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What is cholesterol? Managing Lipids
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Cholesterol is a waxy, fat-like material found in the blood stream. It is present in all of the body's tissues. It is produced by the liver and also extracted from foods of animal origin such as meat, poultry, fish, eggs and dairy products. Your body uses cholesterol to make essential body substances such as cell walls, hormones and vitamin D.
Why should I care about my cholesterol?
While cholesterol is essential for life, too much of it in your blood can increase your risk for stroke and heart disease.
Cholesterol travels through your bloodstream in protein/fat (lipoprotein) particles. One type of particle, called low-density lipoprotein (LDL), delivers cholesterol to the body. LDLs are often called "bad" cholesterol.
Another type of particle, called high-density lipoprotein (HDLs) assist in the removal of cholesterol from the bloodstream. HDLs are often called "good" cholesterol. A high HDL level (greater than 60) is considered to be a protective factor against heart disease.
If you have an excess amount of LDL in your bloodstream, waxy plaques can build up along your artery walls, causing arteries to narrow. Over time, arteries may become damaged with these plaques and susceptible to blood clots. This is called cardiovascular disease. A blood clot in the heart can cause a heart attack. A blood clot in the brain can cause a stroke.
What are triglycerides and why should I care about them?
Triglycerides are the scientific name for the most common form of fat, found in both the body and foods. Triglycerides attach to lipoprotein particles in the blood. Recent studies indicate that elevated triglycerides are an independent risk factor for coronary heart disease (CHD). Some triglyceride-rich lipoproteins may cause plaque build-up in the arteries.
Testing recommendations:
The US Preventive Services Task Force and the American College of Physicians recommend checking cholesterol starting at age 35 for males and 45 for females. The US National Cholesterol Education Program (NCEP) recommends that all adults 20 years or older have a fasting lipid profile done. A lipid profile consists of total cholesterol, LDL-cholesterol, HDL- cholesterol and triglycerides. Experts recommend the lipid profile be repeated every 5 years if normal.
Desirable blood lipid levels:
Total cholesterol:
Less than 200 mg/dL = Desirable
200-239 mg/dL = Borderline high
240 mg/dL and above = High
LDL cholesterol:
Less than 100 mg/dL = Optimal
100-129 mg/dL = Near/above optimal
130-159 mg/dL = Borderline high
160-189 mg/dL = High
190 mg/dL and above = Very high
HDL cholesterol:
Below 40 mg/dL = Suboptimal (Low)
60 mg/dL and above = Optimal (High)
Triglycerides:
Less than 150 mg/dL = Normal
150-199 mg/dL = Borderline high
200-499 mg/dL = High
500 mg/dL and above = Very high
Major risk factors for cardiovascular disease and risk reduction:
Some factors (such as family history of heart disease, age or gender) cannot be altered, however you can make lifestyle changes to help lower your risk.
Smoking tobacco greatly increases the risk for heart disease. See Tobacco Cessation Help.
Hypertension: A blood pressure greater than 140/90 mmHg is considered elevated, increases cardiovascular risk and needs to be controlled. See Hypertension.
Diabetes increases the risk for heart disease. The American Heart Association offers a Family Tree to learn about risk and other tools to manage diabetes.
Elevated LDL (>190 mg/dL) and triglycerides are risk factors for coronary heart disease; see Desirable Blood Lipid Levels.
Lack of physical activity: Regular exercise can help decrease your total cholesterol level and may increase the amount of HDL in our body. People who exercise regularly lower their risk for heart disease, even if their lipid levels do not change. See Exercise.
Excess body weight: With each extra pound, the body must increase blood volume and the number of capillaries to supply the fatty tissue. This means that the heart must work harder. Losing weight can lessen this strain on the heart. Maintaining a healthy weight permanently requires a change in eating habits, exercise patterns and attitudes. See Weight Reduction.
Diet: A diet rich in cholesterol and saturated fat increases risk of plaque build-up in the inner lining of the blood vessels. Eat a healthy diet by following these recommendations:
• Reduce intake of saturated fats to 15-20 grams of saturated fat per day (7% or less of daily calories)
• Reduce cholesterol intake to 200 mg or less daily
• Eat 20-30 grams of fiber daily. Fiber is contained in plant foods (fruits, vegetables, legumes and grains)
• Use nonfat dairy products
• Eat less red meat and processed meat
• Eat two servings weekly of fish that are high in omega-3 fatty acids such as salmon, mackerel, and halibut. Omega-3 fatty acids reduce triglycerides and blood clotting
• Consider use of sterol and stanol-rich margarines such as Take Control® and Benecol®, which are FDA approved. Eat 2 grams of these plant chemicals daily (see product label for recommended serving size)
• Limit fried foods
• Limit sugary foods and beverages
Age: Men 45 years and older, and women 55 years and older, are at increased risk for heart disease.
Family history of premature coronary heart disease, specifically in first-degree male relatives less than 55 years, or in first- degree female relatives less than 65 years, increases one's risk for heart disease. (First-degree relatives are father, mother, and siblings.)
Treatment:
When should drug therapy be used? This question should be discussed and decided with a clinician who knows your total health history. An assessment of your risk for developing cardiovascular disease can help determine appropriateness and the intensity of therapy. Multiple risk factors or pre-existing conditions (previous heart attack or metabolic syndrome) may warrant more aggressive or earlier treatment to lower cholesterol levels.
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