Did your last doctor’s office visit reveal high cholesterol? What’s next? Is it time to start taking pills or can you lower your LDL levels the old-fashioned way – diet and exercise? Learn more about the stages of your condition, including the diagnosis, treatments and medication available. Plus, how well do you understand cholesterol? Take our quiz to find out...
Cholesterol often gets a bad rap, but did you know it’s essential for many bodily functions?
It repairs cell membranes, produces vitamin D on the skin, makes hormones such as estrogen and testosterone, and helps with cells related to memory and learning, says Tracy Stevens, M.D., a cardiologist and spokeswoman for the American Heart Association (AHA).
But too much cholesterol can have deadly consequences, especially if you have diabetes type II. This waxy substance in the blood contributes to 20% of all strokes, 50% of all heart attacks and affects 36 million U.S. adults, according to the AHA.
You could have high cholesterol levels for years and never know it until something goes wrong, says Lisa Reis, M.D., a cardiologist and assistant professor at Saint Louis University Hospital in Missouri.
Fortunately, high cholesterol is easy to tame, says Binoy Singh, M.D., an internist and cardiologist with ColumbiaDoctors of Somers, N.Y.
“Many women can dramatically lower their cholesterol by eating a healthier diet and starting an exercise program and will not need to take medication,” he says.
Some cholesterol is healthy (“good” cholesterol), but high levels of “bad cholesterol” can sabotage your health. People with diabetes have a harder time controlling cholesterol levels because the disease tends to lower "good" cholesterol levels and increase "bad" cholesterol readings. It puts them at a higher risk of heart disease, according to the AHA.
Good cholesterol, or high-density lipoprotein cholesterol (HDL), can protect against heart disease and stroke.
Bad cholesterol, or low-density lipoprotein cholesterol (LDL), accumulates in arteries that feed the heart (coronary arteries) and brain (carotid artery in the neck). Together with other substances, bad cholesterol forms plaque, a thick, hard deposit that narrows arteries and makes them less flexible – a condition called atherosclerosis.
If a blood clot forms and blocks an artery that’s already narrowed by plaque, you could have a heart attack or stroke, depending on which artery is clogged.
Two other substances that affect arteries and contribute to cholesterol are triglycerides and Lp(a) cholesterol, Stevens says.
Triglycerides are a type of fat that’s made by the body. In low levels, they’re not harmful. But lifestyle factors – such as being overweight or obese, being a couch potato, eating a high-carb diet, smoking and drinking too much alcohol – can cause triglycerides to proliferate to dangerous levels, she says.
If you have high triglyceride levels, you’re more likely to have high total cholesterol, too little good (HDL) cholesterol and too much bad (LDL) cholesterol, and an increased risk of cardiovascular disease, Stevens says. High triglyceride levels also increase your risk for metabolic syndrome, which is a combination of obesity, abdominal fat, unhealthy cholesterol levels, high blood pressure and insulin resistance that increases your risk for diabetes, heart disease and even death.
Lp(a) is a variation of bad (LDL) cholesterol. Scientists don’t fully understand Lp(a) but believe it may accelerate the accumulation of fatty deposits, increasing an already high risk of heart disease and stroke, according to the AHA.
About 25% of cholesterol in the body comes from foods that contain cholesterol, namely animal products such as meat, eggs, full-fat dairy treats like milk, cheese, butter and ice cream, and some seafood, including shrimp, says Darlene Zimmerman, M.S., R.D., Heart Smart dietitian at Henry Ford Hospital Heart and Vascular Institute in Detroit.
“Plant foods don’t have cholesterol,” she says.
The liver manufactures the remaining 75% of cholesterol in the body, says Brian Kahn, M.D., a cardiologist with the Heart Center at Overlea in Baltimore.
Testing
A simple blood test can determine whether you have high cholesterol levels.
If you have a family history of high cholesterol, get tested at age 20 and then every five years, advises Cindy Haines, M.D., a family physician and author of The New Prescription, How to Get the Best Health-Care in a Broken System (Health Communications Inc.).
If you’re not at high risk, get your first test by your early 30s, she adds.
How to Read the Numbers
A cholesterol test delivers measurements in milligrams per deciliter of blood (mg/dL). Your total cholesterol level should be less than 200 mg/dL. If it’s 200-239, it’s considered borderline high. If it’s more than 240 mg/dl, your risk is twice as high as a woman with healthy cholesterol, Stevens says.
Your good (HDL) cholesterol should be at least 50 mg/dL. The higher your good (HDL) cholesterol, the lower your risk for heart disease.
Being overweight or obese, smoking, and being inactive can lower your HDL. Estrogen may raise HDL cholesterol levels, which may explain why high cholesterol is more common among postmenopausal women than younger women, says Peter Alagona Jr., a cardiologist and researcher with Penn State Hershey Heart and Vascular Institute.
Your bad (LDL) cholesterol should be less than 100 mg/dL. Unhealthy lifestyle habits raise bad cholesterol levels. But a 2011 study conducted at Texas A&M University found that women who exercised rigorously and gained the most muscle mass also had the highest levels of LDL – an unexpected result that scientists are still trying to figure out.
