September is National Cholesterol Education Month, so here I am, taking the opportunity to spread some awareness about your cholesterol. So many of my patients, when told they have high cholesterol, are a little clueless as to how it affects them. Rightfully so! It’s not that straight-forward. Well, sit tight–I’m about to explain some things!!
What is high cholesterol?
We define high cholesterol (hyperlipidemia/hypercholesterolemia) as a cholesterol greater than 200 mg/dl. We previously defined optimal levels of LDL, but now, we use the levels to calculate risk and decide about benefits of treatment that way. However, generally, an LDL of >160mg/dL is high for anyone, and an LDL of >190 mg/dL would generally indicate a need for some type of treatment. In addition, we worry about what we call dyslipidemia. This is an imbalance in the types of cholesterol. We generally want to see an LDL to HDL ratio of 3.5 to 1, with an optimal ration of 0.5 (1 to 2) to 3 (3 to 1).
Why is it important?
Hypercholesterolemia and dyslipidemia are major risk factors for cardiovascular disease, which is the building up of plaques in the arteries of the heart and the main cause of heart attack and stroke. High cholesterol affects 38.1% of Americans and was estimated to cause 4.51 million deaths in 2020. High cholesterol is believed to increase the risk of cardiovascular disease by contributing to atherosclerosis.
Atherosclerosis is the hardening and narrowing of arteries from plaque build-up. Heart attacks and strokes are caused by atherosclerosis. These plaques eventually become unstable and break off. Clots form on the uneven surface, suddenly blocking the vessel and causing ischemia (lack of blood flow) to the tissue beyond the clot.
Coronary artery disease is the most common type of cardiovascular disease. It causes heart attacks most frequently. Coronary artery disease causes 1 in 5 deaths in the US—that’s one death ever 34 seconds. Strokes are another leading cause of death. In fact, if separated from other cardiovascular causes of death, it is the 5th leading cause of death in the United States. It causes 1 in 19 deaths in the United States—that’s one death every 3 minutes and 30 seconds.
What can we do?
It’s important to go to your primary care appointments so that you can have your routine bloodwork and know your cholesterol values. If they are elevated, there are ways you can try to change your lifestyle to lower your cholesterol.
Additionally, your doctor may suggest you begin medication to help lower your cholesterol if you have one of the following:
- You are at high risk for heart attack and stroke
- If you’ve had a previous heart attack or stroke
- You have certain health problems, like diabetes
Physicians use statins most commonly to address high cholesterol requiring medical intervention. These are medications that not only lower cholesterol, but stabilize plaques, making them harder, and less likely to break. This means that the clot formation that causes heart attack and stroke is much less likely to occur.
So, what about lifestyle?
So glad you asked!
Healthy diet
You can begin by eating a heart healthy diet. There are several different things that constitute a heart healthy diet, but typically, you want to
- reduce saturated fats
- eliminate trans fats
- increase omega 3 fatty acids
- include more soluble fibers in your diet
- increase whey proteins
Of note, cholesterol in your diet doesn’t tend to affect the numbers as much as you might think, but some people, especially people with diabetes, should still watch the amount of cholesterol in their foods. You can find more detail about these interventions HERE.
Exercise/Activity
Experts recommend getting 30 minutes, 5 days weekly or 150 minutes weekly of moderate intensity cardiovascular exercise, or 20 minutes, 3 days weekly, or 75 minutes of high intensity cardiovascular exercise. Moderate intensity exercise is defined as 50-70% of your maximum heart rate. High intensity is 70-85% of your maximum heart rate. Your maximum heart rate changes as you age. (General guide is 220-your age).
You should also incorporate strength training twice weekly. Additionally, experts recommend a stretching and flexibility regimen. Cardiovascular exercise is the most important for targeting the cholesterol. For more on this intervention, see a blog post later this month.
Stop Smoking
Smoking is one of the single greatest ways you can take years off your life. It independently increases your risk for heart attack and stroke, raises blood pressure, increases your risk of cancer, causes lung disease, delays wound healing, and so much more.
When you stop smoking, it is one of the best things you can do for your health. For more information on this lifestyle intervention, see a blog post later this month.
Maintain/Approach a Healthy Weight
No one really likes to talk about weight, but here we are. Let me say this—you should love your body and yourself no matter what the number on the scale says. That being said, that love for yourself is also the reason you should want to be the healthiest you can be.
Evidence shows that high body mass indexes are correlated with worse health, and people who lose weight and have high cholesterol tend to see these numbers improve. With weight, a little goes a long way, so you don’t have to feel like you must do the impossible. Losing 5% of your body weight can change your health status dramatically. For more information on this intervention, see a blog post later this month.
Use Alcohol Within Healthy Limits
Those limits are 7 servings of alcohol weekly for women and 14 servings of alcohol for men.
These are ways YOU can take control of your health and decrease your risk. Change can seem like a lot, but everything is one step at a time. Pick one thing and make a SMART goal. Once that is achieved, add on to it.
You’ve got this!!