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10 Surprising Facts About Cholesterol

The body’s levels of cholesterol — a waxy, fat-like substance found in all your cells — can tell you a lot about your future heart health. Since having high cholesterol doubles your risk for heart disease, it’s important to take steps for prevention and treatment.

A simple blood test at your regular preventive care visit will tell you what your levels of total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol, and triglycerides are. If results show that your numbers are too high, you’re not alone: About 74 million U.S. adults have high cholesterol, but less than half of them are getting treatment to lower their cholesterol and protect their heart health, according to the Centers for Disease Control and Prevention (CDC).

Read on to get the facts about cholesterol.

1. You can’t live without cholesterol. We’re born with cholesterol in our bodies, and infants get more from their mother’s milk; in fact, cholesterol is even added to baby formula. Cholesterol is essential because all of our hormones and cells need it to function properly. It’s also a building block for all of the body’s cells, and it helps the liver make acids that are required to process fat.

2. One out of every three adults has high cholesterol. All people over age 20 should get their cholesterol checked with a simple blood test every five years, according to the CDC, but only about 75 percent of them do. This number is disconcerting considering that about 32 percent of U.S. adults have high LDL levels that put them at a higher risk for heart disease. And because cholesterol levels can be affected by many different things — diet and stress, for example — the most accurate results can be obtained when two separate tests are performed a week apart, says Stephen Kopecky, MD, a cardiologist at the Mayo Clinic in Rochester, Minnesota. Yet many physicians don’t follow this testing recommendation, he says.

3. High cholesterol could be genetic. A lot of focus is placed on controlling cholesterol levels through dietary changes and exercise, but the main influencing factor is genetics.

“Seventy-five percent of cholesterol is due to genes, and about 25 percent is due to diet,” says Dr. Kopecky about the levels of cholesterol in your blood.

When you eat foods that contain cholesterol, like meat, fish, and dairy, your body gets rid of the excess if it’s functioning normally. But how much cholesterol you get rid of depends on your genes. People with familial hypercholesterolemia (FH), for example — an inherited condition that affects about 1 in 200 people (up to 34 million people worldwide) — can’t effectively lose the excess. You may have FH if your family has a history of high cholesterol or early heart attacks (occuring before age 50). Be sure to see your doctor to get your cholesterol levels tested if you fall into this category.

4. Even children can have high cholesterol. Most people think of high cholesterol as an adult’s issue, but the healthcare community now knows that one key to keeping levels normal is to start testing early. The American Academy of Pediatrics recommends cholesterol screening for all kids between ages 9 and 11. And selective screening should be done even earlier — beginning at age 2 — for children at high risk of having cholesterol issues, including kids with:

“Even if people know their cholesterol is high and they’ve talked about it with their siblings, doctors don’t always tell them that their kids need to get checked,” says Martha Gulati, MD, chief of cardiology at the University of Arizona College of Medicine in Phoenix. “They should ask their doctor about this, especially if they have a family history of premature heart disease.”

5. Sweating can raise your good cholesterol levels. Aside from eating a healthy diet, including foods like heart-healthy salmon and avocado, you can raise your HDL levels — which protect against heart disease — by working out. The key, says Kopecky, is to use interval training by exercising at a medium-intensity, sprinkling in bouts of high-intensity.

In a study of women with type 2 diabetes published in June 2016 in the International Journal of Sports Medicine, three weeks of high-intensity interval training significantly boosted the women’s HDL levels by 21 percent and lowered trigylcerides by 18 percent. And a study published in March 2009 in the Journal of Strength and Conditioning Research found that men who jogged and then ran at a high intensity for equal periods of time saw significant improvement in their HDL levels over eight weeks compared with people in the control group.

6. Supplements may work to lower cholesterol — but slowly. Unless you’re at high risk for a heart attack or have familial hypercholesterolemia, diet and exercise are your first options to lower cholesterol. And many people who have high cholesterol don’t want to go on cholesterol medication, says Kopecky. Luckily, eating a healthy diet and supplementing it with 2 to 3 grams of plant stanols and sterols daily can reduce LDL by 6 to 15 percent, according to the Cleveland Clinic in Ohio, thereby reducing your risk of heart disease.

The main drawback of supplements is that they have to be taken daily, and they don’t work overnight.

But cholesterol-lowering medications such as statins work faster. “You can take a cholesterol-lowering pill today, and [your levels] will be down by 3 to 4 percent tomorrow,” Kopecky says. “It takes a few months for lifestyle changes and supplements to make a difference.”

In addition, the magnitude of the decline in cholesterol levels is often not as great with diet and exercise as it is with medication.

RELATED: 8 Foods to Help Lower Your Cholesterol

7. The number of people who should be on cholesterol-lowering meds is on the rise. The medical community used to be somewhat reserved about recommending cholesterol-lowering medication: Statins were suggested for people who had a risk of heart attack above 20 percent in the next 10 years. But the current American Heart Association guidelines recommend statin treatment for people with a 7. 5 percent or higher chance of having a heart attack or stroke in the next decade.

You may also need medication to treat high cholesterol if you:

Have had a heart attack, stroke, angina, or peripheral artery disease
Have very high LDL levels (190 mg/dl or higher) or have familial hypercholesterolemia
Have diabetes and are between ages 40 and 75

8. The woman depicted in the “Mona Lisa” may have had high cholesterol. Did you know you might be able to tell if someone has familial hypercholesterolemia just by looking at them? It’s possible, which is why one researcher says the subject of Leonardo da Vinci’s the “Mona Lisa” may have been the first known case. Da Vinci’s muse, who was painted in her twenties and passed away in her thirties, appears to have had visible traits of the condition: a xanthelasma (a yellowish fatty deposit) in her left eye and possibly on her left hand, too.

9. Women’s cholesterol levels fluctuate over their lifespan. Though women tend to have lower cholesterol levels than men, they may experience a roller coaster ride in levels throughout their lives. During pregnancy, a woman’s cholesterol levels rise, which is thought to help babies’ brains develop. And cholesterol-rich breast milk is thought to be heart-protective for babies as they age. Post-pregnancy, cholesterol levels should return to normal, says Kopecky. But after menopause, women’s LDL cholesterol levels go up, while protective HDL levels decline, notes the Cleveland Clinic. By age 75, women tend to have higher cholesterol levels than men.

10. Your cholesterol levels might be on the borderline. According to the CDC, the average total cholesterol of Americans over age 20 is 192 mg/dl. This is concerning, considering that a borderline high cholesterol level is 200 mg/dl; high is more than 240 mg/dl. But remember that as with many measurements, different people strive for different numbers. If you are concerned, talk with your doctor about setting your individual cholesterol goals.

Cholesterol – HealthyWomen

This article has been archived. We will no longer be updating it. For our most up-to-date information, please visit our heart disease information here.

Overview

High blood cholesterol is a major women’s health issue. One in three Americans has high cholesterol, according to the Centers for Disease Control and Prevention.

Overall, an estimated 78 million American adults (37 percent) have high low-density lipoprotein (LDL) or “bad” cholesterol. Of these, about half are taking the necessary measures to get the condition under control. It is important to keep LDL cholesterol in a healthy range because high LDL cholesterol levels are a contributing factor to heart disease, which develops over years.

But don’t fool yourself into thinking that high blood cholesterol is a problem only for middle-aged or elderly men and women. High cholesterol is a problem for some children and teenagers, too. According to the American Heart Association, 7 percent of adolescents have high cholesterol.

The guidelines regarding the diagnosis and treatment of high cholesterol changed in 2013 and again in 2018 when the American College of Cardiology (ACC) and the American Heart Association (AHA) released new cholesterol guidelines.

The biggest difference in 2013 was that the new guidelines no longer contained “treatment targets”—cholesterol levels at which health care professionals are instructed to start treatment. The ACC/AHA guidelines also endorsed a specific risk assessment tool, which assesses your 10-year risk of heart disease or stroke.

The 2018 ACC/AHA Guidelines on the Management of Blood Cholesterol allow for more personalized care for patients, including more detailed risk assessments and new cholesterol-lowering drug options for people at the highest risk for heart disease.

Also, in addition to traditional risk factors for high cholesterol such as smoking, high blood pressure and high blood sugar, the 2018 guidelines add factors such as certain health conditions including metabolic syndrome, kidney disease, premature menopause, chronic inflammatory diseases and high lipid biomarkers. They also look at family history and ethnicity when determining risk and options for treatment.

The 2018 guidelines recommend that health care providers use coronary artery calcium scores as a secondary tool when deciding whether to prescribe statin drugs.

In addition, the 2018 ACC/AHA guidelines recommend the following:

Looking at the effects of high cholesterol over the full lifespan and identifying and treating the condition as early as possible.
Discussing options for people with newly defined very high risk of atherosclerotic cardiovascular disease (ASCVD) who still have LDL cholesterol levels higher than 70 mg/dL after maximizing statins.
Considering other non-statin drugs, including ezetimibe and PCSK9 inhibitors.
Creating a value statement that highlights the need for patients and health care providers to factor in the cost of drugs when determining treatment. Overall, there’s a new emphasis on making sure the highest risk patients receive the treatment they need.
Using clinician and patient tools to boost understanding of the new guidelines and to provide better treatment.

