Categories: For Potential Participants, [Cardiovascular Diseases, Heart Disease, High Cholesterol, Weight Loss, Diabetes complications, Health News, Weight loss]
At this very moment, your blood vessels are pulsing with the raw material that can cause a heart attack. Every drop of human blood contains cholesterol, a compound popularly referred to as a fat, which your body needs to form healthy cells and tissues. From birth on, your liver manufactures cholesterol, which is pushed out to the gut and reabsorbed back as part of a system for fat absorption. In addition, cholesterol in the food we eat gets absorbed into the body.
When too much cholesterol accumulates in the bloodstream, it can build up in the coronary arteries and block the flow of blood to the heart. But cholesterol doesn't have to be a threat. With a few healthy lifestyle changes -- and a little help from your doctor -- you can lower your cholesterol levels and slash your risks for heart attack.
What's a "healthy" cholesterol level?
When a doctor checks your cholesterol level, he or she will usually do a test that's called a lipid panel, which includes measuring your total cholesterol and some of the other fats that are in the blood. This test requires a 14-hour fast to get an accurate reading of the blood fats. Unfortunately, there's no sharp cutoff point between healthy and unhealthy levels, but ideally, your total cholesterol should be below 200 milligrams per deciliter. Anything between 200 and 239 mg/dL is considered borderline high, and a level of 240 mg/dL or above is high. Check with your doctor about what's right for you.
Looking at a breakdown of your levels of the different types of cholesterol can be even more helpful. The lipid panel can better evaluate your risk for heart disease by measuring your levels of the two major forms of cholesterol, LDL cholesterol and HDL cholesterol. In common lingo, LDL is called the "bad" cholesterol, and HDL is known as the "good" cholesterol. That's because LDL cholesterol is the substance that clogs arteries by delivering cholesterol to the cells and depositing it in the artery wall; HDL cholesterol, on the other hand, actually helps clear LDL cholesterol from the blood by trucking cholesterol back from the cells to the liver for disposal.
The basic goal is simple: You want to keep your LDL within the target level that's right for you. Your target level depends on your situation: If you don't already have coronary heart disease and if you have fewer than two of the major risk factors -- obesity, high blood pressure, or a family history of premature heart trouble -- your LDL cholesterol should be below 160 mg/dL (and preferably under 100). If you already have coronary artery disease or diabetes mellitus and your LDL is over 100, your doctor will probably recommend you take cholesterol-lowering drugs to get your LDL below the 100 mark. If you are at very high risk for a heart attack (you have coronary artery disease or diabetes AND multiple risk factors), doctors may recommend you use drug therapy to bring your LDL readings below 70 mg/dL.
Heart and stroke treatment guidelines adopted in 2013, in fact, suggest statins for people over 21 who have unusually high levels of "bad" LDL cholesterol (190 mg/dL or more).
You also want to keep your "good" HDL levels from getting too low. Your HDL should be at least 40 mg/dL, according to guidelines from the National Heart, Lung, and Blood Institute (NHLBI). Since lower levels of "good" cholesterol appear to cause greater risk of heart disease in women, the American Heart Association (AHA) recommends that women's HDL be at least 50 mg/dl. An HDL level of 60 mg/dL or higher is considered protective against heart disease.
How can I improve my cholesterol levels?
In many people, cholesterol levels are a reflection of lifestyle. In some cases, however, lifestyle may not account for the level of cholesterol in a person's blood, since that level is often influenced by "internal" factors such as genetics, liver disease or other conditions, or hormones. If you're born with a problem in regulating your internal cholesterol production (which is where most cholesterol comes from), you'll probably need medication to control it.
But high cholesterol levels are commonly associated with external factors such as excess weight, lack of exercise, a high-fat diet, and too much alcohol. The good news is that although unhealthy habits can wreak havoc on your cholesterol levels, a few positive changes can help bring them back under control. Here's a look at the best ways to lower cholesterol:
What can my doctor do to help?
