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Elevated cholesterol levels, along with high blood pressure and smoking are main risk factors for heart disease, the leading cause of death for men in the United States. Women have a lower risk of cardiovascular disease due to the role of estrogen, but that risk is rising due to dietary and environmental factors.
Because cholesterol levels are critical when it comes to a person’s overall health, cholesterol level checks are a routine part of lab tests conducted during an annual wellness visit. It is important to understand cholesterol, find out what your levels are, and learn how to control them, so you can be your healthiest self.
What is cholesterol?
Cholesterol is a waxy substance found in the blood that is essential for a variety of cellular functions and maintaining good health.
Cholesterol comes from two main sources:
Eating foods rich in saturated fats signals your liver to make more cholesterol. Most fats that are solid at room temperature are predominately saturated, including animal fats, palm oil, and coconut oil.
If you have too much cholesterol in your blood, it can increase the risk for heart disease, stroke, and peripheral artery disease by contributing to fatty build up in the arteries, otherwise known as plaque, in a process called atherosclerosis.
Cholesterol is transported around in blood vehicles known as lipoproteins. There are three main types of lipoproteins—low density lipoprotein (LDL), high-density lipoprotein (HDL) and very-low-density lipoprotein (VLDL).
LDL is referred to as “bad” cholesterol because it leads to fatty build up in the arteries called atherosclerosis. A diet high in saturated and trans fats can raise LDL cholesterol.
HDL is referred to as “good” cholesterol because it transfers LDL from the arteries and carries it back to the liver where your body breaks it down and passes it out of the body. A healthy HDL level may protect against a heart attack and stroke. Genetic factors, type 2 diabetes, smoking, being overweight, a sedentary lifestyle, and a high carbohydrate diet can all decrease HDL cholesterol. Women tend to have higher levels of HDL cholesterol than men.
Very-low-density lipoprotein (VLDL) is another type of lipoprotein. VLDL also contributes to buildup of plaque in the arteries; however, VLDL is different in that its particles carry triglycerides to your tissues. Triglycerides are a common fat in the body that stores excess energy from diet. High triglyceride levels are also linked to atherosclerosis. Elevated triglycerides can be caused by being overweight, having a sedentary lifestyle, physical inactivity, cigarette smoking, excess alcohol consumption and a diet very high in carbohydrates (more than 60 percent of total calories). These causes can be addressed with lifestyle changes but sometimes underlying diseases or genetic disorders can cause high triglycerides. High triglyceride levels are associated with high LDL and low HDL levels.
In the past, doctors relied on specific ranges for determining healthy HDL, LDL, and triglyceride levels. Those ranges are no longer applicable, and doctors consider these levels only one factor of many in evaluating cardiovascular risk. Other key factors include blood pressure, gender, age, genetics, and smoking status.
How can I control my cholesterol levels?
Cholesterol levels may improve with four main lifestyle changes:
A heart healthy diet is low in saturated and trans fats. The American Heart Association recommends limiting saturated fats to 5-6% of total daily calories and minimizing trans fats as much as possible. To limit saturated fat intake, one should limit eating red meat, dairy products made from whole milk, and fried foods food. Instead one should choose low fat or fat free dairy products, poultry, and fish. Another aspect of a healthy diet is one that is full of fruits, vegetables, fiber rich whole grains, nuts, legumes, and seeds. One should limit sweets and sugary beverages. If you choose to eat meat, select the leanest cuts available. The American Heart Association recommends filling at least half your plate with fruits and vegetable to get to the recommended 5 cups of vegetables and 4 cups of fruits each day.
You should get 150 minutes of moderate-intensity aerobic physical activity (e.g., brisk walking),75 minutes of vigorous intensity aerobic physical activity (e.g., jogging, running), or a combination of both every week. Smokers can improve their cholesterol levels by quitting smoking and nonsmokers should avoid exposure to second hand smoke. If you are overweight or obese, losing 10% of your weight can greatly improve your cholesterol levels.
Cholesterol levels are only one of several important risk factors that could increase your chances of a heart attack or stroke, but based on those levels, your doctor can help you learn your overall risk for cardiovascular disease and what you can do to prevent it. Sometimes lifestyle changes, such as the ones mentioned above, are not enough to lower cholesterol levels and medication is needed. Talk to your doctor about your cholesterol levels to see if lifestyle changes, medication, or a combination of both are right for you.
Rowland Chavez, MD is a member of Summit Medical Group's Internal Medicine team. Dr. Chavez practices general internal medicine, provides preventive care and diagnoses and treats a broad range of acute and chronic conditions. He is dedicated to partnering with adult patients to provide comprehensive, patient-centered, compassionate care and recognizes the value in treating the whole person, not just the condition.
Previously, Dr. Chavez worked as an Assistant Professor of Medicine at Weill Cornell Medical College in New York. Prior to starting medical school, Dr. Chavez spent time volunteering at a community health center for AmeriCorps as part of the Philadelphia Health Corps program. From there, he completed medical school at the Albert Einstein College of Medicine of Yeshiva University, where he was awarded the Dean’s Recognition Award for academic and clinical excellence. During his residency, Dr. Chavez spent time in Mwanza, Tanzania teaching medical students and caring for patients. He is also a member of the American College of Physicians.