More than 70 million American adults have high cholesterol, but only one-third of them are doing something about it.
"There are many silent killers we need to be aware of when managing our health, and cholesterol is one of them. High cholesterol is a major risk factor for heart disease and stroke, however, it has no symptoms," said Dr. Quinn Pack of the Heart & Vascular Program at Baystate Medical Center.
"The good news is that lowering your cholesterol through lifestyle changes can decrease your risk of cardiovascular disease," he added.
National Cholesterol Education Month in September serves as an important reminder for all adults to have their cholesterol measured through a simple fasting blood test in order to know their cholesterol numbers and their risk for cardiovascular disease.
Cholesterol is a waxy substance used in making the walls that surround cells and in making a number of hormones used in human metabolism. It travels through our bloodstream with the aid of lipoproteins, which can deposit cholesterol in the blood vessels, forming plaque and increasing one’s risk of heart attack and stroke.
The American Heart Association recommends starting screening tests for cholesterol at age 20, every 4-6 years for normal-risk people, and more often for those with elevated risk for heart disease and stroke. If you have a family member with severely elevated cholesterol levels, it is likely that you have an inherited cholesterol disorder and you should pay particularly close attention to your own levels and diet.
More than just numbers
So, what should your cholesterol numbers be?
Dr. Pack said it’s "not so much about your individual numbers any longer."
"You will always need to have your cholesterol numbers checked in order for you and your doctor to know what your levels are. But, new guidelines recommend cholesterol lowering statin drugs depending our your overall risk for a heart attack, rather than specific goal numbers. The reason for the change is, over the years, we have learned that statins are good for reducing heart disease risk, regardless of your starting cholesterol numbers," Dr. Pack said.
"Also, a patient who has had a heart attack, even if he or she has had perfect cholesterol levels, should be taking a statin drug because we now know they can reduce a person’s risk of having a second heart attack. Still, patients with moderate to extreme levels of cholesterol should always be on statins, regardless of their risk factors, and even if they lead a pristine lifestyle with plenty of exercise and a healthy diet," he added.
Many risk factors contribute to having high or low cholesterol, including diet, lack of exercise, excess weight, age, sex, race (African Americans and Hispanics are at greater risk for developing high cholesterol), alcohol, and stress levels. For some, high cholesterol is inherited, but many times it is the result of eating too many trans fats, saturated fats, and dietary cholesterol from animal products. Some risk factors can be reduced by following a heart-healthy lifestyle, while others are beyond your control.
When lifestyle changes such as maintaining a healthy diet and weight, exercising regularly, and not smoking are simply is not enough, there are other options.
"We now have years of discovery behind us in cholesterol, and we have medications that are effective and have minimal side effects. So, there are few good reasons anymore for not having your cholesterol under control," said Dr. Pack.
Patients should talk with their primary care doctor to learn if they fall under new guidelines for cholesterol lowering statins.
Living a healthy lifestyle
Taking statins doesn’t give you a license to eat what you want.
"Statins do not stand alone when it comes to lowering your cholesterol. Diet, exercise and lifestyle changes are of utmost importance," said Kathy Roberts, RDN, a clinical dietitian in Food and Nutrition Services at Baystate Medical Center.
She noted it is important to cut back on dietary cholesterol and total fat, most importantly to reduce saturated and trans fats. Saturated fats are found in high-fat cuts of meat, full-fat dairy products and some oils. Trans fats can be found in foods such as margarines, store-bought cookies, crackers, doughnuts, and cakes. Trans fats raise low-density lipoprotein (LDL), the "bad" cholesterol, and lower high-density lipoprotein (HDL), the "healthy" cholesterol.
It is important to include healthy foods in your daily diet, such as oatmeal, Omega-3 rich fatty fish, nuts, olive oil, and fiber-rich food, noted Roberts.
- Oatmeal – High in soluble fiber which reduces LDL. Some other healthy whole grains to include in your diet are barley and quinoa.
- Omega-3 rich fatty fish – They can reduce your blood pressure and risk of developing blood clots. The American Heart Association recommends two servings of fish per week. Some fish rich in Omega-3 are mackerel, lake trout, herring, sardines, salmon, and halibut.
- Nuts – All nuts are healthy for you. The suggested amount is 1.5 oz daily. Remember nuts have lots of calories, so use them sparingly. Try some in your salad or cereal for some crunch, or for a snack. Try to steer away from salted or sugar coated nuts.
- Olive Oil – Contains anti-oxidants which lower LDL. Replace saturated fats, such as lard or butter, with olive oil to introduce a healthier fat into your diet. Extra virgin olive oil has the most concentrated anti-oxidants, but if you are new to the taste, start with a lighter version and work your way to the extra virgin. Use olive oil to drizzle over salads, pasta or vegetables after cooking. Remember fats/oils are high in calories, so use sparingly.
- Fiber Rich Foods – Apples, grapes, citrus fruits and strawberries are rich in pectin, a type of soluble fiber that lowers LDL. All vegetables and beans are rich in fiber and very versatile foods. So, include them in your diet daily.
"In addition to changing your diet, keep in mind healthy cooking methods such as baking, broiling or grilling, and do not add extra fat while cooking. Maintaining an ideal body weight can contribute to keeping your cholesterol in check," Roberts said.