cholesterol.
• Medicines. Certain medicines, including steroids, some blood pressure medicines, and HIV medicines, can raise your LDL level.
• Other medical conditions. Diseases such as chronic kidney disease, diabetes, and HIV can cause a higher LDL level.
• Race or ethnicity. People from certain racial or ethnic groups may have an increased risk of high blood cholesterol. For example, African Americans typically have higher HDL and LDL cholesterol levels than White Americans. Asian Americans are more likely to have higher LDL levels than other groups.

With LDL cholesterol, lower numbers are better, because a high LDL level can raise your risk for coronary artery disease and related problems. The general ranges for healthy adults are:

If you have coronary artery disease or are at high risk for it, your health care provider may have different goals for your LDL level.

There are two main ways to lower your LDL cholesterol level:

• Heart-healthy lifestyle changes, which include:
• Heart-healthy eating. A heart-healthy eating plan limits the amount of saturated and trans fats that you eat. Examples of eating plans that can lower your LDL level include the Therapeutic Lifestyle Changes diet and the DASH eating plan.
• Weight management. If you are overweight, losing weight can help lower your LDL level.
• Physical Activity. Everyone should get regular physical activity.
• Drug Treatment. If lifestyle changes alone do not lower your LDL level enough, you may also need to take medicines. There are several types of cholesterol-lowering drugs available, including statins. The medicines work in different ways and can have different side effects. Talk to your provider about which one is right for you. While you are taking medicines to lower your LDL level, you still should continue with the lifestyle changes.

Some people with familial hypercholesterolemia (FH) may receive a treatment called lipoprotein apheresis. This treatment uses a filtering machine to remove LDL cholesterol from the blood. Then the machine returns the rest of the blood back to the person.

NIH: National Heart, Lung, and Blood Institute

Learning Disabilities

What is a learning disability?

Learning disabilities are conditions that affect the ability to learn. They can cause problems with:

• Understanding what people are saying
• Speaking
• Reading
• Writing
• Doing math
• Paying attention

Often, children have more than one kind of learning disability. They may also have another condition, such as attention deficit hyperactivity disorder (ADHD). This can make learning even more of a challenge. The sooner a learning disability is identified and addressed, the better a child is likely to perform in school.

Learning disabilities don't have anything to do with how smart your child is. They are caused by differences in the brain, and they affect the way the brain takes in and uses information. These differences are usually present at birth. But there are certain factors that can play a role in the development of a learning disability, including:

• Genetics
• Environmental exposures, such as lead
• Using substances while pregnant

The earlier you can find and treat a learning disability, the better. Unfortunately, learning disabilities are usually not found until a child is in school. If you notice that your child is struggling, talk to your child's teacher or health care provider about having your child evaluated for a learning disability. The evaluation may include:

• Doing a physical exam to check for a medical problem that might make learning more difficult.
• Asking about your family history.
• Test your child's intellectual and school performance.

The most common treatment for learning disabilities is special education. A teacher or other learning specialist can help your child learn skills by building on their strengths and finding ways to make up for their weaknesses. They may suggest ways you can help your child when they do homework. Instructors may try special teaching methods, make changes to the classroom, or use technologies that can assist your child's learning needs. Some children also get help from tutors or speech or language therapists.

A child with a learning disability may struggle with low self-esteem, frustration, and other problems. Mental health professionals can help your child understand these feelings, develop coping tools, and build healthy relationships.

If your child has another condition, such as ADHD, they will need treatment for that condition as well.

NIH: National Institute of Child Health and Human Development

Low Blood Pressure

You've probably heard that high blood pressure is a problem. Sometimes blood pressure that is too low can also cause problems.

Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps out blood into the arteries. Your blood pressure is highest when your heart beats, pumping the blood. This is called systolic pressure. When your heart is at rest, between beats, your blood pressure falls. This is the diastolic pressure. Your blood pressure reading uses these two numbers. Usually they're written one above or before the other, such as 120/80. If your blood pressure reading is 90/60 or lower, you have low blood pressure.

Some people have low blood pressure all the time. They have no symptoms and their low readings are normal for them. In other people, blood pressure drops below normal because of a medical condition or certain medicines. Some people may have symptoms of low blood pressure when standing up too quickly. Low blood pressure is a problem only if it causes dizziness, fainting or in extreme cases, shock.

NIH: National Heart, Lung, and Blood Institute

Menopause

What is menopause?

Menopause is the time in your life when you stop having your period and can no longer get pregnant. You have reached menopause when you have not had a period for 12 months.

The time leading up to menopause is called the menopausal transition, or perimenopause. This transition usually begins when you are in your 40s, but sometimes it can start earlier. It can last for several years. The most common age for reaching menopause is between 45 and 55 years old.

Early and premature menopause happens when your ovaries stop making hormones and your periods stop at a younger age than usual. When menopause happens before age 40, it's called premature menopause. If menopause happens before age 45, it's called early menopause.

This can happen on its own (with no known cause). It can also happen because of surgery to remove the ovaries. Surgery to remove the uterus alone will cause your periods to stop, but it does not cause menopause unless the ovaries are also removed. Medical treatments such as chemotherapy or hormone therapy used to treat breast cancer may also cause menopause to start earlier than usual.

A condition called primary ovarian insufficiency (POI) happens when your ovaries stop working normally before you are age 40. But this condition is different from early menopause. If you have POI, you may still have periods, even though they might not come regularly. And you might still be able to get pregnant.

