September is National Cholesterol Education Month, with World Heart Day falling on September 29th. This makes September the perfect time to talk about heart health and how to control and lower cholesterol levels.
What is Cholesterol?
Cholesterol is a waxy substance that is produced by your liver and used by your body as a building block to make hormones and to help the body digest fatty foods. We also get cholesterol from foods in our diet that are high in saturated fats, such as egg yolks, fatty meats, and dairy products. Most people don’t know that the body makes all the cholesterol that it needs and that too much cholesterol can build up in your arteries. Cholesterol build-up can narrow your arteries, which can increase your risk for heart disease and stroke.
Not all cholesterol is bad. There are two types of cholesterol your body uses. One is called low-density lipoprotein cholesterol (LDL), known as the “bad” cholesterol. The other is high-density lipoprotein cholesterol (HDL), or the “good” cholesterol. HDL cholesterol is called “good” cholesterol because it protects and repairs your arteries. LDL, the “bad” cholesterol, can make arteries narrower, potentially leading to a heart attack. Recommended levels for these different types of cholesterol, as well as both of them combined, is shown in the table below:
| Type of Cholesterol | Recommended Level (mg/dL) |
| Total cholesterol (HDL plus LDL) | Less than 170 |
| LDL (“bad”) cholesterol | Less than 110 |
| HDL (“good”) cholesterol | 35 or higher |
According to the American Heart Association, more than 102 million American adults have total cholesterol levels above 200 mg/dL, and more than 28.5 million of those have levels at 240 mg/dL or higher, which puts them at very high risk for heart disease.1 Do you know what your cholesterol levels are? Doctors recommend that adults over the age of 20 have their cholesterol checked every 5 years, as there are no symptoms of high cholesterol. If you have high cholesterol your doctor will recommend lifestyle changes and, possibly, medication.
Who is at Risk?
Certain risk factors including family history, lifestyles, and medical conditions can put some people at higher risk for high cholesterol than others. Some of these risk factors can be changed over time. These are called modifiable risk factors. Some examples of modifiable risk factors include diet, physical activity level, smoking, alcohol intake, and weight.
Other risk factors cannot be changed. These are called non-modifiable risk factors. Non-modifiable risk factors include family history, any preexisting health conditions (such as diabetes), age, and gender. Focusing on the modifiable risk factors is important when trying to lower or manage your cholesterol levels.
How to Prevent and Manage High Cholesterol
If you have high cholesterol levels, the first thing your doctor will probably talk to you about is lifestyle management. This is a broad term that encompasses many aspects of your daily life. Lifestyle management means customizing your current lifestyle to make better choices regarding cholesterol.
Since most of us get a lot of extra, unnecessary cholesterol from our diet, the first thing doctors usually recommend is to try is changing your eating habits. Foods high in saturated and trans fats are the biggest contributors to high cholesterol. Some foods high in saturated and trans fats include desserts, baked goods, dairy products, fried foods, ground beef, and whole milk. It is important to limit your intake of these kinds of foods, which can be challenging as these are foods most Americans love!
Adding foods that are high in fiber (such as beans) and unsaturated fats (such as avocado, vegetable oils, and nuts) can help manage both your LDL and HDL cholesterol levels. Changing your diet can be a daunting challenge, but a good place to start is finding healthy versions of your favorite recipes. Million Hearts, an initiative led by the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare and Medicaid Services (CMS). Million hearts has a lot of heart-healthy recipes to help make changing your diet a bit easier. My personal favorite is the avocado and shrimp spring roll.
The Millenial way of managing cholesterol… avocado on everything!
Stay Active
Weight management and physical activity levels are also important when trying to control and lower your cholesterol. Obesity has been linked to higher triglyceride levels, higher LDL cholesterol levels, and lower HDL cholesterol levels.2 Excess body fat can slow down the body’s ability to use and get rid of LDL cholesterol. Exercise can help combat this, decreasing LDL levels and increasing HDL levels. Adults are encouraged to get around 2½ hours of moderately-intense exercise per week. Examples include jogging, bicycling or brisk walking.
If lifestyle changes such as diet and exercise are not enough to lower your cholesterol to a desirable range, your doctor may prescribe you medication. The type of medication that your doctor prescribes will depend on your cholesterol levels and other medications you are taking. Some examples of medications include statins, niacin, and fibric acid agents. If you have diabetes, a doctor will often recommend (with some exceptions) a statin drug to help protect your heart, even if you don’t have high cholesterol levels.
As always, if you have any questions about cholesterol and heart health, feel free to talk to one of our pharmacists.
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