Going By the Numbers

Despite new ACC/AHA guidelines, some practitioners still prefer to follow the previous guidelines from the National Cholesterol Education Program (NCEP), a division of the National Heart, Lung and Blood Institute (NHLBI). The NHLBI/NCEP guidelines provide specific numbers for cholesterol goals and beginning treatment. To that end, here are the older guidelines:

Total blood cholesterol levels (calculated by taking your LDL cholesterol plus your high-density lipoprotein [HDL] cholesterol plus 20 percent of your triglycerides)
Normal: less than 200 mg/dL
Borderline high: 200 to 239 mg/dL
High: 240 mg/dL or above

HDL blood cholesterol levels
Optimal: above 60 mg/dL. Levels above 60 mg/dL are considered especially beneficial and can offset risk factors for heart disease, according to AHA. The higher the level, the healthier it is.
Average: 50 to 60 mg/dL for women; 40 to 50 mg/dL for men
Low: less than 50 mg/dL for women; less than 40 mg/dL for men. Below these levels is considered a major risk factor for heart disease.

Non-HDL cholesterol levels
This is calculated by subtracting HDL cholesterol from total cholesterol.
Optimal: Less than 130 mg/dL. Higher numbers indicate a higher risk of heart disease.

Triglyceride levels
Normal: less than 150 mg/dL
Mildly increased: 150 to 499 mg/dL
Moderately increased: 500 to 886 mg/dL
Very high: Greater than 886 mg/dL

Your Cholesterol Glossary—Terms to Know

While high levels of cholesterol—a waxy, fat-like substance—are dangerous, our bodies do need some cholesterol. Cholesterol belongs to a family of chemicals called lipids, which also includes fat and triglycerides. Cholesterol is found in cells or membranes throughout the body and is used to produce hormones, vitamin D and the bile acids that help digest fat. The body is able to meet all these needs by producing cholesterol in the liver.

Saturated fats, found primarily in whole-milk dairy products and meats, and trans fats from foods like coconut oil, cocoa butter, palm kernel oil, palm oil and partially hydrogenated oils—sometimes found in processed foods—raise blood levels of cholesterol. Over the years, cholesterol and fat in the blood are deposited in the inner walls of the arteries that supply blood to the heart, called the coronary arteries. These deposits make the arteries narrower, a condition known as atherosclerosis. It is a major cause of coronary heart disease (CHD).

Dietary cholesterol, such as is found in eggs, dairy products and some other foods, may also raise cholesterol in the blood slightly, but newer studies find that consumption of dietary cholesterol is unlikely to substantially increase risk of coronary heart disease or stroke among healthy men and women.

If the coronary arteries become narrowed or blocked, then oxygen- and nutrient-supplying blood can’t reach the heart. The result is coronary heart disease (CHD) or a heart attack. The part of the heart deprived of oxygen dies.

Types of blood cholesterol

Cholesterol travels in the blood in packages called lipoproteins, which consist of lipids (fats) and protein. Cholesterol packaged in low-density lipoprotein (LDL) is often called “bad” cholesterol because too much LDL in the blood can lead to cholesterol buildup and blockage in the arteries. LDL carries most of the cholesterol in the blood.

Another type of cholesterol package is high-density lipoprotein (HDL), often called “good” cholesterol. HDL helps transport cholesterol from other parts of the body to the liver, which helps remove it from the body, preventing it from piling up in the arteries.

A third type of lipoprotein is very low density (vLDL). This package transports triglycerides in the blood; high levels of vLDL and triglycerides have also been linked to an increased risk of heart disease. However, vLDL is not measured routinely.

You can think of all bad cholesterol put together as “non-HDL cholesterol.” Non-HDL cholesterol is a good predictor of cardiovascular disease risk, and it is a better predictor of risk than LDL cholesterol in women, as well as in people with type 2 diabetes

Diagnosis

The American Heart Association (AHA) recommends checking cholesterol levels once between the ages of 9 and 11 years and again between the ages of 17 and 21 years for children and young adults without other risk factors or a family history of early heart disease. After age 20, your health care provider should recheck your cholesterol and other risk factors every four to six years as long as your risk remains low.

Medicare beneficiaries can now get a free cardiovascular screening test for cholesterol, triglycerides and lipid levels. Ask your health care professional about this benefit.

Additionally, children ages 2 or older with a family history of premature heart disease, at least one parent with high blood cholesterol or a condition commonly associated with increased risk of coronary heart disease, such as obesity or hypertension, should have their cholesterol levels tested.

Blood cholesterol levels are measured with a small blood sample. You should have a complete lipoprotein panel, which measures total cholesterol (LDL + HDL), LDL (bad cholesterol), HDL (good cholesterol) and triglyceride levels. Ideally, it should be a fasting panel, completed after you’ve fasted for nine to 12 hours.

Your health care professional may also order “expanded” cholesterol testing. These tests identify the levels of certain types of LDL cholesterol, including the number of particles and their size, providing a more accurate reading of your overall risk of cardiovascular disease.

Additionally, other markers indirectly related to lipids but associated with cardiovascular risk, like homocysteine and C-reactive protein, may be measured.

It is possible to have a standard lipid profile with all your numbers in the target range, but still have an LDL particle number or homocysteine level that increases your risk for cardiovascular disease. Such expanded testing may help your health care provider better target your therapy to reduce your individual risk.

Treatment

Therapeutic lifestyle changes (TLC) are generally considered the first line of treatment for high LDL cholesterol. They focus on limiting saturated fat and increasing soluble fiber in the diet, managing weight and increasing physical activity.

Guidelines issued by the ACC/AHA emphasize intensified use of nutrition, physical activity and weight control in the treatment of elevated blood cholesterol—specifically LDL cholesterol. The 2018 guidelines put an even greater emphasis on lifestyle factors, particularly in adults ages 20 to 39, who have more years to adopt healthy habits and prevent cardiovascular heart disease.

The guidelines emphasize creating a healthy balance between the calories you take in with food and the calories you burn with physical activity. If you are trying to lose weight, aim to burn more calories than you take in. They recommend getting at least 30 minutes of moderate physical activity on most—preferably all—days of the week. For those with high blood pressure or cholesterol, the AHA recommends 40 minutes of moderate to vigorous activity, three to four times a week.

In terms of diet, the guidelines suggest:

Eat a variety of nutrient-dense, low-calorie foods from each of the food groups, with an emphasis on fruits and vegetables, whole grains, lean poultry, oily fish rich in omega-3 fatty acids (two times a week), and nuts.
Limit processed sugary foods and beverages full of empty calories.
Limit trans fats and saturated fats.
Restrict consumption of saturated fats to no more than 5 percent to 6 percent of your daily calories (this amounts to about 13 grams in someone eating 2,000 calories per day). Limit your sodium (salt) intake to no more than 2,300 milligrams per day, and optimally, no more than 1,500 mg.
If you drink alcohol, limit your intake to one drink per day if you are a woman and two drinks per day if you are a man.

For more information on lifestyle changes, check out the AHA’s Diet and Lifestyle Recommendations.

In children with elevated cholesterol, the AHA recommends the first line of treatment be lifestyle changes to encourage healthier eating and more physical activity.

Soluble fiber. According to the AHA, you should aim for 25 grams of soluble fiber per day. Good sources of soluble fiber include oats and oat bran, barley, beans, eggplant and okra.

Nuts. Nuts contain a lot of calories, but a small handful a day of any kind of nut can be a heart-healthy snack.

Lean protein. Aim for about 646 grams of protein a day. Opt for low-fat sources of protein, such as lean meats, low-fat dairy products, soy and legumes. You can find soy in soybeans (edamame), tofu, soy milk, soy bars, soy burgers, dried soy protein and more. Fish is another good protein source for heart health; try for two servings per week.

Comprehensive lifestyle changes—low-fat vegetarian diet, stopping smoking, stress management training and moderate exercise—have even been shown to decrease coronary atherosclerosis. Your health care provider will likely recommend lifestyle changes as a first step in treating high cholesterol.

How Treatment Is Determined

If you have high cholesterol, you and your health care professional will determine the type of treatment that is most appropriate for you and your lifestyle. There are several major risk factors that affect your LDL cholesterol goal and will be considered when recommending a treatment plan. These are:

Diabetes
Kidney disease
Coronary heart disease
Peripheral vascular disease
Presence of vascular disease
Age (in general, the older you are, the more likely your health care professional will decide drug therapy is appropriate if your LDL cholesterol level is too high; for women, 55 is often the threshold age)
Smoking (or daily exposure to secondhand smoke)
High blood pressure. The goal is less than 120/80 mm Hg for the general population, less than 140/90 mm Hg for people who have been diagnosed with high blood pressure and less than 130/80 mm Hg in people with kidney disease or diabetes.
Low levels of HDL cholesterol (below 50 mg/dL for women)
Family history of premature heart disease (heart disease in father or brother before age 55; heart disease in mother or sister before age 65)
Metabolic syndrome

The ACC/AHA guidelines include a risk assessment tool to help you determine your 10-year risk of having a heart attack or dying from heart disease. The tool assigns risk values based on age, total cholesterol levels, HDL cholesterol levels, blood pressure level and diabetes and smoking status. Click here to access the risk calculator.

