If you’re like most people, you know it’s important to keep your cholesterol in a healthy range. According to the Center for Disease Control and Prevention (CDC), that means less than 100 mg / dL low density lipoprotein (LDL), more than 60 mg / dL high density lipoprotein (HDL), and less than 150 mg / dL triglycerides.
But in addition to simply knowing whether your cholesterol is too high or not, understanding the role cholesterol plays in promoting and preventing disease can help you stay healthy, says Deirdre Mattina, MD, a preventive cardiologist at the Cleveland Clinic. “Knowing more about your cholesterol helps you have a more informed conversation with your doctor. This can help your healthcare team identify your risk for heart disease early and develop a treatment plan that will help you live longer with plenty of vitality, ”she says.
So, what do you need to know about cholesterol to prevent heart disease, strokes, and more? Read more.
1. Total cholesterol is only part of the picture.
When you get your blood test results back, chances are you are focusing on your total cholesterol, targeting that one number. Dr. However, Mattina says that what’s more important than total cholesterol is understanding each of the different components that make up that score. “You really have to break down the different types of cholesterol to get the full picture,” says Dr. Mattina. A typical cholesterol test measures the following:
- LDL: This is considered the ‘bad’ cholesterol because it leads to plaque buildup in your arteries and increases the risk of heart attack and stroke. (The more build-up, the stiffer and narrower your arteries, and the more difficult it is for blood to flow freely to and from the heart.) For the general population, less than 100 is ideal, and a score above 160 is considered high. However, if you’ve already been diagnosed with heart disease, you want your LDL to be lower than 70 – and possibly even lower, adds Randal Thomas, MD, medical director of the Mayo Clinic’s Cardiac Rehabilitation Program.
- HDL: This is considered the “good” cholesterol because it is carries LDL cholesterol away from the arteries and back to the liver, where it is broken down and flushed out of the body. For men, the ideal range is between 40 and 100 HDL; for women, 50 to 100 is ideal, says Dr. Thomas
- Triglycerides: This is a type of fat in the blood that your body uses for energy. For most people, a triglyceride score of over 150 is considered high, says Dr. Thomas, and over 1000 is dangerously high. The combination of high triglycerides with low “good” HDL cholesterol or high “bad” LDL cholesterol can increase your risk of heart attack and stroke.
To get a more accurate picture of how your cholesterol might put you at risk for heart disease, add all three of these cholesterol components and then subtract your HDL number. “Which number tells us how many particles of cholesterol are circulating that put you at risk, ”says Dr. Mattina. (According to the CDC’s guidelines, you want this number to be 250 mg / dL or less.)
2. Even if you have normal cholesterol you can have a heart attack.
Especially for women, the new thinking is that it is not only cholesterol particles that transmit the risk of heart disease, but also how that cholesterol behaves, says Dr. Mattina. “Many people with normal cholesterol have a heart attack, and that’s probably because their cholesterol acts in an anti-inflammatory way,” she says.
The best way to find out if you have inflammatory cholesterol particles in your blood is to ask for a high-sensitivity C-reactive protein (CRP) test, says Dr. Mattina. “This is not checked in a typical cholesterol panel and is not specific for heart disease, but it gives your doctor a sense of general inflammation in your body,” which will then help guide your treatment plan. (CRP is a byproduct of inflammation, and experts agree that it is just as good at predicting heart disease as it is measuring LDL.)
If your C-reactive protein is elevated, your doctor may also prescribe one coronary calcium score to better understand your risk of heart disease. That test involves a low-dose radiation scan of the heart to look for hardened cholesterol in the arteries, says Dr. Mattina. “If you have an elevated calcium score, that tells us that there is some hardened cholesterol in the arteries around the heart,” she says. “That’s when we want to consider cholesterol-lowering drugs as a treatment option to prevent heart attack.”
Eating well can improve your cholesterol score, but it may still be necessary medicines.
There is no question that certain unhealthy habits will cause an increase in your triglycerides and LDL cholesterol and lower your HDL levels. According to the American Heart Association, eating a diet high in saturated fats and simple carbohydrates, smoking, insufficient exercise, and being overweight or obese negatively affect your cholesterol and increase the risk of heart disease. On the other hand, improving your diet by choosing healthier fats and increasing your fiber intake, exercising more and quitting smoking can go a long way in controlling your cholesterol.
That said, even if you make the right choices to improve your cholesterol profile, medication may still be necessary – and it’s important to understand that you may not be able to improve your cholesterol with lifestyle measures alone, says Dr. Mattina. “This is especially true if you’ve had a heart attack, when we need to drastically lower your LDL cholesterol,” she says. “However, if you make major changes in your habits, you can affect the total dose or amount of cholesterol medication you need to take for maintenance.”
4. Preventive cardiologists can help you control cholesterol and heart health.
Since heart disease is the number 1 killer in this country, most of our lives with high cholesterol, says Dr. Mattina – and the longer cholesterol lingers in the bloodstream, the more likely it is to build up in your arteries, causing plaque build-up and inflammation spikes. In addition, there is very little data showing that we can reverse the damage caused by high levels of “bad” cholesterol, she says. “The best we can do is stabilize cholesterol and keep it from getting worse,” says Dr. Mattina. Which means prevention is key. And the sooner you start, the better. “
If you have a family member who had a heart attack in his or her 30s or 40s, your doctor may suggest seeing a cardiologist if you’re in your 20s, Dr. Mattina says. “I also like to see women in their childbearing years, regardless of family history, because we see that the risk of heart disease increases when women develop gestational diabetes and preeclampsia during pregnancy.” Chronic conditions that cause chronic inflammation, such as autoimmune diseases like lupus and rheumatoid arthritis, can also put you at a higher risk for heart disease – even if your cholesterol isn’t high, Dr. Mattina adds. Ask your doctor what she thinks is right for you, given your health history.
If you want to be proactive, make an appointment with a preventive cardiologist no matter how old you are or what your risk factors are, says Dr. Mattina. “This type of specialist can assess your cholesterol and overall risk of heart disease and help you develop a long-term health plan,” she says. “When it comes to heart disease, the sooner you identify your risk and treat it if necessary, the better.”
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