Cholesterol: What You Need to Know

Smiling woman with long curly hair holding her hands in the shape of a heart over her chest.

There are important medical numbers associated with your body and its functions that provide vital information to understanding the state of your personal health, like those reflecting your Body Mass Index (BMI), blood pressure and weight, among others.

But there are additional numbers which greatly impact the quality of your personal health: your blood cholesterol levels.  Your blood cholesterol levels provide significant data that not only educate you and your doctor about the status of your cardiovascular health, but also your susceptibility to cardiovascular and additional potential health risks you may encounter within your lifetime.

Cholesterol education and awareness is crucial to optimization of cardiovascular and overall health. Many serious health conditions such as diabetes, obesity, hypertension, stroke, heart attack and heart disease can stem from having high numbers associated with bad cholesterol levels. These conditions can negatively impact quality of life and can even lead to premature death.

More than 1 million Americans have a heart attack each year and about 500,000 die of heart disease, the leading cause of death in the U.S., according to the Centers for Disease Control and Prevention (CDC.) High blood cholesterol is 1 of the major risk factors for heart disease, causing heart attack and stroke.

Despite the dangers of high cholesterol and heart disease, many may not completely understand their link, or even know if they have these risk factors which can jeopardize and deteriorate cardiovascular health.

September is National Cholesterol Education Month, a good time to have your blood cholesterol checked and take steps to lower it should it be determined too high, learn about lipid profiles plus important food and lifestyle choices you can implement to achieve and maintain normal cholesterol levels.

Your Capital Women’s Care team offers important knowledge to empower you and increase your awareness of the substantial role your blood cholesterol numbers have in your cardiovascular health and offers you guidance on reducing personal risk factors so you can you achieve and maintain your cholesterol goals to optimize your overall health and quality of life.

What Is Cholesterol?

Cholesterol is a waxy, fat-like substance that is found within your body and many animal-based foods laden with saturated fats. Your body needs cholesterol to function. Your body uses it to make hormones and bile acids to aid food digestion and the absorption of nutrients from within your intestines.

Your cells and liver produce cholesterol and normally and make all that your body requires for proper function. Blood cholesterol level is affected not only by what you eat but also by how quickly your body makes LDL ("bad") cholesterol and disposes it. In fact, your body makes all the cholesterol it needs, and it isn’t necessary to take in any additional cholesterol from foods. Additional intake of cholesterol from animal-based foods containing saturated fats can increase your body’s cholesterol to unhealthy levels, resulting in an increased risk of potential heart disease and other serious health conditions. 

There are 2 cholesterol types:

  • LDL (low-density lipoproteins) – also known as “bad cholesterol,” this is the main source of cholesterol build up and blockage within the arteries, which can eventually narrow arteries, increasing heart disease and stroke risks. LDL lipoprotein deposits cholesterol on the artery walls, causing the formation of a hard, thick substance called cholesterol plaque. Over time, cholesterol plaque causes thickening of the artery walls and narrowing of the arteries, a process called atherosclerosis.

Multiple clinical studies show a definitive relationship between an increased LDL level and increased cardiovascular events risk, such as heart attack and stroke. In fact, LDL is a leading risk factor for heart disease worldwide.

According to the Centers for Disease Control and Prevention (CDC), more than 71 million American adults have high LDL. This puts them at risk of heart disease, the number 1 cause of death globally. There are an estimated 17.3 million deaths a year from heart disease worldwide. This number is projected to reach 23.3 million by 2030.

  • HDL (high-density lipoproteins) – known as “good cholesterol,” this form keeps LDL cholesterol from building up within the arteries, thus protecting against heart disease which results in plaque build-up. The greater the HDL level, the better your protection from heart disease.

Another form of fat called triglycerides is also found within the blood. High triglycerides levels can also increase heart disease risk.

Children, young adults and older Americans can all have high LDL cholesterol levels.

Sobering Statistics

High cholesterol is a growing health concern in the U.S, as evidenced in these statistics:

  • In 2015–2016, more than 12% of adults age 20 and older had total cholesterol higher than 240 mg/dL, and more than 18% had high-density lipoprotein (HDL, or “good”) cholesterol levels less than 40 mg/dL.
  • More than half of the U.S. adults (55%, or 43 million) who could benefit from cholesterol medicine are currently taking it.
  • 95 million U.S. adults age 20 or older have total cholesterol levels higher than 200 mg/dL. Nearly 29 million adult Americans have total cholesterol levels higher than 240 mg/dL.
  • 7% of U.S. children and adolescents age 6 to 19 have high total cholesterol.
  • High cholesterol has no symptoms, so many people don’t know that their cholesterol is too high.
  • Having high blood cholesterol raises risk for heart disease, the leading cause of death, and for stroke, the 5th leading cause of death.

 It is important to know how you can prevent high LDL cholesterol levels, your personal risk factors and how you can reduce your risks so you can enjoy optimal cardiovascular health.

High Cholesterol Risk Factors  

There are several risk factors for high cholesterol levels, including:

  • Genetics – Some people inherit genes which may cause their body to produce too much LDL cholesterol or keep their body from absorbing enough cholesterol. High LDL cholesterol levels can happen even when not you are eating food high in cholesterol.