Other reasons for early or premature menopause can include:

• A family history of early or premature menopause
• Smoking
• Certain health conditions

During the menopausal transition, your ovaries start to make less of the estrogen and progesterone hormones. The changes in these hormones cause the symptoms of menopause, which can include:

• A change in your periods; they may be:
  • Irregular, with more or less time in between periods.
  • Shorter or longer.
  • Lighter or heavier.
• Hot flashes, a sudden warm feeling in your face, neck, and chest. They may cause you to sweat. If they happen at night and cause sweating, they are called night sweats.
• Trouble sleeping, such as trouble falling asleep or getting back to sleep when you wake up. Over time, a lack of sleep can lead to fatigue and memory problems.
• Vaginal dryness, which may cause pain or discomfort during sexual intercourse.
• Mood changes, which can make you feel moody, anxious, or more irritable.
• Bladder issues, such as urinary incontinence (loss of bladder control) and urinary tract infections (UTIs).

You may also have other physical changes which could put you at risk for certain diseases. For example, the loss of estrogen can:

• Cause you to lose bone density. This can lead to osteoporosis, a condition that causes bones to become weak and break easily.
• Raise your cholesterol levels and increase your risk of heart disease and stroke.

You may not need treatment for the symptoms of menopause. But if you do, there are several different types of treatments:

You may find that you can manage your symptoms with lifestyle changes. Here are some changes that might make you feel better:

• If you have hot flashes, dress in layers that can be removed at the start of a hot flash. You may want to carry a portable fan to use when you get a hot flash.
• Avoid alcohol, spicy foods, and caffeine. They can make your menopause symptoms worse.
• If you smoke, try to quit, not only for hot flashes, but for your overall health.
• Try to maintain a healthy weight. Being overweight or having obesity can make hot flashes worse.
• Have good sleep habits. Keep your bedroom dark, quiet, and cool.
• Get regular exercise. It can help you sleep better, improve your mood, and help lower your risk for many age-related diseases.
• Lower stress, for example by using relaxation techniques such as meditation, deep breathing, and muscle relaxation exercises.

If lifestyle changes are not enough to improve your symptoms, you may want to contact your health care provider. They will talk to you about your symptoms, family and medical history, and preferences. They also can explain the risks and benefits of the treatments.

There are various non-hormone treatments for menopause symptoms, such as:

• Medicines for hot flashes, including certain antidepressants, a medicine just for hot flashes, an antiseizure medicine, and a blood pressure medicine. Some of these medicines may also help with sleep problems.
• Medicines for urinary incontinence.
• Medicines to treat or help prevent osteoporosis.
• Low-dose birth control pills for very heavy bleeding or periods that are close together.
• Water-based lubricants to treat vaginal dryness.
• Medicines for painful intercourse that is caused by vaginal changes from menopause.
• Cognitive behavioral therapy (CBT), a type of talk therapy, for trouble sleeping.

Like all medicines, hormone therapy for menopause has benefits and risks. Talk with your provider about whether it is safe for you. If you decide to take it, your provider may recommend taking the lowest dose that works for the shortest time needed.

There are various products that are marketed for menopause symptoms. They include supplements, herbs, and over-the-counter "natural" hormone creams. There has been research on many of these products, but the results are mixed. Some studies suggest they may help, while others show little or no benefit. Also, there is little information on the long-term safety of these products. Some supplements can have harmful side effects or interact with medicines. Check with your provider before you take any of them.

Mental Health

What is mental health?

Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act as we cope with life. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood and aging.

Mental disorders are serious conditions that can affect your thinking, mood, and behavior. They may be occasional or long-lasting. They can affect your ability to relate to others and function each day. Mental disorders are common; many Americans will be diagnosed with one at some time in their life. But there are treatments. People with mental disorders can get better, and many of them recover completely.

Mental health is important because it can help you to:

• Cope with the stresses of life
• Be physically healthy
• Have good relationships
• Make meaningful contributions to your community
• Work productively
• Realize your full potential

Your mental health is also important because it can affect your physical health. For example, mental disorders can raise your risk for physical health problems such as stroke, type 2 diabetes, and heart disease.

There are many different factors that can affect your mental health, including:

• Biological factors, such as genes or brain chemistry
• Life experiences, such as trauma or abuse
• Family history of mental health problems
• Your lifestyle, such as diet, physical activity, and substance use

You can also affect your mental health by taking steps to improve it, such as doing meditation, using relaxation techniques, and practicing gratitude.

Over time, your mental health can change. For example, you may be dealing with a difficult situation, such as trying to manage a chronic illness, taking care of an ill relative, or facing money problems. The situation may wear you out and overwhelm your ability to cope with it. This can worsen your mental health. On the other hand, getting therapy may improve your mental health.

When it comes to your emotions, it can be hard to know what is normal and what is not. There are warning signs that you may have a mental health problem, including:

• A change in your eating or sleeping habits
• Withdrawing from the people and activities you enjoy
• Having low or no energy
• Feeling numb or like nothing matters
• Having unexplained aches and pains
• Feeling helpless or hopeless
• Smoking, drinking, or using drugs more than usual
• Feeling unusually confused, forgetful, angry, upset, worried, or scared
• Having severe mood swings that cause problems in your relationships
• Having thoughts and memories that you can't get out of your head
• Hearing voices or believing things that are not true
• Thinking of harming yourself or others
• Not being able to perform daily tasks like taking care of your kids or getting to work or school

If you think that you may have a mental health problem, get help. Talk therapy and/or medicines can treat mental disorders. If you don't know where to start, contact your primary care provider.