If lifestyle changes alone don’t improve your cholesterol levels, your health care provider may recommend drug treatment. When to begin drug therapy typically depends on your risk factors. Several classes of safe, effective medications for reducing cholesterol levels are available. You may have to be proactive in getting your health care professional to consider drug therapy.

Children over age 10 whose LDL cholesterol remains high even after they’ve changed their dietary habits may benefit from cholesterol-lowering medication.

Medication Options for Treating High Cholesterol

There are several medications that reduce cholesterol levels. Before taking these or any other medications, talk to your health care professional about other conditions you have and medications you are taking, including birth control pills (statins, for example, can raise blood levels of birth control hormones) and over-the-counter medications, including vitamins and nutritional supplements.

Statins. Many statin drugs are available in the United States: atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor, Altoprev), pravastatin (Pravachol), pitavastatin (Livalo), simvastatin (Zocor) and rosuvastatin (Crestor). These highly effective drugs help reduce cardiovascular disease risk. They also provide the added benefits of increasing HDL cholesterol somewhat and reducing triglyceride levels.

Statins are also found in the combination medications Advicor (lovastatin + niacin), Caduet (atorvastatin + amlodipine) and Vytorin (simvastatin + ezetimibe).

Statins work by inhibiting an enzyme called HMG-CoA reductase, which controls the body’s cholesterol production rate. They ramp down production of cholesterol and boost the liver’s ability to remove LDL cholesterol from the blood. In several large clinical trials, they have proven their merit not only in lowering cholesterol levels, but also in achieving the ultimate goal: reducing heart attacks and deaths related to heart disease.

According to the ACC/AHA guidelines, there are four groups that benefit from taking a statin to lower their blood cholesterol. These groups are:

People with a history of a cardiac event—a heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack or coronary or other arterial revascularization.
Individuals ages 21 and older with elevated LDL cholesterol greater than 190 mg/dL.
People ages 40 to 75 who have LDL cholesterol levels between 70 and 189 and a 7.5 percent higher risk of having a heart attack or stroke within 10 years.
Individuals with diabetes and an LDL cholesterol level of 70 to 189 mg/dL who are between 40 and 75 years old.

It takes about four to six weeks of taking a statin to achieve its full effect. After six to eight weeks, your health care professional will probably check your LDL cholesterol and perhaps adjust your medication.

According to the U.S. Food and Drug Administration, all statin drugs have been associated with reports of a rare and potentially fatal muscle condition called rhabdomyolysis, which causes muscle cells to breakdown and enter the bloodstream.

A much more common side effect is benign muscle pain, which sometimes responds to supplemental coenzyme Q10.

The risk of rhabdomyolysis increases with higher doses of statins and when statins are used in combination with certain drugs, such as the fibrate gemfibozil (Lopid), and cyclosporine (Restasis), a drug used to suppress immunity in people who undergo organ transplants and for the treatment of rheumatoid arthritis.

The most common side effects associated with statins are upset stomach, gas, constipation, abdominal pain or cramps and muscle pain. The effects are usually mild to moderate and fade as your body adjusts to the drug. However, if you experience brown urine or muscle soreness, pain or weakness—possible symptoms of rhabdomyolysis—contact your health care professional immediately.

Bile acid sequestrants (resins). The main bile acid resins prescribed in the United States are cholestyramine (Questran, Prevalite), colestipol (Colestid) and colesevelam (WelChol). These drugs work by binding with bile acids in the intestines that contain cholesterol. The cholesterol is then eliminated in the stool. A bile acid sequestrant may be prescribed in combination with another drug if you have high triglycerides or a history of severe constipation.

Bile acid sequestrants come in powders that are mixed with water or fruit juice and usually taken once or twice a day with meals. They are also available in pill form. They should be taken with plenty of water to avoid gastrointestinal side effects, such as constipation, bloating, nausea and gas.

If you take bile acid sequestrants, you should take any other medications at least one hour before or four to six hours after taking a bile acid resin because the bile acids can interfere with the absorption of other medications.

Niacin. This compound is more commonly known as nicotinic acid, a water-soluble B vitamin. Unfortunately, you can’t lower your cholesterol by taking a vitamin supplement —to have such an effect it must be taken in doses well above the daily vitamin requirement. Although nicotinic acid is inexpensive and available over the counter, you should only take it under the direction of a health care professional.

Niacin appears to have stronger effects on HDL cholesterol and triglycerides than it does on LDL cholesterol. It comes in capsule and tablet forms, both regular and time released.

Niacin also widens blood vessels, making flushing and hot flashes frequent side effects. These side effects may be reduced by taking the drug with meals or by taking aspirin or a similar medication with nicotinic acid. The extended release form, available by prescription as Niaspan, results in less flushing and liver toxicity than the immediate or sustained release forms.

Nicotinic acid can also intensify the effect of high blood pressure medication and produce various gastrointestinal problems—nausea, indigestion, gas, vomiting, diarrhea and activation of peptic ulcers. Serious side effects include liver problems, gout and high blood sugar, with risk rising in tandem with the dose.

This drug may not be prescribed if you have diabetes because it can raise blood sugar slightly.

Fibrates. These drugs reduce triglycerides and usually raise HDL cholesterol. Fibrates are not recommended as the sole drug therapy for women with heart disease if the primary goal is reducing LDL cholesterol levels. Available fibrates are fenofibrate (Tricor, Antara, Lofibra and Triglide), clofibrate (Atromid-S) and gemfibrozil (Lopid).

Side effects are rare, with gastrointestinal problems the most common. Fibrates may also increase the risk of cholesterol gallstones and can boost the effects of blood thinners—a possibility your health care professional should watch for. Fibrates may also increase the risk of rhabdomyolysis when used in combination with statins.

Newer drugs. A relatively new class of drugs lowers cholesterol by preventing it from being absorbed in the intestine. More specifically, one approved medication in this class—ezetimibe (Zetia)—acts in the small intestine to prevent cholesterol absorption so less cholesterol reaches the liver and more is cleared from the blood. Studies find it lowers LDL cholesterol, but there is no evidence yet that it reduces heart attack risk. Another class of non-statin drugs—PCSK9 inhibitors—also shows promise in the treatment of high cholesterol.

Combination drug therapy. If you haven’t achieved your target LDL cholesterol level after a few months on a single medication, your health care professional may recommend adding another. Various combinations have been shown to be effective and safe. Lower doses of each individual drug can reduce the risk of side effects.

Update on Postmenopausal Hormone Therapy for Treating Elevated Cholesterol

Postmenopausal hormone therapy once was considered a medical option for treating elevated cholesterol in postmenopausal women because research suggested it might prevent the development of heart disease—the end result of high cholesterol levels for a long time.

Most medical professionals now advise against using menopausal hormone therapy to prevent heart disease. Studies to date have not shown that hormone therapy reduces the risk for major coronary events or deaths among postmenopausal women, particularly when compared to statins.

Prevention

There are things you can do to try to keep your cholesterol levels within healthy ranges. In addition to getting your cholesterol screened regularly (every four to six years for individuals with no heart disease risk factors), take these steps:

Be physically active for at least 30 minutes, most days of the week (preferably every day, if possible). For those with high blood pressure or cholesterol, the AHA recommends 40 minutes of moderate to vigorous activity, three to four times a week.
Lose weight if you are overweight.
Increase your intake of whole grains, with an emphasis on soluble fiber. Eat at least 25 to 30 grams of fiber a day, preferably from whole grains, fruits, vegetables and legumes.
Increase your intake of poly- and monounsaturated fatty acids and reduce your intake of saturated and trans fats. Limit your saturated fat consumption to less than 5 percent to 6 percent and your intake of trans fat as much as possible.
Increase your intake of fruits and vegetables high in antioxidants. Aim for at least 4.5 cups of fruits and vegetables per day.
If you drink alcohol, consume only moderate amounts, defined as equal to or less than one drink a day for women (and two drinks a day for men).

You might think the key to lowering your blood cholesterol levels is to zero in on the amount of cholesterol in foods. But such an approach addresses only part of the problem—and the lesser part at that. Reducing your cholesterol intake does indeed lower your risk of heart disease, but it has less impact on blood cholesterol levels than cutting back on saturated fat.

Saturated fat increases your blood cholesterol level more than anything else in your diet. Saturated fat is found mainly in food that comes from animals, including whole-milk dairy products such as butter, cheese, milk, cream and ice cream, as well as the fat in meat and poultry skin.

A few vegetable fats—coconut oil, cocoa butter, palm kernel oil and palm oil—are also high in saturated fat. These fats may be found in cookies, crackers, coffee creamers, whipped toppings and snack foods, which may also contain trans fatty acids, another form of fat that acts like saturated fat in the body. It is important to read food labels, which detail total fat, saturated and trans fat levels. Research is continuing to determine which of these fats are harmful; not all saturated fatty acids cause the same effects.

Polyunsaturated fats, such as safflower and corn oil, and monounsaturated fats, such as olive and canola oil, may lower LDL cholesterol levels slightly and raise HDL cholesterol levels. However, don’t try to boost your intake of these fats. Instead, concentrate on cutting back fat from all sources with an eye toward using these “healthier” fats in place of saturated fats.

