Cholesterol: The Good, The Bad, And The Ugly

 What Is Cholesterol? 

Cholesterol is a soft, fat-like, waxy substance found in the bloodstream and in all your body’s cells. It’s normal to have cholesterol because it is used for producing cell membranes and some hormones, and serves other needed bodily functions. But too much cholesterol in the blood is a major risk for coronary heart disease (which leads to heart attacks) and for strokes.  

Cholesterol comes from two sources: your body and food. Your liver and other cells in your body make about 75 percent of blood cholesterol. The other 25 percent comes from the foods you eat.

How Do I Interpret My Lipid Profile?

 Cholesterol can’t dissolve in the blood. It has to be transported to and from the cells by carriers called lipoproteins. Low-density lipoprotein, or LDL, is known as “bad” cholesterol. High-density lipoprotein, or HDL, is known as “good” cholesterol. These two types of lipids, along with triglycerides make up your total cholesterol count. 

LDL (Bad) Cholesterol
When too much LDL (bad) cholesterol circulates in the blood, it can slowly build up in the inner walls of the arteries that feed your organs such as the heart and brain.  It can form plaque, a thick, hard deposit that can narrow the arteries and make them less flexible. This condition is known as atherosclerosis. If a clot forms and blocks a narrowed artery, a heart attack or stroke can result.     

HDL (good) Cholesterol
Approximately one-fourth to one-third of blood cholesterol is carried by high-density lipoprotein (HDL). HDL cholesterol is known as “good” cholesterol, because high levels of HDL seem to protect against heart attack. Low levels of HDL (less than 40 mg/dL) also increase the risk of heart disease.  HDL carries cholesterol away from the arteries and back to the liver, where it’s passed from the body. Some experts believe that HDL removes excess cholesterol from arterial plaque, slowing its buildup.

Triglycerides
Triglyceride is a form of fat made in the body. Elevated triglycerides can be due to being overweight/obesity, physical inactivity, cigarette smoking, excess alcohol consumption and a diet very high in carbohydrates (60 percent of total calories or more). People with high triglycerides often have a high total cholesterol level, including a high LDL (bad) level and a low HDL (good) level. Many people with heart disease and/or diabetes also have high triglyceride levels.  People with high triglycerides also tend to carry more of their fat around their middle.

What Should My Cholesterol Be?

The following guidelines are from the American Heart Association:

Initial classification based on total cholesterol and HDL cholesterol

 

Total Cholesterol Level	Category
Less than 200 mg/dL	Desirable level that puts you at lower risk for coronary heart disease. A cholesterol level of 200 mg/dL or higher raises your risk.
200 to 239 mg/dL	Borderline high
240 mg/dL and above	High blood cholesterol. A person with this level has more than twice the risk of coronary heart disease as someone whose cholesterol is below 200 mg/dL.

 

HDL Cholesterol Level	Category
Less than 40 mg/dL (for men) Less than 50 mg/dL (for women)	Low HDL cholesterol. A major risk factor for heart disease.
60 mg/dL and above	High HDL cholesterol. An HDL of 60 mg/dL and above is considered protective against heart disease.

If your total cholesterol is 200 mg/dL or more, or your HDL cholesterol is less than 40 mg/dL (for men) and less than 50 mg/dL (for women), you need to have a lipoprotein profile done to determine your LDL cholesterol and triglyceride levels. If your cholesterol is high or you have other risk factors, your healthcare provider will likely want to monitor your cholesterol more closely. Follow your provider’s advice about how often to have your cholesterol tested. He or she will set appropriate management goals based on your LDL cholesterol level and other risk factors.

LDL Cholesterol Level	Category
Less than 100 mg/dL	Optimal
100 to 129 mg/dL	Near or above optimal
130 to 159 mg/dL	Borderline high
160 to 189 mg/dL	High
190 mg/dL and above	Very high

Your LDL cholesterol goal depends on how many other risk factors you have.^†

• If you don’t have coronary heart disease or diabetes and have one or no risk factors, your LDL goal is less than 160 mg/dL.
• If you don’t have coronary heart disease or diabetes and have two or more risk factors, your LDL goal is less than 130 mg/dL.
• If you do have coronary heart disease or diabetes, your LDL goal is less than 100 mg/dL and closer to 70.