Lifestyle changes can make a difference in cholesterol levels, but many people need medications to bring cholesterol completely under control. Drugs are especially important if you have other risk factors for heart disease or if you already have heart trouble.
In fact, NHLBI officials have urged doctors to take a more aggressive stance in treating high cholesterol, including prescribing cholesterol medication even if you've never had a heart attack. In July 2004, the National Cholesterol Education Program updated its guidelines advising doctors to prescribe cholesterol drugs for anyone who is at high risk for a heart attack if their LDL is above 100 mg/dL. High risk is defined as anyone who has coronary artery disease or diabetes or multiple risk factors that give them a greater than 20 percent chance of having a heart attack within 10 years. In addition, the new guidelines suggest that people at very high risk for heart disease (those who have coronary artery disease or diabetes AND multiple risk factors) take medication to lower their LDL below 70 mg/dL.
The most effective cholesterol medications available today belong to a group of drugs called statins. These drugs can dramatically lower cholesterol levels and have few side effects, although some patients complain of constipation, stomach pains, and cramps. In rare cases, a patient may develop significant muscle pain and weakness. (Report any unusual symptoms to your doctor; since some of these drugs interact with other medications, always mention any other drugs or herbs you're taking as well.) A recent study of heart patients found that one statin drug cut the relative risk of heart attacks by more than 60 percent.
Your doctor can also help you track your cholesterol. Starting at age 20, adults should have their lipid panels levels checked at least once every five years. Men over 45 and women over 55 should be checked more often. If you already have high cholesterol or are at risk for heart disease, your doctor may want to measure your cholesterol more often.
What's the right age to start thinking about cholesterol?
Heart attacks usually strike people in their 40s and older, but the clogging process starts decades earlier. Researchers at the University of Texas examined the arteries of 3,000 people aged 15 to 34 who died from an accident, homicide, or suicide. As reported in the American Journal of Clinical Nutrition, many of these people already had clumps of cholesterol in their arteries. Not surprisingly, the victims with the highest cholesterol levels in their blood also had the most serious buildup in their arteries.
The researchers concluded that the teen-age years are an excellent time to start protecting the heart. But don't worry -- even if your teens are a distant memory, it's not too late to make some healthy lifestyle changes to bring your cholesterol count under control. When it comes to preventing heart attacks, a late start is much better than no start at all.
National Institutes of Health. "Update on Cholesterol Guidelines: More-Intensive Treatment Options for Higher Risk Patients." July 12, 2004.
Expert Panel of Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Journal of the American Medical Association, May 16, 2001, Vol. 285 No 19 p. 2486-97
Ahmed SM. Management of dyslipidemia in adults. American Family Physician. May 1, 1998.
The American Heart Association. For Professionals: Cholesterol levels.
Bayer Voluntarily Removes Baycol, FDA Talk Papers, U.S. Food and Drug Administration, T01-34, Aug. 8, 2001
American Heart Association. What Are Healthy Levels of Cholesterol? http://www.americanheart.org/presenter.jhtml?identifier=183
American Heart Association. Cholesterol. http://www.americanheart.org/presenter.jhtml?identifier=4488
American Heart Association. Cholesterol Levels. http://www.americanheart.org/presenter.jhtml?identifier=4500
American Heart Association. Fat. http://www.americanheart.org/presenter.jhtml?identifier=4582
American Heart Association. Our 2006 Diet and Lifestyle Recommendations. http://americanheart.org/presenter.jhtml?identifier=851
Smith SC et al. AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update. Circulation. 113:2363-2372. May 2006. http://circ.ahajournals.org/cgi/content/full/113/19/2363
McGill, H. et al. Origin of atherosclerosis in childhood and adolescence. American Journal of Clinical Nutrition. 2000; 72 (supp.): 1307-1315S.
Heart Disease: New Health and Stroke Guidelines. Guidelines Resource Center, 2013. American Health Association. http://news.heart.org/aha-guidelines-resource-center/