Omega-3 fatty acids, which are found in oily fish such as salmon and soybean and canola oil, appear to lower blood levels of triglycerides. You may want to add fish to your diet at least twice a week and choose these oils over others. Oily fish such as salmon, mackerel, albacore tuna, herring, lake trout and sardines are highest in heart-healthy omega-3s.

Psyllium, a fiber supplement, also provides cholesterol-lowering benefits when taken in conjunction with a low-fat, low-cholesterol diet. Studies have shown psyllium can lower LDL cholesterol levels, thus reducing risk of cardiovascular disease. When taken in combination with cholesterol-lowering drugs, psyllium provides added heart-healthy benefits.

If you don’t have high cholesterol or heart disease, you’re probably already on the right track when it comes to lifestyle. Be sure to stick with a program that keeps saturated fats to no more than 6 percent of daily calories. You should also engage in regular physical activity (at least 30 minutes a day, most days of the week; every day if possible) to keep your weight in check and possibly lower high cholesterol levels. For those with high blood pressure or cholesterol, the AHA recommends 40 minutes of moderate to vigorous activity, three to four times a week.

If your cholesterol is elevated but you don’t have heart disease, develop an action plan in consultation with a health care professional.

Facts to Know

Today, more than one-third of American adults need to lower their blood cholesterol.
Cholesterol travels in the blood in packages called lipoproteins, which consist of cholesterol (fat) and protein. Cholesterol packaged in low-density lipoprotein (LDL) is often called “bad” cholesterol, because too much LDL in the blood can lead to cholesterol buildup and blockage in the arteries. LDL carries most of the cholesterol in the blood.
Another type of cholesterol package is high-density lipoprotein (HDL), often called “good” cholesterol. That is because HDL cholesterol helps transport cholesterol to the liver, which removes it from the body, preventing buildup in the arteries.
A third type of lipoprotein, very low-density lipoprotein (vLDL), transports triglycerides in the blood; high levels of vLDL and triglycerides have been linked to increased risk of heart disease.
All women should begin blood cholesterol testing at age 20, with testing repeated every four to six years, earlier and more frequently if there are other risk factors for heart disease.
A healthy diet, healthy weight and regular exercise can all protect against heart disease and high cholesterol levels, while your age (over 55 for women) and family history may increase your risk of heart disease and high cholesterol.
If there is too much cholesterol in your bloodstream, it builds up in the form of plaque on the walls of your arteries, narrowing them and eventually blocking them and reducing the blood flow to your heart. This process increases your risk of a heart attack.
Reducing your intake of high-cholesterol food lowers your risk of heart disease, but it has less impact on blood cholesterol levels than cutting back on saturated and trans fats. Some people with high cholesterol levels do not respond to changes in diet, however. They will need medication.
A normal total cholesterol level for adults without heart disease is less than 200 mg/dL. An HDL cholesterol level of 60 mg/dL and above is considered protective against heart disease, while a level less than 50 mg/dL for women or 40 mg/dL for men is considered a major risk factor for heart disease.

Questions to Ask

Review the following Questions to Ask about cholesterol so you’re prepared to discuss this important health issue with your health care professional.

What is my overall risk for heart disease? Can we review my risk factors?
How often should I have my cholesterol level tested?
Why do I keep hearing about “good” and “bad” cholesterol? What are they?
What are triglycerides? What do they have to do with my heart disease risk?
What type of test best measures my cholesterol levels?
Will you explain the results of my cholesterol test?
If I have high LDL cholesterol, what lifestyle and dietary changes can I make to lower it?
What types of food should I avoid or add to my diet?
When and how often should I have my cholesterol level checked?
Based on my cholesterol and other risk factors, am I a good candidate for a statin medication? What are the risks and benefits of using a statin?
Are there alternative medications I can take if I cannot or do not wish to use a statin?
If I have high blood cholesterol, are my children at risk for developing high blood cholesterol?
I have diabetes. How does it affect my risk for developing high cholesterol? Will it affect treatment?

Key Q&A

What is cholesterol?
Cholesterol is a waxy, fat-like substance found in whole-milk dairy products, eggs, animal fats and meat. It belongs to a family of chemicals called lipids, which also includes fat and triglycerides. It is found in cell walls or membranes throughout the human body and is used to produce hormones, vitamin D and the bile acids that aid the digestion of fat. Your body is able to meet all these needs by producing cholesterol in the liver.
What is the connection between cholesterol and heart disease?
Over the years, excess cholesterol and fat are deposited in the inner walls of the arteries that supply blood to the heart. These deposits make the arteries narrower, contributing to atherosclerosis and, if the process is unchecked, heart attack.
Why should I worry about cholesterol? Aren’t women protected from heart disease?
No, women aren’t protected. Cardiovascular disease, which includes diseases of the heart and blood vessels such as stroke, is the leading cause of death in women, accounting for one in every four female deaths. Though women, in general, seem to develop heart disease later in life than men—typically after menopause—the time to worry about your heart’s health is NOW. Talk to your health care professional for guidance.
What is the difference between “good” cholesterol and “bad” cholesterol?
“Bad” cholesterol comes in the form of low-density lipoprotein (LDL). This is the primary type of cholesterol in the blood and contributes to heart disease. High-density lipoprotein (HDL) is often called “good” cholesterol because it transports cholesterol from the body to the liver, which helps remove it from the body and prevents it from clogging arteries.
How are cholesterol levels tested?
A lipid profile is a blood test usually administered after fasting for nine to 12 hours. It measures LDL cholesterol, total cholesterol, HDL cholesterol, and triglyceride levels. It is the preferred test for measuring cholesterol levels.
What can I do to reduce my cholesterol level without taking medications?
Talk to your health care professional for the best strategy based on your personal and family health history. Lifestyle changes—including weight loss, exercise and a healthy diet—are just as effective as medication in lowering cholesterol for most people.
What drugs are available to lower high cholesterol?
Many medications in the statin class of drugs are available, including atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor, Altoprev), pravastatin (Pravachol), rosuvastatin calcium (Crestor), pitavastatin (Livalo) and simvastatin (Zocor). These drugs are highly effective, reducing overall cardiovascular risk. Statins are the most frequently prescribed cholesterol-lowering drugs, but there are other types of cholesterol-lowering drugs available, including bile acid sequestrants (resins), fibrates and cholesterol absorption inhibitors. The updated 2018 guidelines recommend considering non-statin drugs in the treatment of high cholesterol, including ezetimibe and PCSK9 inhibitors.
Isn’t niacin just a vitamin I can take without a prescription?
The amount of niacin, or nicotinic acid, needed to reduce cholesterol levels is higher than the recommended amount in vitamins. You shouldn’t attempt to take cholesterol-reducing quantities without a recommendation from your health care professional health care professional. The drug can have severe side effects, including liver problems, gout and high blood sugar. If you have diabetes, you should check with your health care professional because niacin can have a modest impact on blood sugar.
Is there any nutritional supplement or alternative medication that will do the trick?
Omega-3 fatty acids have been publicized for cholesterol-lowering effects. Ask your health care professional for more information about fish oil supplements that may help to reduce cholesterol.

Lifestyle Tips

Practice cholesterol-lowering cooking
The definition of “low fat” is now more specific. Medical guidelines suggest you should reduce the amount of saturated fat you eat to keep your cholesterol in check. Saturated fat is found in animal products, including meat and whole-milk dairy foods. To cut back on saturated fats, try these cooking tips—they’re a healthier way for the whole family to eat:
- Rely on spices and other seasonings instead of fat for flavor.
- Select poultry, fish and lean cuts of meat.
- Remove the skin from chicken and trim the fat from meat.
- Use low-fat cooking methods like poaching, baking and broiling instead of frying.
- When sautéing or stir-frying, use monounsaturated fats such as olive oil, canola oil, peanut oil, sunflower oil and sesame oil or substitute bouillon.
- Use low-fat or non-fat yogurt, sour cream and cream cheese instead of the high-fat varieties.
“Check” heart-healthy eating off your list
Research has found people who follow the American Heart Association’s Heart Check Food Certification program nutrition requirements are more likely to eat healthier and have fewer heart disease risk factors than those who do not. The Heart Check program assigns a heart-check mark icon to the front-of-packages of foods that meet the AHA’s criteria for a heart-healthy diet.
Get Serious About Exercising
Do you keep putting off exercising? You shouldn’t. Not only can regular physical activity such as walking make you look and feel better, it may lower your LDL or “bad” cholesterol levels, raise HDL or “good” cholesterol levels, help you trim down if you’re overweight, lower your blood pressure and make your heart and lungs more fit. Before starting any activity program, talk with your health care professional to make sure it’s safe for you.
Steer clear of trans fats
Like saturated fat, trans fatty acids (TFAs) can raise cholesterol. TFAs are present in small amounts in various animal products such as beef, pork, lamb and the butterfat present in butter and milk. To avoid them, use canola or olive oil when possible. Some fast foods and commercial baked goods and snack foods may contain trans fatty acids, but that is rapidly changing. Increasingly, manufacturers are not using hydrogenated fats, and many packaged snacks are now labeled to show that they contain no trans fatty acids.
Leave the cholesterol testing to your health care professional
A word of caution concerning the new home cholesterol tests now available at local pharmacies and through the internet: Home cholesterol tests are indeed faster than visiting your health care professional and may be a good way to get an idea of your cholesterol level, but they are no substitute for a cholesterol test ordered by your health care professional. The kits, which require the user to draw blood from a prick of the skin, measure cholesterol (some kits break numbers down into HDL and LDL cholesterol), but they don’t provide other important information about your overall cardiovascular risk or address the impact of diet or exercise on your cholesterol. To get the most accurate measurement of your cholesterol and how it fits into your cardiovascular risk profile, see your health care professional.

