Life's Simple 7 | Control Cholesterol

Updated:Feb 20,2018

Your body needs cholesterol, but too much can increase your risk for heart disease.

“The higher the LDL cholesterol, the more likely you are to develop heart disease,” said Dr. Roger S. Blumenthal, director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease.

That’s why controlling your LDL-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 steps can lead to a lower risk of heart disease and stroke and improve your quality of life.

Educate Yourself

Cholesterol gets to your cells by carriers called lipoproteins. There are two main types of lipoprotein: high-density and low-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 one-fifth of 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 narrowing of the inside of the arteries, or atherosclerosis, and an increased risk of heart attack and stroke.  Peripheral artery disease (PAD) describes atherosclerosis in blood vessels outside of the heart and brain. If atherosclerosis occurs in the arteries of your lower legs, it can result in pain while walking (claudication), said Dr. Blumenthal, who is also an American Heart Association volunteer. If left untreated PAD can be bad enough to eventually lead to gangrene and amputation. Additionally, PAD increases the risk for heart attack and stroke.

Getting your cholesterol levels checked once at least every four to six years, starting around age 20, is important for keeping tabs on your cholesterol as part of an overall cardiovascular risk assessment, Dr. Blumenthal said. “If you have a strong family history, or other risk factors, you may need to have it checked earlier and more frequently,” 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 9-12-hour fast.

In general, the higher the HDLs in proportion to your total cholesterol level, the better, Dr. Blumenthal said. “Certain people have high HDLs but for genetic reasons it doesn’t function very well. This puts them at risk for heart disease at an early age, but that’s uncommon,” Dr. Blumenthal said. 

Sometimes family genetics can cause you to have inherited risk factors that can lead to high cholesterol, but even if your parents had high cholesterol, you can help reduce your risk if you maintain a healthy lifestyle, eat a healthy diet, and get plenty of exercise.

Take Action

"Elevated LDL-cholesterol affects many people," Dr. Blumenthal said.

If your LDL-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 LDL-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 help keep your LDL-cholesterol at a healthy level, eat a heart-healthy diet. Eat a diet that emphasizes fruits, vegetables, whole grains, low-fat dairy products, poultry, fish, and nuts and limits red meats and avoid saturated and trans fats. And remember to keep added sugars and sweets and salty foods to a minimum.

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.   

“Exercise can raise the good cholesterol and lower LDLs and triglycerides — and helps with blood pressure and blood sugar,” Dr. Blumenthal said. 

If you’re a smoker, quitting smoking can reduce your risk and help you improve your HDL cholesterol levels.

If your lifestyle changes don’t reduce your risk enough, your healthcare provider might prescribe medication. The most common type of medications used to lower LDL-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 LDL-cholesterol levels go down.

Some patients are able to sustain their LDL-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 to manage their risk.

“Don’t just stop taking medication,” Dr. Blumenthal said. “Your risk might just go back up.”

Last reviewed 9/2014