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For Your Heart's Sake, Lower Your Cholesterol

There's a lot of news about cholesterol these days, and with good reason. High cholesterol contributes to heart disease, which kills more Americans than all cancers combined.

What is cholesterol?

Cholesterol is a waxy, fatlike substance that your body – mainly the liver – produces. Cholesterol is used to make some hormones, vitamin D, and bile acids, which help to digest fat. Cholesterol also is used to build healthy cell membranes (walls) in the brain, nerves, muscles, skin, liver, intestines, and heart. It only takes a small amount of cholesterol to meet all these needs. Your body makes enough; you don’t have to get cholesterol in your diet.

Why is a high cholesterol level unhealthy?

Cholesterol causes a problem only when you have too much of it in your blood. Excess cholesterol is deposited in the lining of the arteries, including the arteries that feed your heart muscle. This narrows the area inside the artery, through which blood flows. High blood cholesterol itself does not cause symptoms, so many people are unaware that their cholesterol level is too high.

You should have your cholesterol checked at least every five years, starting at age 20. The most accurate test is a lipoprotein profile, a blood test given after fasting for nine to 12 hours. The test will give you these details:

  • Your total cholesterol

  • Your LDL ("bad") cholesterol; this cholesterol is what's deposited in your arteries

  • Your HDL ("good") cholesterol; this cholesterol helps keeps deposits from building up in your arteries

  • Your triglycerides; these are another form of fat in your blood

Even without a lipoprotein profile, you can get a rough idea of your cholesterol health if you know your total cholesterol and HDL cholesterol. These levels can be determined through a non-fasting cholesterol test often given at shopping malls or health fairs. If your total cholesterol is 200 mg/dL or more, or if your HDL cholesterol is less than 40 mg/dL, you should ask your doctor about getting a complete lipoprotein profile.

Total cholesterol

For adults, a total cholesterol level of 190 mg/dL to 224 mg/dL is considered borderline high. Anything above 225 mg/dL is high.

HDL (high-density lipoprotein) cholesterol

An HDL level of less than 40 mg/dL for men and 50 mg/dL for women is low; 60 mg/dL and above is considered optimal. The higher your HDL cholesterol, the better, because it helps protect against heart disease.

LDL (low-density lipoprotein) cholesterol

The National Heart, Lung, and Blood Institute says that 100 mg/dL is an optimal LDL level. An LDL level of 120 to 159 mg/dL is considered borderline high; 160 mg/dL and above is high to very high. For people with known heart disease, the cholesterol level targets are more stringent; ask your doctor what they are. Having a high level of LDL cholesterol can cause fatty plaque to form along the insides of your artery walls. This makes the arteries narrower and stiffer. Narrower arteries mean less room for blood to flow through – like a partially clogged pipe. This process, called atherosclerosis, develops over a long time. It is especially dangerous if it narrows the vessels to the heart and brain, creating a major risk for heart attack and stroke. Build-up of cholesterol in the arteries of the legs can cause leg and foot pain and trouble walking.

What causes high cholesterol?

Heredity is the main factor determining your cholesterol. Then, depending on your genetic makeup, your diet is next in line as a risk factor for high cholesterol. Foods containing cholesterol, saturated fats, or trans fats all contribute to your total cholesterol pool. People with the right genes to handle cholesterol usually have no problem handling a regular fatty diet. For a large portion of the population, however, a bad diet drives the cholesterol up. 

Many foods that come from animals are high in both saturated fat and cholesterol. Some non-animal foods also are high in saturated fat; these include foods made with coconut and palm oils and trans fats, or hydrogenated vegetable oils like shortening and margarine.

These are other factors that influence your cholesterol levels:

  • Weight. Being overweight usually raises your LDL cholesterol. Losing weight may lower your LDL level, as well as your triglycerides, and boost your HDL cholesterol.

  • Exercise. Getting regular exercise may lower your LDL cholesterol and raise your HDL cholesterol.

  • Age and gender. Until menopause, women usually have lower total cholesterol levels than those of men. After age 50, women often have higher total cholesterol levels than men of the same age. For both men and women, total cholesterol levels rise until about age 65.

  • Alcohol. Although alcohol boosts HDL cholesterol, it has no effect on LDL cholesterol, and excessive alcohol consumption raises triglycerides. Too much alcohol also damages the liver, brain, and heart.

The main goal of cholesterol-lowering treatment is to lower your LDL level enough to reduce your risk for developing heart disease or having a heart attack. The higher your risk, the lower your LDL goal will be.

What should you eat?

To eat a heart-healthy diet, you need to cut down on foods high in saturated fats, like fried foods, red meat, processed meats (cold cuts and hot dogs), some kinds of cheese, and most commercially prepared baked goods (muffins, cookies, doughnuts). Commercial food manufacturers are responding to health concerns by reducing saturated fats and trans fats in their products. Make sure you check the nutrition labels on the foods you buy to ensure you are getting the least possible amount of saturated and trans fats.

A low-saturated-fat, low-cholesterol eating plan has less than 7 percent of calories from saturated fat and less than 200 mg of dietary cholesterol per day. This plan calls for only enough calories to maintain a desirable weight and avoid weight gain. If reducing your saturated fat and cholesterol intake doesn't lower your LDL enough, you should increase the amount of soluble fiber in your diet.

Fish is a good choice for a healthy diet. Many types contain high levels of omega-3 fatty acids, which may help lower blood cholesterol and blood pressure and reduce your risk for dangerous blood clotting. Cold-water and fatty fish, such as salmon and herring, contain the most omega-3s.

You should also eat more vegetables, fruit and whole grains like oatmeal and barley. They contain fiber, which fills you up and helps limit your fat intake while still giving you the nutrients you need.

If you eat red meat, here are some ways to decrease fat without giving up flavor:

  • Decrease the amount of meat in a recipe.

  • Serve smaller portions of meat and add more vegetables, grains and fruit to a meal.

  • Select a lean cut when you buy meat. The terms "round" and "loin" indicate lower fat.

  • Trim all visible fat from meat before cooking.

Other tips for reducing cholesterol

  • Exercise. Regular physical activity – 30 to 60 minutes on most, if not all days – is recommended for everyone. It can help raise HDL and lower LDL cholesterol. For adults, the CDC recommends 150 minutes of moderate intensity aerobic activity every week and muscle-strengthening activities on two or more days a week. 

  • Maintain a healthy weight. Losing weight if you are overweight can lower your LDL cholesterol.

  • Control your blood pressure.

  • Don't smoke.

  • Consider medications. If your cholesterol level remains high six months after you change your lifestyle, ask your doctor about available medications that can lower your cholesterol by 25 to 60 percent. Medication is mandatory for cholesterol of 300 mg/dL or higher, and is usually recommended for people with cholesterol of 240 mg/dL or higher who do not meet total cholesterol and LDL goals by diet and exercise alone.