Organizations and Support

For information and support on Cholesterol, please see the recommended organizations, books and Spanish-language resources listed below.

American College of Cardiology (ACC)
Website: https://www.acc.org
Address: Heart House
2400 N Street, NW
Washington, DC 20037
Hotline: 1-800-253-4636
Phone: 202-375-6000
Email: [email protected]

American Heart Association (AHA)
Website: http://www.americanheart.org
Address: 7272 Greenville Avenue
Dallas, TX 75231
Hotline: 1-800-AHA-USA-1 (1-800-242-8721)
Email: [email protected]

National Heart, Lung, and Blood Institute (NHLBI) – NHLBI Health Information Center
Website: http://www.nhlbi.nih.gov
Address: Attention: Website
P.O. Box 30105
Bethesda, MD 20824
Phone: 301-592-8573
Email: [email protected]

WomenHeart: National Coalition for Women with Heart Disease
Website: http://www.womenheart.org
Address: 818 18th Street, NW, Suite 930
Washington, DC 20006
Hotline: 1-877-771-0030
Phone: 202-728-7199
Email: [email protected]

Women’s Health Initiative (WHI)
Website: https://www.whi.org
Address:Clinical Coordinating Center
Fred Hutchinson Cancer Research Center
1100 Fairview Ave N, M3-A410
PO Box 19024
Seattle, WA 98109-1024
Phone: 800-218-8415
Email: [email protected]

Women’s Heart Foundation
Website: http://www.womensheart.org
Address: P.O. Box 7827
West Trenton, NJ 08628
Phone: 609-771-9600

Books

American Heart Association 365 Ways to Get Out the Fat: A Tip a Day to Trim the Fat Away
by American Heart Association

Good Cholesterol Bad Cholesterol
by Eli M. Roth M.D., Sandra Streicher-Lankin

Spanish-language resources

Family Doctor
American Academy of Family Physicians
Website: http://familydoctor.org/online/famdoces/home/common/heartdisease/risk/029.html

Health Risks, Ways to Lower Levels

What are triglycerides?

Triglycerides are fats from the food we eat that are carried in the blood. Most of the fats we eat are in triglyceride form. Extra calories, alcohol and sugar in the body turn into triglycerides and are stored in fat cells throughout the body.

How are triglycerides different from cholesterol?

Triglycerides and cholesterol are both fatty substances called lipids. But triglycerides are fats; cholesterol is not. Cholesterol is a waxy, odorless substance made by the liver. It is used to build cell walls, helps the nervous system and plays an important role in digestion and hormone production.

How do triglycerides circulate in the blood?

Pure cholesterol cannot mix with or dissolve in the blood. Instead, the liver packages cholesterol with triglycerides and proteins called lipoproteins. The lipoproteins move this fatty mixture to areas throughout the body.

Types of these lipoproteins include very low-density lipoproteins (VLDLs), high-density lipoproteins (HDLs) and low-density lipoproteins (LDLs).

What is a high triglyceride level?

High triglycerides (hypertriglyceridemia) can be dangerous to your health. Unfortunately, high triglycerides, like high cholesterol, rarely causes symptoms. It’s vital to get routine lipid blood tests to check cholesterol numbers.

Your healthcare provider determines total cholesterol by looking at a combination of triglycerides, HDL and LDL numbers. If your triglycerides and LDL cholesterol are high, but your HDL is low, you have an increased risk of heart attack and stroke.

For the most accurate reading, you should fast 8 to 12 hours before a lipid blood test. A healthy number for triglycerides is below 150 milligrams per deciliter (mg/dL).

Your healthcare provider classifies high triglyceride levels as:

Mild: 150-199 mg/dL.
Moderate: 200-499 mg/dL.
Severe: Greater than 500 mg/dL.

What are risk factors for high triglycerides?

Factors that may raise triglyceride levels include:

How often should you get triglyceride tests?

High triglyceride levels become more of a problem with age. As the risk rises, your healthcare provider might recommend tests more often.

Younger adults may need cholesterol tests every four to six years. If you have diabetes, a family history of high cholesterol or other heart disease risk factors, you may need more frequent tests. Men ages 45 to 55 and women ages 55 to 65 need annual tests.

Children also need cholesterol and triglyceride tests. Your child usually gets tested between 9 and 11 and again during young adulthood (between 17 and 21).

What are the complications of high triglycerides?

High levels of triglycerides increase your risk of pancreatitis. This severe and painful inflammation of the pancreas can be life-threatening.

High triglyceride levels also increase your risk of heart and vascular disease, including:

How can you prevent or lower high triglycerides?

Certain dietary and lifestyle changes can lower triglyceride numbers. To keep triglycerides and total cholesterol within a healthy range:

Be physically active for at least 30 minutes every day.
Eat a heart-healthy diet with less unhealthy fats and simple sugars (carbohydrates) and more fiber.
Control high blood pressure and diabetes.
Cut back on alcohol.
Get enough sleep.
Lose weight (if needed) and maintain a healthy weight.
Manage stress.
Quit smoking.

How are high triglycerides treated?

People at high risk for heart attacks, strokes or other problems may need medications to lower triglycerides. These may include cholesterol-lowering drugs such as statins.

A note from Cleveland Clinic

High levels of triglycerides increase your risk of heart disease and pancreatitis. Eating or drinking too many calories can lead to high triglyceride levels. The good news is that you can take steps to lower triglyceride numbers. Your healthcare provider can offer suggestions for heart-healthy lifestyle changes. If needed, medications can also help.

Does Your Total Cholesterol Number Even Matter?

February is National Heart Health Month. So, we thought we’d do our part in spreading awareness by bringing you a three-part heart health blog series. First up? The ever-ominous “total cholesterol.”

As one of the most ordered lab tests, total cholesterol can provide a high level glance at how your body is handling lipids, or fats. According to the CDC, roughly nine percent of all doctor’s visits include a cholesterol test.¹ So, how should you interpret your total cholesterol value? Is the whole greater than the sum of its parts?

Want help lowering your cholesterol? Download recipes here!

Total cholesterol can be determined in two ways. It can either be directly measured in the blood, or more commonly, it can also be calculated. The calculation takes into account the two main forms of cholesterol – HDL (high density lipoprotein) and LDL (low density lipoprotein) – as well as a small fraction of triglycerides. Any one of these three components can skew total cholesterol values. Here’s a brief definition of each:

HDL: High density lipoprotein is a protective form of cholesterol that helps to remove harmful particles from circulation before they can cause damage to blood vessels. This process earned it the nickname “good cholesterol.”

LDL: Low density lipoprotein is a potentially dangerous type of cholesterol that can become oxidized (a process that makes it unstable and capable of causing damage), which can lead to the hardening of arteries. If LDL builds up, it can lead to blockages – which can cause serious cardiovascular incidents. LDL is therefore aptly referred to as the “bad cholesterol.”

Triglycerides: A form of stored fat that circulates in the bloodstream usually from excess weight, calories, alcohol, lack of exercise, liver damage, or genetics.

Knowing which biomarker (or combination of the three) is responsible for the skew of your total cholesterol number is more important than the total cholesterol value itself. Three scenarios can account for high total cholesterol:

1. High total cholesterol, high LDL cholesterol, low HDL cholesterol, and high triglycerides

High alert! This is the most dangerous combination of lipid markers. Roughly 32% of Americans have elevated LDL cholesterol, according to the CDC.¹ In this ratio, where high LDL is coupled with low HDL, the risk of developing cardiovascular disease is high. It is very important here to bring down LDL cholesterol and increase HDL cholesterol to help combat the “bad” LDL. The ratio of HDL to LDL is very important.

2. High total cholesterol, normal LDL, high HDL, normal triglycerides

In this case, the high total cholesterol is less troublesome since it’s largely due to elevated HDL (remember, that’s the “good” kind). The fact that HDL is high and LDL is normal also makes for a favorable HDL:LDL ratio. Although, extremely high levels of HDL cholesterol can be due to genetics. Generally, HDL levels shouldn’t exceed 116 mg/dL for men and 135 mg/dL for women.²

3. High total cholesterol, normal LDL cholesterol, normal HDL cholesterol, very high triglycerides

Even though triglycerides only contribute a small fraction to the total cholesterol value, very high levels can drastically skew this value and are very dangerous. High levels of triglycerides, especially without high levels of HDL or LDL, may indicate issues in the liver, where triglycerides are made. Testing your liver enzymes can help you identify whether there is in fact a problem – levels of these enzymes would be high if this were the case. Elevated triglycerides can be damaging to your cardiovascular system, but can also lead to acute pancreatitis (inflammation of the pancreas), which requires immediate medical attention.³

There is a lot of buzz in the health community about LDL particle size. If you recall, LDL is low density lipoprotein. Its “low” density is due to its high proportion of fat, which is not a very dense substance (think of salad dressing when it separates – the oil floats to the top). HDL, on the other hand, has a lower fat-to-protein ratio than LDL, making it more dense.

