The "good" and the "bad" of high cholesterol
By: Jessica Woodward, M.D.
We hear a lot about cholesterol and the importance of lowering our “bad” cholesterol while raising our “good” cholesterol. There’s a link between high cholesterol and heart disease, stroke, diabetes and other health problems. For the estimated 71 million American adults who have high LDL or “bad” cholesterol, it’s important to understand exactly what that means and how to make lifestyle changes to get cholesterol numbers under control.
Your body needs some cholesterol to function properly. Cholesterol helps to produce hormones, vitamin D and the bile acids that help the body digest fat. But too much cholesterol can cause health problems. According to the Centers for Disease Control, people with high cholesterol have about twice the risk of heart disease as people with lower levels.
Cholesterol is a waxy, fat-like substance that travels through the blood attached to a protein. The combination of the protein and cholesterol is called a lipoprotein. Lipoproteins can be low density (LDL) or high density (HDL).
LDL cholesterol is also called “bad” cholesterol because it causes plaque buildup on the walls of arteries. This plaque hinders the blood flow through the arteries, making it difficult for the heart to get enough oxygen-rich blood. The more LDL there is in the blood, the greater the risk of heart disease. Similarly, decreased blood flow to the brain can cause a stroke. When someone talks about having high cholesterol, they are referring to their LDL levels. High cholesterol in an otherwise healthy person is defined as having an LDL of 160 or above. Borderline is 130 to 159. Optimal levels are less than 100.
HDL, or “good” cholesterol, helps the body get rid of LDL. If your level of HDL is low, your risk for heart disease increases. A low level of HDL is defined as 40 or less. Optimal numbers for HDL are 60 or greater.
Certain factors increase the risk for high cholesterol. Some are within our control, others are not. They include:
• Smoking. Cigarette smoking can lower your HDL cholesterol.
• Being overweight or obese.
• A large waist circumference. Risk increases for men with a waist circumference of at least 40 inches; for women of at least 35 inches.
• Diabetes. High blood sugar contributes to higher LDL and lower HDL levels.
• Other diseases such as hypothyroidism, chronic kidney disease and some types of liver disease can increase risk.
• Family history. High cholesterol runs in some families.
• Medications you may take. Certain medications influence cholesterol levels.
• Your age and gender. In general, risk increases with age, with men 45 or older and women 55 or older being at greater risk.
• A poor diet. Foods high in cholesterol, saturated fat and trans fats will increase your total cholesterol.
• Inactivity. Exercise helps boost HDL levels while lowering LDL cholesterol.
The goal of treatment for high cholesterol is to raise HDL while lowering LDL cholesterol. This can often be accomplished with lifestyle changes. This includes eating a heart-healthy diet rich in fruits, vegetables, whole grains, fish and low-fat or non-fat dairy foods. The American Heart Association recommends limiting daily cholesterol intake to less than 300 milligrams. For people with heart disease, that number decreases to 200 milligrams. In addition to a healthy diet, your doctor will recommend exercise, with a goal of being active for at least 30 minutes on most, if not all, days of the week. Also, losing weight if needed and quitting smoking can aid in treatment.
Sometimes lifestyle changes aren’t enough to lower cholesterol to healthy levels. In these cases, your doctor may prescribe medication to aid in treatment. Some of the cholesterol lowering drugs include statins, niacin, bile-acid resins and fibrates. The choice of medications or combination of medications depends on factors specific to your individual situation. Medications are most effective when combined with a low-cholesterol diet and other healthy lifestyle changes.
The age to start screening for high cholesterol is dependent on risk factors and family history. High cholesterol has no symptoms and is a silent enemy. Many people are walking around with high cholesterol not even realizing they are at risk. Your doctor can do a blood test to check your levels and, if needed, recommend a treatment plan to get both your LDL and HDL back on track.
Dr. Woodward is a board certified family practice physician at Raiter Clinic in Cloquet.