Most of your body’s cholesterol is produced by your liver, but blood cholesterol levels can rise if you eat the wrong foods every day. Blood contains both high-density lipoprotein (HDL), referred to as “good cholesterol,” and low-density lipoprotein (LDL), also called “bad cholesterol.” Too much bad cholesterol over time can lead to the build-up of fatty substances in arteries that can cause blockages as part of cardiovascular disease, and in the worst cases, heart attack or stroke.
Unfortunately, potentially dangerous high cholesterol levels do not always have symptoms. For this reason, everyone is urged to get their cholesterol levels checked – from young adulthood throughout their lifetime. A simple blood test can help save your life or allow you to make lifestyle changes to maintain healthy cholesterol levels to prevent a future cardiac event or heart disease.
Here are 5 steps to keep your cholesterol in check.
Know Your Cholesterol Numbers
A simple blood test to check LDL and HDL cholesterol levels, as well as your triglycerides, is key. An ideal LDL cholesterol level is 100-129 mg/dL; an ideal HDL cholesterol level is 60 mg/dL and above; and an ideal level for triglycerides, below 150 mg/dL. An ideal “total cholesterol” level measuring your HDL, LDL, and triglycerides together is less than 180 mg/dL. A statin medication may be prescribed by your doctor to help lower your LDL cholesterol, which also may have additional health benefits.
Stay active and avoid a sedentary lifestyle to maintain healthy cholesterol levels. You should aim to walk briskly for at least 30 minutes a day, or perform aerobic exercise for at least 30 minutes as part of your everyday routine. This can include exercising at the gym, brisk walking, bicycling, or swimming. The key to success is finding an exercise activity that you love and doing it daily.
A heart-healthy diet low in bad LDL cholesterol and high in good HDL cholesterol is best. To reduce your bad cholesterol, include more colorful fruits, vegetables, whole grain breads and pastas, brown rice, nuts, and some fish, while reducing your intake of red meats, whole milk, eggs, fried foods, fast food, processed foods, trans fat, and saturated fats.
Maintain A Healthy Weight
It is critical to maintain a healthy weight, or a normal body mass index (BMI), to remain heart healthy and keep cholesterol levels under control. BMI is a number calculated based on a person’s height and weight. A healthy BMI is between 18.5 and 24.9; more than 25 is considered overweight; and 30 or greater is considered obese.
Cigarette smoke narrows and damages the arteries of the body. Smoking can lead to extra buildup of cholesterol inside or lining the body’s arteries, so it is important to not smoke – or quit if you are a smoker.
Keeping Your Numbers In The Green
Good or bad, our cholesterol levels affect our daily lives. They affect our risk for certain conditions, and lifestyle changes can be required to keep them in control. “Good cholesterol recycles cholesterol and fat in the body,” says Alex Garton, MD, noninvasive cardiologist at PinnacleHealth CardioVascular Institute. “What we call bad cholesterol is deposited into the blood vessels, increasing the risk of vascular disease. HDL can help prevent this by ‘recycling’ excess amounts of bad cholesterol.”
“Total cholesterol” can be deceiving, so be sure you know the numbers for both your “bad” cholesterol and “good” cholesterol,” Garton continued. “But while knowing your numbers is important, cholesterol levels don’t always tell the whole story. Smoking cigarettes, having high blood pressure or having a family history of early heart disease can also increase a patient’s cholesterol-related risks,” says Dr. Garton. “These factors actually lower the LDL cholesterol number that signifies a patient is at risk for heart disease.”
Other factors that can lower the threshold at which LDL levels become a concern include diabetes, obesity and a family history of unhealthy cholesterol levels. The American College of Cardiology and American Heart Association recently released new treatment guidelines for cholesterol levels. These guidelines outlined a new method for estimating a patient’s future risk of cardiovascular disease.
“Using the new method and population health statistics, more people would be recommended to take statins – cholesterol-lowering drugs – than before,” Dr. Garton says. “Under the new recommendations, candidates for statins include patients with a history of atherosclerotic cardiovascular disease, anyone with very high LDL levels, and anyone between the ages of 40 and 75 who lives with Type 2 diabetes.”
Statins are more effective at lowering cholesterol than the majority of other cholesterol-lowering drugs and can reduce a patient’s risk of premature death, heart attack, stroke and blood clots. You doctor may recommend that drug therapy be combined with a diet low in saturated fat, trans fat, cholesterol, sodium, and added sugars that is also rich in fruits, vegetables, fiber-rich whole-grain foods, and fat-free and low-fat dairy.
The American Heart Association recommends all adults age 20 or older have their cholesterol, and other traditional risk factors, checked every four to six years. High cholesterol often shows no symptoms, so the best way to protect yourself is to be screened regularly.
What To Do About IDL Cholesterol?
Eating fatty fish increases the size and lipid composition of HDL particles in people with impaired glucose metabolism, according to a recent study from the University of Eastern Finland. These changes in the size and lipid composition of HDL particles make them beneficial for cardiovascular health. Published in Molecular Nutrition & Food Research, the study also found that camelina sativa oil decreases the number of harmful IDL particles.