LDL is particularly troublesome due to its capacity to oxidize, which makes it more likely to become implanted in blood vessels and harden. This can eventually cause blockages. This is where the particle size becomes important: smaller LDL particles can become lodged in the arteries more easily. The larger LDL particles appear to be less dangerous.

Unfortunately, LDL particle size is still new science. While it is promising, it should not yet be used to determine and manage someone’s risk of cardiovascular disease (CVD).⁴

Because of this need for further research, InsideTracker doesn’t include LDL particle size in our lipid panels just yet. In the meantime, it appears that there is an association between small LDL particle size and high triglycerides coupled with low HDL.⁴

As mentioned above, the oxidation and hardening of LDL is largely responsible for the development of heart disease. Accordingly, lowering your LDL value is the first hurdle to tackle when prioritizing your heart health (hint: increase soluble fiber and limit saturated fat intake).

Once you have reached an optimal level, protecting the LDL from oxidation is just as important. Free radicals (yep, the same ones that cause inflammation) are the main stimulant for oxidization.⁵ They’re also counteracted by antioxidants, hence the name. Therefore, it follows that in order to reduce the potential for LDL to cause damage in the body, you should eat anti-inflammatory foods.

Common antioxidants include vitamins A, C, and E, as well as selenium. These are plentiful in dark leafy greens, bright red, orange or yellow fruits and vegetables, citrus, berries, broccoli, bell peppers, and nuts and seeds – get a serving of at least one of these foods every day. Dark chocolate and red wine in moderation are also high-antioxidant foods.

Already have your total cholesterol values? Let us help you interpret them by adding them to the InsideTracker platform. Haven’t had your values checked before? Perhaps it’s been a while? We can help with that, too. Your lifestyle choices might also be influencing your cholesterol number; if it needs a fine tune, let us build you a personalized plan to improve!

Lower your cholesterol now with this free recipe Ebook.

Ashley Reaver, MS, RD, CSSD

Ashley is the Lead Nutrition Scientist at InsideTracker. As a registered dietitian and educator, Ashley enjoys cooking and teaching individuals the power that food has on their health. You’ll find Ashley hiking, eating, and spending time with her family. Follow her on Instagram @lower.cholesterol.nutrition.

References:

[1] High Cholesterol Fact Sheet. 17 March 2015. https://www.cdc.gov/cholesterol/facts.htm
[2] Madsen, Christian M., Anette Varbo, and Børge G. Nordestgaard. “Extreme high high-density lipoprotein cholesterol is paradoxically associated with high mortality in men and women: two prospective cohort studies.” European Heart Journal (2017): ehx163.
[3] Murad, M. Hassan, et al. “The association of hypertriglyceridemia with cardiovascular events and pancreatitis: a systematic review and meta-analysis.” BMC endocrine disorders 12.1 (2012): 2.
[4] Allaire, Janie, et al. “LDL particle number and size and cardiovascular risk: anything new under the sun?.” Current Opinion in Lipidology 28.3 (2017): 261-266.
[5] Amiot, M. J., C. Riva, and A. Vinet. “Effects of dietary polyphenols on metabolic syndrome features in humans: a systematic review.” Obesity Reviews 17.7 (2016): 573-586.

Normal Cholesterol With High Triglycerides — What is That?

Are you one of the 42 million Americans who suffer from high cholesterol? With healthy lifestyle changes, including diet and exercise, and sometimes prescription medication, reducing cholesterol levels is within reach — but what if your triglycerides remain high?

Cholesterol: What’s Normal?

When measuring total cholesterol levels, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides are used in the measurement.

For adults, standard cholesterol levels are:

Less than 200 mg/dL is desirable

Between 200 – 239 mg/dL is considered borderline

Over 240 mg/dL is considered high

My Cholesterol is Normal, but My Triglycerides are High: Why Is That?

So both your HDL and LDL levels are where they should be, but your triglycerides are still high — why is that?

Triglycerides become elevated due to excess calories that do not get burned off, and in turned get stored in fat cells. “Statins are medications that primarily lower LDL cholesterol, but depending on the medication dose, can lower Triglycerides from 20 to 40 percent,” Sai Hanumanthu MD, with the TriHealth Heart Institute explains.

There are steps you can take to lower your triglyceride levels while promoting good cardiovascular health, including:

Losing 5 to 10 pounds if overweight

Avoiding alcohol (even small or moderate amount of alcohol can significantly raise triglycerides)

Avoiding foods high in saturated fats (fried foods)

Limiting simple carbs that have high processed sugars (white bread, cakes, pastries).

Participating in 30 minutes of exercise per day

“All these suggestions and routine follow up with a medical professional will lower you triglyceride level, even despite a low total cholesterol,” Dr. Hanumanthu says.

Calculating Your Cholesterol | Johns Hopkins Medicine

Your cholesterol numbers are an important factor in assessing your risk of cardiovascular disease, but the standard way they’re determined doesn’t always provide the most accurate assessment. Johns Hopkins researchers have developed a better way to calculate more precisely the level of so-called bad cholesterol, known as low-density lipoprotein (LDL) cholesterol.

“The traditional way of measuring LDL cholesterol too often underestimates it,” says Johns Hopkins cardiologist Steven Jones, M.D. This means that some high-risk patients need more aggressive treatment than they may be receiving.

Understanding Cholesterol Basics

Cholesterol is a waxy substance that circulates through your body and takes part in some beneficial functions such as cell membrane health and brain function. Low-density lipoprotein (LDL) cholesterol is the garbage left behind after the beneficial cholesterol has been used. This is the “bad” cholesterol we want to get rid of. Too much LDL cholesterol can build up in artery walls, contributing to the formation of plaque, the deposits that harden and narrow the arteries. This sets the stage for a possible future heart attack or stroke.

Cholesterol doesn’t float freely in the blood—it must be carried by lipoproteins, particles formed in the liver that are made of fat and protein. There are several types, including high-density lipoprotein (HDL), which helps remove cholesterol from the arteries and prevent fatty buildup, and various non-HDL lipoproteins, which in excess are linked to artery damage, heart disease and stroke. These include intermediate-density lipoprotein (IDL), LDL and very-low-density lipoprotein (VLDL).

Measuring Cholesterol

A simple blood test called a lipid panel is used to measure total cholesterol, HDL cholesterol and triglycerides, another type of fat molecule. Also included is LDL cholesterol, which is normally estimated rather than directly measured, since its direct measurement is more difficult. To calculate LDL, labs have traditionally used a formula known as the Friedewald equation, a more expedient way to assess LDL compared with actually measuring it, which involves a cumbersome and expensive process called ultracentrifugation.

A More Accurate Measurement Tool

The traditional Friedewald equation estimates LDL cholesterol this way: total cholesterol minus HDL cholesterol minus triglycerides divided by five. For simplicity’s sake, the formula applies a one-size-fits-all factor of five to everyone. But Johns Hopkins researchers found that this often makes LDL cholesterol appear lower than it really is for some high-risk patients. The researchers sought a more accurate formula that would take into account specific details about a person’s cholesterol and triglyceride levels.

Using a database of blood lipid samples from more than 1.3 million Americans—almost 3,000 times larger than the one used to develop the Friedewald equation — Johns Hopkins researchers developed a more accurate system for calculating LDL cholesterol. It can be used to make more precise decisions about treatment to prevent heart attack and stroke.

This newer LDL cholesterol formula is being adopted by U.S. laboratories as well as others around the world. The best implementation is direct coding the LDL cholesterol estimation in the lab IT system, which automates the process and saves clinicians time. The formula is also available as a mobile device app called the LDL Cholesterol Calculator. It is available on the iTunes App Store and on Google Play, for those whose lab hasn’t adopted it.

Researchers hope the new formula will one day be adopted by all labs that process lipid panels, as it can improve patient care.

Definitions

Arteries (are-te-rease): The blood vessels that carry oxygen-rich blood away from your heart for delivery to every part of your body. Arteries look like thin tubes or hoses. The walls are made of a tough outer layer, a middle layer of muscle and a smooth inner wall that helps blood flow easily. The muscle layer expands and contracts to help blood move.

Rich Holiday Food Appears to Skew January Cholesterol Measurements

Copenhagen, Denmark—Here’s a possible explanation why prescriptions for statins might increase after the holiday season.

An article in the international journal Atherosclerosis reports that too much rich, celebratory food raises cholesterol levels—at least in Denmark.

In fact, University of Copenhagen researchers found that cholesterol levels are 20% higher after the Christmas break than in the summer.

“Our study shows strong indications that cholesterol levels are influenced by the fatty food we consume when celebrating Christmas. The fact that so many people have high cholesterol readings straight after the Christmas holiday is very surprising,” explained corresponding author Anne Langsted, MD.