Triglyceride is the most common type of fat in the body. Many people who have heart disease or diabetes have high triglyceride levels. Normal triglyceride levels vary by age and sex. A high triglyceride level combined with low HDL cholesterol or high LDL cholesterol seems to speed up atherosclerosis (the buildup of fatty deposits in artery walls).  Atherosclerosis increases the risk for heart attack and stroke.

Triglyceride Level	Category
Less than 150 mg/dL	Normal
150–199 mg/dL	Borderline high
200–499 mg/dL	High
500 mg/dL and above	Very high

^† Electronic 10-year risk calculators are available at http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=pub.

 How Much Cholesterol Should I Eat Per Day?

Someone with normal LDL cholesterol should have less than 300mg of total cholesterol per day, and someone with high LDL or who is on a cholesterol lowering medication should get less than 200mg per day.

You can go to the following link to get a report on personalized cholesterol treatment options based on your profile.  http://www.americanheart.org/presenter.jhtml?identifier=3000416

 What Can I Do To Lower My Cholesterol?

 Some cholesterol is made by your body. The food you eat is responsible for the rest. Food products from animals contain cholesterol — including meats, poultry, shellfish, eggs, butter, cheese and whole or 2 percent milk. And any type of food can also contain saturated fats and trans fats, which cause your body to make more cholesterol.

The American Heart Association recommends that you keep your intake of total fat to between 25 percent and 35 percent, your saturated fat consumption to less than 7 percent and your intake of trans fat to less than 1 percent of your total daily calories.

At the same time, limit your intake of cholesterol from food to less than 300 mg per day. People with high LDL (bad) blood cholesterol levels or who are taking cholesterol medication should consume less than 200 mg of cholesterol per day.

Eat at least 25 to 30 grams of dietary fiber each day — preferably from whole grains, fruits, vegetables and legumes.

To combat high blood pressure and for overall cardiovascular health, limit sodium to 2,300 mg or less ( 1 tsp or less) per day. Some people — African Americans, middle-aged and older adults, and people with high blood pressure — need less than 1,500 mg per day. And if you drink alcohol, do so in moderation (no more than one drink a day for women, no more than two for men).

But a heart-healthy diet isn’t just about what you shouldn’t eat. It also means eating a diet rich in vegetables and fruits, with whole grains, high-fiber foods, lean meats and poultry, fish at least twice a week, and fat-free or 1 percent fat dairy products. Also, the diet should be low in saturated fat, trans fat and cholesterol.

By learning to make smart choices — whether you’re cooking at home or eating out — you can enjoy flavorful foods while you manage your cholesterol.

For those of you who need some help in planning and preparing healthy meals, you may want to check out meal planning sites on the web.  Here is a good site that I recommend to my patients:  Healthy Menu Planning

You’ve Put Me On A Cholesterol Lowering Drug, Now What?

We will check your liver every 3 months for at least the next year then determine the frequency of testing.  You should continue to take this every day and follow a low cholesterol diet.  I want to see your LDL below 100 for sure and as low as 70 if you have multiple risk factors (high blood pressure, diabetes, previous heart disease).   You still need to incorporate exercise and a low cholesterol diet into your daily regimen.  A drug can only do so much…

How long do I need to take my statin drug?  Can I just go off it when my cholesterol goes down?

No, studies have shown that statin therapy taken continuously can reduce the long term risk of developing heart disease if you don’t have it and preventing another heart attack/or increasing plaque build up in the coronary arteries if you already have known heart disease. 

 I’ve Heard So Much Bad News About Statins.  Aren’t These Drugs Dangerous?

Here’s the scoop on statins:  If 1,000 people take statins for a year, about 51 will report minor muscle pain. But if 1,000 people take a placebo, about 49 will report such pain. That means that statins are responsible for minor muscle pain in just 2 out of 1,000 people per year. Similarly, statins are responsible for serious muscle pain (called myopathy, severe enough to stop use of the drug) even less often—in about 5 out of 100,000 users per year. Finally, the drugs cause a potentially fatal muscle disorder (rhabdomyolysis) in 1 or 2 out of 100,000 users per year. To put this in perspective, it’s estimated that statins prevent more than 1,500 heart attacks and strokes per 100,000 users each year.