The researchers studied the effects of camelina oil and fatty fish intake on the size and composition of cholesterol-carrying lipoproteins. The HDL lipoprotein is commonly known as “the good” cholesterol, although the health effects of HDL particles actually are dependent on their size and composition. Earlier research has shown that large HDL particles are associated with a reduced risk of cardiovascular diseases, whereas a small HDL particle size may increase the risk.
The IDL lipoprotein, on the other hand, is the precursor of LDL, which is also known as “the bad” cholesterol. Previous studies have shown that long-chain omega-3 fatty acids found in fish have a beneficial effect on lipoprotein size and composition. Camelina oil, on the other hand, is rich in alpha-linolenic acid, which is an essential omega-3 fatty acid whose associations with lipoproteins aren’t well understood yet.
The study involved 79 Finnish men and women aged between 40 and 72, and with impaired glucose metabolism. Study participants were randomly divided into four groups for a 12-week intervention: the camelina oil group, the fatty fish group, the lean fish group, and the control group. People in the lean and fatty fish groups were instructed to eat lean or fatty fish four times a week, and people in the camelina oil group were asked to use 30 milliliters of camelina sativa oil daily. Participants in the control group were allowed to eat fish once a week, and the use of camelina oil and other oils containing alpha-linolenic acid, such as rapeseed oil, was prohibited.
The researchers found that eating fatty fish increased the size and lipid composition of HDL particles, and that the use of camelina oil decreased the number of harmful IDL particles. Both of these changes can reduce the risk of cardiovascular diseases. Eating lean fish, however, was not associated with changes in the number, size or composition of lipoprotein particles.
Follow-Up Cholesterol Testing
If you have a heart attack or stroke, it’s important to get your “bad” cholesterol measured by your doctor on a follow up visit. Researchers have found that one step is significantly associated with a reduced risk of suffering another serious cardiovascular episode. Recent research, conducted by researchers at the Intermountain Medical Center Heart Institute in Salt Lake City, found that patients who don’t follow up with their doctor by getting an LDL cholesterol test following a heart attack or stroke are significantly more likely to have a recurrence.
Researchers found a significant and clinically meaningful difference in major adverse outcomes – including death, a heart attack, a stroke, and a vascular bypass or an angioplasty – based on whether or not a patient has a follow-up measurement of their LDL cholesterol. Researchers say the results of the study suggest LDL cholesterol levels should be regularly measured after an initial heart attack or stroke. LDL is the “bad” cholesterol, and main source that becomes part of the plaque that clogs arteries and makes heart attacks and strokes more likely.
“It’s clear that anyone with a previous heart problem caused by clogged arteries should be taking a cholesterol-lowering medication,” said Kirk U. Knowlton, MD, lead author of the study and director of cardiovascular research at the Intermountain Medical Center Heart Institute.
The study of more than 60,000 patients with known heart disease, cerebrovascular disease or peripheral artery disease, including stroke and heart attack patients, showed the major adverse clinical event rate was lower in both patients who took cholesterol-lowering statins and those who didn’t if their LDL was measured. “The large difference is surprising,” Knowlton said. “The risk of dying after three years with no LDL follow-up is 21 percent versus 5.9 percent for patients who have an LDL follow-up.”
Take Your Cholesterol Medications
The Intermountain Medical Center Heart Institute study reviewed Intermountain Healthcare’s enterprise data warehouse, one of the nation’s largest depositories of clinical data, to identify all adults who came to one of Intermountain’s 22 hospitals for the first time with a heart attack or stroke. These included patients with coronary artery disease, cerebrovascular disease, and peripheral arterial disease admitted between January 1, 1999, and December 31, 2013. Researchers looked at patients who survived and were followed for three years or more, or until their death. Patient demographics, history, prescribed medications, and whether LDL was measured was analyzed.
“We looked at a variety of parameters – which represents one real benefit Intermountain offers to medical researchers and providers nationwide,” Knowlton added. “They’ve been collecting data since the 1990s and it’s a phenomenal data set.”
The study compared 62,070 patients in the database who met the study criteria. The average age was 66 years old, with 65 percent of patients being male. Of those who met the criteria, 69.3 percent had coronary artery disease, 18.6 percent had cerebrovascular disease, and 12.1 percent had peripheral arterial disease when they came to the hospital with their first heart attack or stroke. Researchers found the risk of a patient having a secondary event or dying decreased in those who had a follow-up LDL test before a subsequent adverse outcome or before the end of their follow-up.
The study reinforces how important it is for patients to continually take their cholesterol medications. “Patients need to know that if they’ve had a cardiovascular event, continuing to take their medications will not only lower their LDL, but substantially lower their risk of having another event,” Knowlton said. “We need to emphasize to doctors how important it is to follow up therapy for patients with measurement of their LDL cholesterol. And patients need to talk to or ask their doctors about the test, especially if they’ve had a heart attack or stroke.”