To reach that conclusion, the study team conducted an observational study of 25,764 individuals from the Copenhagen General Population Study, with participants aged 20 to 100 years. For the study, the main outcome measures were defined as mean total and LDL-cholesterol levels, with hypercholesterolemia defined as total cholesterol >5 mmol/L (>193 mg/dL) or LDL cholesterol >3 mmol/L (>116 mg/dL).

Results indicate that mean levels of total and LDL cholesterol increased in individuals examined in summer through December and January.

Specifically, the study determined that compared with individuals examined in May-June, those examined in December-January had 15% higher total cholesterol levels, while the corresponding value for LDL cholesterol was 20%.

Of the participants tested during the first week of January, immediately after the Christmas holidays, 77% had LDL cholesterol above 3 mmol/L (116 mg/dL) and 89% had total cholesterol above 5 mmol/L (193 mg/dL).

“In individuals attending the Copenhagen General Population Study in the first week of January, the multivariable adjusted odds ratio of hypercholesterolemia was 6.0 (95% CI 4.2-8.5) compared with individuals attending the study during the rest of the year,” study authors concluded.

Based on that, the researchers suggest that “a diagnosis of hypercholesterolemia should not be made around Christmas, and our results stress the need for re-testing such patients later and certainly prior to initiation of cholesterol-lowering treatment.”

“For individuals, this could mean that if their cholesterol readings are high straight after Christmas, they could consider having another test taken later on in the year,” added first author Signe Vedel-Krogh, MD, who noted healthcare professionals should be aware of the trend.

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90,000 What does high blood lipid levels mean?

The most important blood lipids include triglycerides and cholesterol. Triglycerides are important sources of energy and are the main constituents of the fats we eat. Cholesterol is fat that makes up about 80% of our body. If for a long period of time the amount of lipids in our blood exceeds the normal level, this is called a lipid metabolism disorder. Lipid metabolism disorders, which are characterized by high blood cholesterol levels, are called “hypercholesterolemia” by doctors.

High blood lipids – hereditary or not hereditary?

Distinguish between the so-called primary and secondary hypercholesterolemia. Primary hypercholesterolemia includes familial hypercholesterolemia, in which gene defects are responsible for elevated cholesterol levels. This is common in the family: cholesterol can no longer be absorbed by cells or is partially absorbed.

If primary hypercholesterolemia is not hereditary, it is called non-familial hypercholesterolemia.In these cases, patients have cholesterol levels that are too high for their individual situation.

Secondary hypercholesterolemia leads to an increase in blood cholesterol levels due to underlying diseases such as diabetes mellitus, hypothyroidism, renal or hepatic dysfunction. Also, taking medications such as cortisone or some beta-blockers can cause a secondary form of hypercholesterolemia.

The most important blood lipids include triglycerides and cholesterol. Triglycerides are important sources of energy and are the main constituents of the fats we eat.Cholesterol is fat that makes up about 80% of our body. If for a long period of time the amount of lipids in our blood exceeds the normal level, this is called a lipid metabolism disorder. Lipid metabolism disorders, which are characterized by high blood cholesterol levels, are called “hypercholesterolemia” by doctors.

High blood lipids – hereditary or not hereditary?

Distinguish between the so-called primary and secondary hypercholesterolemia.Primary hypercholesterolemia includes familial hypercholesterolemia, in which gene defects are responsible for elevated cholesterol levels. This is common in the family: cholesterol can no longer be absorbed by cells or is partially absorbed.

If primary hypercholesterolemia is not hereditary, it is called non-familial hypercholesterolemia. In these cases, patients have cholesterol levels that are too high for their individual situation.

Secondary hypercholesterolemia leads to an increase in blood cholesterol levels due to underlying diseases such as diabetes mellitus, hypothyroidism, renal or hepatic dysfunction.Also, taking medications such as cortisone or some beta-blockers can cause a secondary form of hypercholesterolemia.

Why high cholesterol levels are dangerous

If too much LDL-cholesterol (low-density lipoprotein cholesterol) is present in the blood that the body cannot use, then the excess LDL-cholesterol is deposited on the walls of blood vessels. These deposits are called plaques. The plaque makes the walls of the arteries, which carry oxygen-rich blood from the heart to the organs, harder and harder over time.In short, these changes are called “vascular calcification”, doctors call it atherosclerosis. The most dangerous thing about this disease: it develops slowly and imperceptibly and without discomfort in the early stages.

As arteriosclerosis develops, the inner opening of the artery becomes narrower, and blood also cannot pass through it. In the affected organs, this leads to circulatory disorders, and in the worst case, to the complete closure of the vessel with corresponding complications.

Disorders of blood circulation in the arteries of the heart and brain are especially frequent and dangerous: in this case, the lack of oxygen supply to the tissue can lead to a heart attack or stroke.Arteriosclerosis is the most important cause of these diseases, which are still the number one killer in Germany.

Too high LDL cholesterol levels endanger blood vessels

In addition to hypertension, diabetes and smoking are the earliest causes of increased levels of LDL-cholesterol, “bad cholesterol”, the most important risk factor for atherosclerosis and cardiovascular disease.

How high your blood LDL cholesterol level depends on whether you have other cardiovascular risk factors – the overall risk of cardiovascular disease.These risk factors include age, gender, smoking, systolic blood pressure, and diabetes mellitus. In principle, the higher the overall risk of cardiovascular disease, the lower the recommended LDL-cholesterol endpoint. The German Society of Cardiology classifies the following risk levels:

Moderate risk: With a moderately increased overall cardiovascular risk (no more than one additional risk factor), an LDL-cholesterol target below 115 mg / dL (3 mmol / L) should be sought.
High risk: In case of high cardiovascular risk (eg, severe hypertension or familial hypercholesterolemia, smokers), a target LDL cholesterol level below 100 mg / dL (2.5 mmol / L) should be sought.
Very high risk: If there is a very high risk of cardiovascular disease (such as diabetes or cardiovascular disease), the LDL-cholesterol target should be below 70 mg dL (1.8 mmol / L).

Which patient is at high risk?

People with familial hypercholesterolemia who have significantly elevated LDL-cholesterol levels are considered high-risk patients. Atherosclerosis often begins at an early age. Therefore, such patients have a particularly high risk of developing early pathologies of the cardiovascular system. Another risk group is people who have had a heart attack in recent years.Particular attention is also paid to those patients who cannot or are taking insufficient doses of statins, standard cholesterol-lowering drugs. Patients belonging to the aforementioned risk groups require a special approach to treatment in order to achieve the target LDL cholesterol values. They especially need consistent therapy, which usually includes medication along with a balanced diet and adequate exercise.

If too much LDL-cholesterol (low-density lipoprotein cholesterol) is present in the blood that the body cannot use, then the excess LDL-cholesterol is deposited on the walls of blood vessels.These deposits are called plaques. The plaque makes the walls of the arteries, which carry oxygen-rich blood from the heart to the organs, harder and harder over time. In short, these changes are called “vascular calcification”, doctors call it atherosclerosis. The most dangerous thing about this disease: it develops slowly and imperceptibly and without discomfort in the early stages.

As arteriosclerosis develops, the inner opening of the artery becomes narrower, and blood also cannot pass through it.In the affected organs, this leads to circulatory disorders, and in the worst case, to the complete closure of the vessel with corresponding complications.

Disorders of blood circulation in the arteries of the heart and brain are especially frequent and dangerous: in this case, the lack of oxygen supply to the tissue can lead to a heart attack or stroke. Arteriosclerosis is the most important cause of these diseases, which are still the number one killer in Germany.

Too high LDL cholesterol levels endanger blood vessels

How high your blood LDL cholesterol level depends on whether you have other cardiovascular risk factors – the overall risk of cardiovascular disease. These risk factors include age, gender, smoking, systolic blood pressure, and diabetes mellitus. In principle, the higher the overall risk of cardiovascular disease, the lower the recommended LDL-cholesterol endpoint. The German Society of Cardiology classifies the following risk levels:

Moderate risk: With a moderately increased overall cardiovascular risk (no more than one additional risk factor), an LDL-cholesterol target below 115 mg / dL (3 mmol / L) should be sought.
High risk: In case of high cardiovascular risk (eg, severe hypertension or familial hypercholesterolemia, smokers), a target LDL cholesterol level below 100 mg / dL (2.5 mmol / L) should be sought.
Very high risk: If there is a very high risk of cardiovascular disease (such as diabetes or cardiovascular disease), the LDL-cholesterol target should be below 70 mg dL (1.8 mmol / L).

Which patient is at high risk?

Clinic of Cardiology and General Internal Medicine of the City Clinical Hospital of St.Solingen is one of the best in Europe for diagnosing and successfully treating diseases of the cardiovascular system. Contact us for a free consultation or a second opinion.

We have Russian speaking staff.

INTERNATIONAL OFFICE AM KLINIKUM SOLINGEN

Gotenstraße 1

42653 Solingen

NRW / Deutschland

Tel.:+49 (0) 212/547 – 69 13

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HOW TO QUIT SMOKING?

Why is smoking dangerous?

