Health
Get the entire 411 on cholesterol.
Of all the risk factors for coronary heart disease (blockages in the heart’s arteries that can cause heart attacks), cholesterol receives the most attention. Hundreds of medical studies confirm the truth: you must understand cholesterol in order to manage your heart health.
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The Internet offers millions of sites promising to reveal the “secrets” of cholesterol. Some are accurate, but many are not. Beware websites claiming that cholesterol has nothing to do with heart disease (wrong!) and those that tout “magic” remedies that promise to drive cholesterol levels to super-low levels that will melt away plaques and reverse heart disease (don’t count on it!). Accurate, evidence-based information is your key to successful cholesterol management.
What is cholesterol?
A waxy, yellowish white substance, cholesterol was first isolated by an eighteenth-century French chemist who was studying gallstones. This observation led scientists to link cholesterol to illness and disease, but subsequent research proved this theory incorrect. It turns out that every cell in your body contains cholesterol, and you can’t live without it!
Cholesterol is a key component of the cell membrane, the outer barrier between the cell and the rest of the body. Within the membrane, cholesterol molecules act like tollbooths, helping to regulate the passage of materials into and out of the cell. Cholesterol also serves as a building block for many important hormones, including estrogen and testosterone. Your body even needs cholesterol to manufacture vitamin D from sunlight.
Cholesterol tests: what do the numbers mean?
When you get a cholesterol test (lipid profile), we measure cholesterol and fat concentrations in your blood. The typical blood test provides four values.
Lipid Profile
| Test | Normal Value |
| LDL cholesterol | Less than 130 |
| HDL cholesterol | Greater than 40 in men and 45 in women |
| Total cholesterol | Less than 200 |
| Triglycerides | Less than 150 |
Of these tests, LDL cholesterol is most important. A high LDL cholesterol is associated with the development of coronary heart disease, as well as stroke and peripheral arterial disease. In general, the lower the LDL cholesterol, the lower the risk of heart disease. While we state that a value less than 130 is “normal,” the person with multiple risk factors for coronary heart disease should aim for 100 or less and the person who already has heart disease should target 70 or less.
HDL cholesterol is the “good” cholesterol. The higher a person’s HDL, the lower the risk of coronary heart disease. In general, your total cholesterol is somewhat less important than your LDL or HDL values.
Elevated triglycerides have been associated with coronary heart disease, although scientists have not yet proven that lowering triglycerides is protective.
How can you improve your cholesterol levels?
Although many people take statins (see below) to improve their cholesterol profiles, diet and lifestyle are important. Stated another way, don’t count on a daily pill to offset a diet filled with saturated fat and a lifestyle devoid of exercise. Through your choices and actions, you can make a difference in your cholesterol values.
Improve Your Cholesterol Profile
| Diet | |
| Avoid saturated fats | Limit red and processed meats, full fat dairy products |
| Favor monounsaturated fats | Use olive oil and canola oil |
| Incorporate dietary fiber | Whole grains, oats and oatmeal, beans, barley |
| Exercise | Aerobic exercise at least 30 minutes per day |
| Ideal body weight | Achieve by decreasing calories and increasing exercise |
| Quit smoking | Increases HDL |
Some studies suggest that consuming soy protein and spreads fortified with plant sterols may also help to lower LDL.
“I followed the recommendations, but I can’t get my LDL down. Why not?”
Diet is important, but there are other factors at play in determining your cholesterol values. For the most part, your body manufactures the cholesterol in your blood. Eighty percent of the body’s cholesterol is made by the liver, while only twenty percent comes from your diet. This explains why it can be so difficult to lower cholesterol by dietary interventions alone.
Do you need a statin?
Because lowering LDL cholesterol is the primary goal of cholesterol management, drugs that reduce LDL levels are the “big guns” in our armamentarium. Statins, the most important class of LDL-lowering drugs, have revolutionized cardiology. Acting on the liver (which produces most of the cholesterol in our blood), statins can cause dramatic drops in blood levels of LDL and total cholesterol.
Statins save lives and prevent heart attacks and strokes. Among people who have already suffered a heart attack, statins reduce the risks of a second heart attack and death. Statins also benefit people who have a high LDL cholesterol but who have never had a heart attack. Recent studies suggest that they even help certain people who have normal LDL levels but a high level of inflammation in their bodies.
The critical message here is that if you have had a heart attack or if you have a high LDL cholesterol in spite of lifestyle changes, ask your doctor if a statin is right for you.
Do you know your cholesterol numbers?
You can’t make plans to control your cholesterol unless you know your numbers. Beginning at age 20, every adult should have a lipid panel at least every five years. If any values are abnormal or if you have cardiovascular disease, you’ll need the blood test annually. Most patients on statins should have a lipid panel every six months.
Today, only half of young adults have undergone cholesterol screening. Find the time in your schedule and have this simple blood test. It could save your life.
Understanding the limitations of dietary interventions can help people with high cholesterol levels accept the fact that they have to take cholesterol-lowering drugs. If your cholesterol level is 50 percent higher than normal, you are simply not going to reach your cholesterol goals by diet alone. In such a case, you need to combine a good diet with the right medication.
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