Your triglyceride levels should be less than 150 mg/dL.
If you have risk factors for high cholesterol but normal test results, your doctor can order a special blood test called NMR LipoProfile that measures regular cholesterol and the number of LDL cholesterol-carrying particles in your bloodstream for a more complete picture of your cardiovascular risk, says James Underberg, M.D., a lipidologist with New York University Center for the Prevention of Cardiovascular Disease.
Treatment
So how is high cholesterol treated?
“Diet and exercise form the cornerstone of high cholesterol treatment,” says Brian Kahn, M.D., a cardiologist with the Heart Center at Overlea in Baltimore. “You may be able to lower your levels in a few months with healthier lifestyle habits.”
Some steps you can take:
“Eat a heart-healthy Mediterranean diet that revolves around fresh fruits and vegetables, whole grain foods, foods that are high in fiber, lean meats and poultry. Try to eat fish at least once or twice a week,” Zimmerman says.
Cut the fat: Eat a low-fat diet that contains no more than 25%-30% calories from fat, says Julie Bolick, M.S., R.D., a clinical nutritionist and lipid specialist for University of Utah’s Cardiovascular Genetics division. “Limit saturated fat to 7% of your daily fat intake by eating lean meats, margarine instead of butter and switching to low-fat and fat-free dairy products. The rest should come from monounsaturated fats and polyunsaturated fats.” Monounsaturated fats are found in olive, peanut and canola oils, nuts and fatty fish like salmon, mackerel and herring. Polyunsaturated fats are found in soybean, corn and safflower oils, fatty fish, walnuts and sunflower seeds, oils and butters.
Focus on omega-3 fatty acids: A 2002 study conducted at Penn State Hershey Heart and Vascular Institute found that the omega-3 fatty acids in fish oil lowered triglycerides by as much as 30% and raised HDL cholesterol by as much as 3%. Best sources of the fatty acids include Pacific herring, farm-raised Atlantic salmon, mackerel, sardines and fresh tuna, as well as canola, flaxseed, walnut, soybean and fish oils.
Lower dietary cholesterol: Limit cholesterol to 300 milligrams (mg) daily, or 200 mg if you have heart disease, Bolick says. Avoid concentrated sources of cholesterol such as organ meats, egg yolks and whole milk products and switch to lean meats, egg substitute or egg whites and skim milk.
Avoid trans fats: “These are the black sheep of fats because they raise bad cholesterol and lower good cholesterol,” says Dominique Fradin-Read, M.D., a physician, and assistant clinical professor at Loma Linda University School of Medicine in Los Angeles. Trans fats also raise triglycerides and Lp(a). “Products can claim to be free of trans fats if they contain less than 0.5 grams of trans fat per serving, but small amounts can really add up,” he says. Check the food label. If it lists partially hydrogenated fat, the product contains trans fats.
Stop smoking: Smoking increases inflammation of arteries and destabilizes plaque, which can rupture and lead to heart attacks or even death, says Stevens.
Drink in moderation: “One drink a day, such as a glass of red wine or a beer, can help increase good cholesterol,” Zimmerman says.
Lower sodium: High cholesterol levels contribute to high blood pressure and a high sodium diet increases the risk. Reduce your intake to 2,300 mg or less and slash sodium by eating fresh, rather than canned or preserved, foods and avoiding salty items such as bacon, soups and stews. For more information, check out the DASH diet (Dietary Approaches to Stop Hypertension).
Medications
If diet and exercise aren’t enough to lower your cholesterol or if you have very high cholesterol, your doctor may prescribe one of these medications, which can lower cholesterol in 4-6 weeks, Kahn says:
Statins (Lipitor, Lescol, Crestor): These medications inhibit an enzyme in the liver from producing cholesterol. Side effects are rare but include muscle aches and pains.
Bile-acid-binding resins (Welchol, Prevalite, Questran): The liver converts cholesterol to bile to aid in digestion. Resins bind to this bile in the digestive tract and it’s then eliminated from the body. In response, the liver uses excess cholesterol to make more bile acids, which in turn are also cleared from the body.
Cholesterol absorption inhibitors (Zetia, Vytorin): These drugs inhibit absorption of dietary cholesterol and reduce blood cholesterol.
Fibrates (Lofibra, Tricor, Lopid): Fibrates decrease triglycerides by reducing the liver's production of very-low-density lipoprotein (VLDL) cholesterol and increasing the removal of triglycerides from your blood.
Niacin (Niaspan): Prescription-strength niacin inhibits the liver from producing bad (LDL and VLDL) cholesterol.
Omega-3 fatty acids (Lovaza, a prescription-strength omega-3 fatty acid): will help lower your triglycerides.
For more information, visit our Cholesterol Health Center.
How Well Do You Understand Cholesterol?
Cholesterol is much maligned, yet many people don’t understand this essential substance and how it works in our bodies. Do you know your HDL from your LDL? How about which lifestyle choices influence cholesterol levels?
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