Active and passive smoking increases the risk of developing many serious diseases, primarily oncological and cardiovascular diseases, as well as the brain, respiratory system, digestive system, the appearance of a person suffers, especially of the skin and teeth. Smoking in itself harms the health of the heart and blood vessels, since tobacco smoke contains a whole range of substances harmful to many organs and tissues, the main ones are: nicotine, carbon monoxide – CO, hydrogen cyanide, carcinogenic substances (benzene, vinyl chloride, various “Resins”, formaldehyde, nickel, cadmium, etc.). Nicotine, for example, disrupts the tone of the vascular wall, contributing to its damage, spasms and the formation of blood clots in the blood vessels. Carbon monoxide, combining with hemoglobin, forms carboxyhemoglobin, which blocks the transfer of oxygen to organs and tissues. In addition, harmful components of tobacco smoke contribute to the development of such powerful risk factors as arterial hypertension, disturbances in the system of cholesterol transfer to the walls of blood vessels, aggravating the deposition of cholesterol in them. As a result, the most dangerous complex of risk factors for the health of the heart and blood vessels is created, the so-called high total risk.

Advice to friends and relatives: Remind the smoker about the dangers of smoking for his health and for the health of people close to him (children, women), never create comfortable conditions for smoking, do not give the smoker pleasant “smoking” accessories (expensive cigarettes, lighters , ashtrays), do all you can to promote the desire of the smoker to quit smoking.

A person who is starting to smoke or just trying to “indulge in” smoking should be aware of the fact that nicotine addiction is quickly formed, which then, when the desire to quit smoking arises, will make it very difficult.

Tips for smokers who want to quit smoking:

When you decide to quit smoking, think about what you get instead: your health and your loved ones, saving money. Quitting smoking after 6 months will have a positive effect on your health.
Schedule a day to quit smoking in advance.
Stop smoking immediately, without first trying to reduce the number of cigarettes or switch to “light” cigarettes or cigarettes with filters, as it has been proven that this is only a “fiction” of reducing the harm of smoking and only prevents it from decisively ending.
Try to avoid situations that provoke smoking, including the society of smokers.
Reward yourself for every step you complete with something enjoyable.
Chewing gum helps to overcome the urge to smoke.
After quitting smoking, there is an improvement in taste sensitivity, an increase in appetite is possible, which leads to an increase in body weight in the first 2-3 months, so try to eat low-calorie foods, increase your physical activity, usually within a year after quitting smoking, body weight comes to the original.
Don’t be discouraged if a breakdown occurs. With repeated attempts, the chances of success increase.
Ask your doctor for help in fulfilling your desire to quit smoking for prescribing medication support and to reduce withdrawal symptoms, follow their advice.

How to quit smoking? Do I need to quit smoking?

You asked yourself questions: – “Why do I smoke?”

Is it really that:

Calm down?
Relax?
Relieve stress?
Relax?
Concentrate?
Start a difficult conversation?

Analyzing the reasons for our habits, it becomes clear that: we smoke because we cannot be calm, we cannot imagine rest without a smoke break, I am constantly nervous in anticipation of something, I cannot concentrate and communicate adequately without another cigarette…

I smoke because I can’t help but smoke!

How dependent are you?

I smoke a lot! I can’t live without a cigarette and I think about it all the time!

This is probably an addiction! Is it possible to measure the degree of your nicotine addiction?

A special test – the Fagestrem test will help assess the degree of nicotine addiction

Just answer the questions and count the points!

Question

Answer

Points

1.How soon after waking up do you smoke 1 cigarette?

– During the first 5 minutes

– Within 6-30 minutes

90 110 – 30 min – 60 min

– More than 60 min

2. Is it difficult for you to abstain from smoking in non-smoking areas?

– Yes

– No

3.Which cigarette can you not easily give up?

– First in the morning

– All others

4. How many cigarettes do you smoke per day?

– 10 or less

– 11-12

– 21-30

– 31 and more

5.Do you smoke more often in the early hours of the morning after waking up than during the next day?

– Yes

– No

6. Do you smoke if you are very ill and have to stay in bed all day?

– Yes

– No

So, the sum of points:

90 110 0-2 – I have a very weak addiction, I can handle it!

3-4 – I have a weak addiction, maybe, in fact, take and quit smoking!

90 110 5 – I have an average addiction, I have to think about it!

6-7 – I have a high addiction! What to do, you have to run for help!

8-10 – I have a very high addiction! You definitely need to look for help!

Have you decided to quit smoking? How can you check it?

Count the points again!

Question1

Would I quit smoking if it was easy?

90 110 1 Definitely not – 0

90 110 2 Probably not – 1

90 110 3 Probably yes – 2

90 110 4 Most likely, yes – 3

90 110 5 Definitely yes – 4

Question2

How badly do I want to quit smoking?

90 110 1 I don’t want at all – 0

90 110 2 Weak desire – 1

3 Medium – 2

4 Strong desire – 3

90 110 5 I definitely want to quit smoking – 4

The total of points is more than 6 – hurray! I want, I can, I will quit smoking! Hurry, for help, in order to completely abandon this addiction!

The sum of points from 4 – 6 – yes, the motivation is weak! But it is worth trying, at least to reduce the intensity of smoking first, and work on yourself… Need to seek help …

The total of points is less than 3 – yes, it looks like I’m not yet ready for such feats! But you have to do something! Maybe start smoking less for now ?!

Stop smoking once and for all!

We must “quit” – quit smoking once and for all !!!

The only effective way to permanently get rid of cigarettes, and all the harm associated with them.

Others quit, and I can! Sharply, boldly, without excuses, self-deception and ridiculous attempts to reduce the number of cigarettes smoked.

I just need to find a method that works for me! Doesn’t help, let’s try another one!

But I can’t do it abruptly and immediately, why should I give up and remain a smoker not all my life?

No, you can try to quit gradually for a start, but then – for good! I’ll do it:

I will plan the number of cigarettes smoked for each day until I finally quit;
I will begin to reduce the number of cigarettes smoked every day;
I will buy no more than one pack of cigarettes, replace the brand with a less favorite one….
I will hide cigarettes in unusual places or give them to someone for safekeeping, so that every time I have to look for them, ask when I want to smoke.

Quitting smoking: where to start?

I’ll try to figure out why I smoke!
I’ll try to figure out how much I smoke: how many cigarettes a day, one, one and a half or two packs, how many of them are “on business”, and how many automatically?
I will move the cigarettes to a new place, away from the lighter, so as not to “automatically” suddenly light a cigarette.
We’ll have to bypass the company of smokers and smoky premises
We need to get together, and, finally, appoint a day of complete smoking cessation – on the weekend, or on your birthday? On the other hand, having a drink on your birthday can upset your plans to quit smoking.
In general, one should beware of unnecessary incentives to smoke – alcohol, coffee.
I need to tell my family, their support will not hurt.
It is necessary to be more outdoors, I will start running in the morning, or at other times, walking.By the way, I’ve been planning to sign up for a gym for a long time. I think the time has come!

Where to go, what to do?

There are many ways to quit smoking, which one to choose?

Himself: got ready, decided, gave up. Cheap and cheerful. But not always and not for everyone.

Sports: is a very useful activity and a pleasant alternative to smoking – it can prevent the craving for smoking, depression, nervousness, stressful situations, weight gain, and therefore helps to prevent smoking relapse and increase self-esteem.

With the help of a doctor: The doctor will recommend, explain, help and support …

Individual or in a group: psychological support – individual or group helps to quit smoking. Often combined with medications.

Hypnosis: may help, although there is no conclusive evidence. Maybe find something else?

Medicines: there are some, but it is better that they are recommended and prescribed by a doctor. Some medications in the form of patches, inhalers and chewing gums contain nicotine and are designed to partially replenish its reserves in the body of an already ex-smoker, so that he does not experience the withdrawal syndrome of his favorite cigarettes.Other medications behave like nicotine and are also designed to reduce the urge to smoke.

Not a drug. Needles, electromagnetic waves, electropuncture – all this is good, everything works, it helps to overcome the withdrawal syndrome, and sometimes even to prevent it.

All methods are good if there is a desire and a strong will to win!

Done! What’s next?

It looks like the first days after quitting smoking are the hardest;
I have to stifle the desire to smoke, they advise me;

– eat fractionally;

– eat more fruits and vegetables;

– drink juices, water

– spending more time outdoors.

Then the body will be freed from nicotine and its harmful effects.

Cough may get worse, but will soon be over
If you have a strong craving for smoking, you can always see a doctor.
I lost it, I couldn’t stand it – to him! And do not lose heart! Some need a few tries, some more!
You just need to understand the reason for the breakdown and not repeat the mistakes …

I made the decision to quit smoking, and I did it!

The material was developed by Gambaryan Marine Genrievna (leading researcher of the State Research Center of the PM,
pulmonologist, candidate of medical sciences,
Master of Public Health)

REFERENCES RELATED TO:

5.1 Primary prevention / ConsultantPlus

5.1 Primary prophylaxis

– Recommended for all patients (in the absence of diabetes mellitus or kidney disease) with an increase in systolic blood pressure of more than 140 mm Hg. Art. and / or diastolic blood pressure more than 90 mm Hg. Art. regular blood pressure screening and appropriate therapy for hypertension (lifestyle modification and drug therapy) in order to reduce the risk of acute ischemic events [12, 13, 59, 60, 193].