Cholesterol

Cholesterol is a waxy, fat-like substance that is found in the blood. Everyone has some cholesterol and it is made by your liver. It is needed for good health. Your body needs it to perform important jobs, such as making hormones and digesting fatty foods. If your cholesterol is too high, it builds up on the walls of your arteries in the form of plaques. Cholesterol plaques form by a process called atherosclerosis. This condition causes arteries to become narrowed, and the narrowed blood vessels reduce blood flow to the heart and brain. It puts you at the risk for heart disease and stroke, two leading causes of death in the United States.  

There are different types of cholesterol¹:

• Total cholesterol
• LDL cholesterol or the “bad” cholesterol. Having high LDL levels raises your risk of heart attacks, strokes, and other health problems.
• HDL cholesterol or the “good” cholesterol. People with high HDL levels tend to have a lower risk of heart attacks, strokes, and other health problems.
• Non-HDL cholesterol – it is total cholesterol minus HDL cholesterol.
• Triglycerides – Triglycerides are not cholesterol. They are another type of fat. But they often get measured when cholesterol is measured. (Having high triglycerides also seems to increase the risk of heart attacks and strokes.)

High cholesterol has no signs or symptoms, so the only way to know is to get your cholesterol checked. The test is called Lipid profile. It is done by a simple blood draw. You may need to fast (not eat or drink) for 8 to 12 hours before your cholesterol test. Click here to read more: Know Your Health Screening Checklist

• Children and adolescents should have their cholesterol checked at least once between ages 9 and 11 and again between ages 17 and 21.
• Most healthy adults should have their cholesterol checked every 4 to 6 years.
• People who have heart disease or diabetes or who have a family history of high cholesterol, need to get their cholesterol checked more often (at least once a year).

Research shows that eating patterns that include less dietary cholesterol is associated with a reduced risk of cardiovascular disease, but your overall risk depends on many factors. If you are at high risk of heart attacks and strokes, having high cholesterol is a problem. On the other hand, if you are at low risk, having high cholesterol might not lead to treatment. No matter your age, you can take steps each day to keep your cholesterol levels in a healthy range.

Other risk factors include:

• Cigarette smoking– Smoking damages your blood vessels, making them more likely to collect fatty deposits. Smoking may also lower high-density lipoprotein (HDL, or “good”) cholesterol levels.
• High blood pressure- A normal blood pressure level is less than 120/80 mmHg. When the body can not clear cholesterol from the bloodstream, the excess cholesterol can deposit along artery  walls. When arteries become stiff and narrow from deposits, the heart has to work hard to pump blood through them. This causes blood pressure to go up and up.
• Family history-Having a parent, sister, or brother who got heart disease at a young age, means younger than 55 for men and younger than 65 for women.
• A diet that is not heart-healthy – A “heart-healthy” diet includes lots of fruits and vegetables, fiber, and healthy fats (like those found in fish and certain oils). It also means limiting sugar and unhealthy fats.
• Older age- Everyone’s risk for high cholesterol goes up with age. This is because as we age, our bodies cannot clear cholesterol from the blood as well as they could when we were younger. This leads to higher cholesterol levels, which raise the risk of heart disease and stroke. Until around age 55 (or until menopause), women tend to have lower low-density lipoprotein (LDL, or “bad”) levels than men do.
• Not getting enough physical activity can make you gain weight, which can lead to high cholesterol.
• Obesity is linked to higher triglyceride levels, higher LDL cholesterol levels, and lower HDL cholesterol levels. Obesity can also lead to heart disease, high blood pressure, and diabetes.
• Type 2 diabetes lowers high-density lipoprotein (HDL, or “good”) cholesterol levels and raises low-density lipoprotein (LDL, or “bad”) cholesterol levels. This combination raises your risk of heart disease and stroke.
• Familial hypercholesterolemia– Family members share genes. High cholesterol can run in families. If you have a family history of high cholesterol, you are more likely to have high cholesterol.

You can help prevent and manage high cholesterol by making healthy choices and by managing any health conditions you may have.

How to prevent high cholesterol?

• Limit foods high in saturated fat. Saturated fats come from animal products (such as cheese, fatty meats, and dairy desserts) and tropical oils (such as palm oil). Foods that are higher in saturated fat may be high in cholesterol. Click here to read more: A mindful diet 
• Choose foods that are low in saturated fat, trans fat, sodium (salt), and added sugars. These foods include lean meats; seafood; fat-free or low-fat milk, cheese, and yogurt; whole grains; and fruits and vegetables. Drink skim (non-fat), 1% or 2% milk to get your calcium intake. Look for non-fat or low-fat yogurt varieties. Use extra-virgin olive oil or avocado oil instead of butter. Cookies, cakes and doughnuts usually contain butter or shortening, making them high in saturated fat and cholesterol. They also tend to be full of sugar. Omega 3 fatty acids can help lowering triglycerides and raising good HDL levels. Click here to read more: Do I Need Fish Oil?
• Eat foods naturally high in fiber, such as oatmeal and beans (black, pinto, kidney, lima, and others), and unsaturated fats, which can be found in avocado, olive oil, and nuts). These foods may help prevent and manage high levels of low-density lipoprotein (LDL, or “bad”) cholesterol and triglycerides while increasing high-density lipoprotein (HDL, or “good”) cholesterol levels.
• Healthy weight-To determine whether your weight is in a healthy range, your body mass index (BMI) and waist circumference can be calculated. Body mass index (BMI) is a person’s weight in kilograms divided by the square of height in meters. It should be checked annually. Normal adult BMI (body mass index) is between 18.5 to 25. BMI between 25-30 is overweight and more than 30 is obesity. You can calculate your BMI here: Adult BMI Calculator
• Get regular physical activities– Get active as a family. Children and adolescents should get 1 hour of physical activity every day. Adults should be physically active at least 150 minutes per week. Make physical activity a part of each day. Take the stairs instead of the elevator, park a little farther away, walk to the store, or do jumping jacks during commercials. Click here to read more: Dare to be Fit: Physical Activity Guidelines
• Quit smoking
• Limit alcohol consumption
• Medicines– Not everyone who has high cholesterol needs medicines. Your doctor will decide if you need them based on your age, family history, and other health concerns.

You should probably take a cholesterol-lowering medicine² called a statin if you:

• Already had a heart attack or stroke
• Have known heart disease
• Have diabetes
• Have a condition called peripheral artery disease, which makes it painful to walk, and happens when the arteries in your legs get clogged with fatty deposits
• Have an abdominal aortic aneurysm, which is a widening of the main artery in the belly

Most people with any of the conditions listed above should take a statin no matter what their cholesterol level is. If your doctor puts you on a statin, stay on it. The medicine can help prevent heart attacks, strokes, and death.

References:

1. https://www.cdc.gov/cholesterol/index.htm
2. https://www.uptodate.com