Your body needs cholesterol, but too much can increase your risk for heart disease.
“The higher the LDL and total cholesterol, the more likely you are to develop heart disease,” said Dr. Roger S. Blumenthal, director of the Johns Hopkins Ciccarone Preventive Cardiology Center.
That’s why controlling your cholesterol is one of what the American Heart Association calls Life’s Simple 7® — key health factors and behaviors that define ideal heart health. Following these Simple 7 can lead to a lower risk of heart disease and stroke and improve your quality of life.
Cholesterol gets to your cells by carriers called lipoproteins. There are two main types of lipoprotein: low-density and high-density, also known as "good" and "bad" cholesterol. HDL, the “good” cholesterol, helps keep the LDL, the “bad” cholesterol, from sticking to your artery walls.
The HDL and LDL in your blood, along with the level of blood fat called triglycerides, make up your total cholesterol count.
Excessive cholesterol can get deposited in your arteries as fatty deposits called plaque, leading to the narrowing of arteries, or atherosclerosis, and an increased risk of heart attack and stroke. If atherosclerosis occurs in the arteries of your lower legs, it can also lead to pain while walking (claudication) and peripheral artery disease (PAD), said Dr. Blumenthal, who is also an American Heart Association volunteer. If left untreated it can be bad enough to eventually lead to gangrene.
Getting your cholesterol levels checked once at least every five years, starting around age 20, is important for keeping tabs on any changes before your cholesterol rises to unhealthy levels, Dr. Blumenthal said. “If you have a strong family history, or other risk factors, you may need to have it checked earlier and also on annual basis,” he said.
Similar to screening for blood sugar levels, cholesterol testing is done with a simple blood test by your health care provider, usually after a 10-hour fast.
When combined, healthy cholesterol levels should be lower than 200, but the individual figures are important to understand.
LDLs should be less than 100 to stay in the healthy range; HDLs should be at least 40 mg/dL for men and at least 50 mg/dL for women.
In general, the higher the HDLs in proportion to your total cholesterol level, the better, Dr. Blumenthal said.
“Certain people have high HDLs and for genetic reasons it doesn’t function very well and puts them at risk for heart disease at an early age, but that’s uncommon,” Dr. Blumenthal said.
The blood test will also show your level of triglycerides, a type of blood fat, which should be below 100 mg/dL to be in the healthy range.
Sometimes family genetics can cause you to have inherited risk factors and lead to high cholesterol, but even if your parents had high cholesterol, you can help prevent it if you maintain a healthy diet and get plenty of exercise.
“There can be a family predisposition to high cholesterol, but lifestyle clearly plays the main role,” Dr. Blumenthal said.
Elevated cholesterol affects many people. About 14 percent of adults have total cholesterols greater than 240 and almost half have cholesterol values greater than 200, Dr. Blumenthal said.
If your cholesterol levels are too high, Dr. Blumenthal encourages you first to try to bring them back down through healthy lifestyle changes.
For patients who are also overweight or obese, even modest weight loss can help change cholesterol levels.
“If you are overweight, even a 10-percent loss in body weight over a year can make a big difference in lowering your risk factors,” Dr. Blumenthal said.
To keep your cholesterol at a healthy level, eat a heart-healthy diet and avoid saturated and trans fats and deep-fried foods that can increase your levels. Choose lean meats and non-fat dairy products and emphasize fruits and vegetables and whole grains. But remember to keep added sugars and sweets and salty foods to a minimum.
“Fill up your plate with fruits and vegetables and fiber and try to have more fruits for dessert rather than rich pies and cakes,” Dr. Blumenthal said.
Watching your portion sizes is another good way to avoid adding pounds.
Getting the recommended physical activity is another key tool to controlling your cholesterol. Dr. Blumenthal encourages patients who haven’t been exercising to start with brisk walking for 30 minutes, four days a week.
If you’re a smoker, quitting smoking can reduce your risk and help you decrease your HDL cholesterol levels.
If your diet changes and regular exercise don’t help control your cholesterol, drug therapy for high cholesterol might be effective. The most common type of medications used to lower cholesterol are statins, which inhibit the liver from producing cholesterol and help it remove cholesterol that is already circulating in the body. Other types of medication are also available. Your healthcare provider can identify what’s best for you.
It’s important to communicate any changes to your healthcare provider and to continue taking the medication as prescribed, even if your cholesterol levels go down.
Some patients are able to sustain their cholesterol changes by sticking with a healthy lifestyle that enables them to take a lower dose of medication, or stop it completely. But most will need to keep taking their medicine so their cholesterol stays at a healthy level.
“Don’t just stop taking medication,” Dr. Blumenthal said. “Your cholesterol might just go back up.”
- Share the Controlling Cholesterol With Life's Simple 7 Infographic
- Family History and Heart Disease, Stroke
- What Are My Risks Of Getting Heart Disease Infographic
- Learn about getting heart healthy one simple step at a time with the other 6 of Life's Simple 7®