Many factors can cause high LDL cholesterol levels, including the genetic condition called familial hypercholesterolemia (FH), estimated to affect 14 to 34 million people worldwide.

 There are 2 types of FH:

 Heterozygous FH (HeFH) is more common and occurs in approximately 1 in 200 to 500 people. People with HeFH have LDL levels twice as high as normal and can have heart attacks at an early age.

Homozygous FH (HoFH) is the rare, more severe form, occurring in approximately 1 in a million individuals. People with HoFH have LDL levels in the range of 650 to 1,000 mg/dL, or more than 6 times higher as normal, and often develop heart disease in their 20s or even earlier in severe instances.

FH doesn’t always present with symptoms, which means many people are unaware of their risk. Less than 1 percent of people with FH in most countries are diagnosed and many don’t know the condition’s risks until it is too late. The good news is that FH can be diagnosed with a simple blood test and a reported family history of early cardiovascular disease. Genetic testing can be used to confirm FH presence. With early and regular treatment, individuals facing FH can live longer, healthier lives.

  • Lifestyle – People having a diet filled with saturated fats and cholesterol risk elevated LDL cholesterol levels, which can lead to heart disease and other serious health consequences including stroke and even death. A healthy diet low in saturated fats and cholesterol is a major component to reduce cardiovascular health risks. 
  • Weight – High body weight tends to increase LDL cholesterol levels. A healthy weight not only lowers LDL levels but is particularly important if you face additional risk factors like low HDL levels or high triglycerides levels.
  • Physical Activity – Regular exercise – about 30 minutes a day -- can decrease detrimental LDL levels and raise beneficial HDL levels. This is especially important for those with high triglycerides levels and/or low HDL levels who are overweight and have a large waist measurement.
  • Age and sex.Before menopause, women usually have total cholesterol levels that are lower than those of men the same age.

As women and men get older, blood cholesterol levels rise until about age 60 to 65.

After about age 50, women often have higher total cholesterol levels than men of the same age, making testing of women’s cholesterol levels doubly important during this stage of life.

  • Alcohol.Alcoholintake increases HDL “good” cholesterol but does not lower LDL “bad” cholesterol. Doctors don't know for certain whether alcohol also reduces risk of heart disease. Drinking too much alcohol can damage the liver and heart, lead to high blood pressure, and raise triglycerides. Because of the risks, alcoholic beverages should not be used to prevent heart disease. 
  • Stress.Long-term stress has been shown in several studies to raise cholesterol levels. One way that stress may do this is by affecting your habits. For example, when some people are under stress, they may console themselves by eating fatty foods. The saturated fat and cholesterol found within these comforting foods contribute to higher “bad” cholesterol levels. 
  • Smoking habits. Smoking adversely affects your cardiovascular health. Make it a priority to quit.

Knowing your family history, early screening and diagnosis are essential to help lower your risk for heart disease.

Cholesterol Screening

High LDL cholesterol levels usually don’t present any symptoms. As a result, many people do not know they have unhealthy cholesterol levels.

However, your doctor can do a simple blood test called a lipoprotein profile to measure your total cholesterol levels, including LDL (low-density lipoprotein, or “bad” cholesterol), HDL (high-density lipoprotein, or “good” cholesterol), and triglycerides.

The following are optimal lipid levels for adults (levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood:

  • Total cholesterol – less than 200 mg /dL
  • LDL (bad) cholesterol – less than 100 mg/dL
  • HDL (good) cholesterol – 40 mg/dL or higher
  • Triglycerides – less than 150 mg/dL

HDL cholesterol protects against heart disease, as higher numbers are better. A number less than 40 mg/dL is low and considered a major increased risk factor for developing heart disease. HDL levels of 60 mg/dL or greater can help lower heart disease risk.

Too many triglycerides can also raise heart disease risk. Levels that are borderline high (150-199 mg/dL) or high (200 mg/dL or greater) may require treatment in some instances.

It’s important to have cholesterol levels checked regularly. High cholesterol is a major risk factor for heart disease, the leading cause of death in the U.S. The American Heart Association (AHA) recommends adults 20 years and older have cholesterol checked every 4 to 6 years.

Experts agree screening young adults who have other risk factors for coronary heart disease, including obesity, smoking, high blood pressure, diabetes and family history. Less than half of young adults who have these risk factors don’t get cholesterol screening, even though up to 25% of them have elevated cholesterol levels.

Additionally, children and adolescents can have high cholesterol. High cholesterol can develop in early childhood and adolescence, and risk increases as weight increases. In the U.S., more than 20% of youth ages 12 to 19 years have at least 1 abnormal lipid level.

It is important for children over 2 years to have cholesterol checked if they are overweight/obese, have family history of high cholesterol, family history of heart disease, diabetes, high blood pressure, or certain chronic condition (such as chronic kidney disease, chronic inflammatory diseases, congenital heart disease, and childhood cancer survivorship.)

High cholesterol can be controlled through lifestyle changes or the addition of medications if lifestyle changes alone don’t improve cholesterol levels to reach healthy levels.

Lowering Cholesterol

If your cholesterol levels are unhealthy, your doctor can guide you to implement several actions to help lower unhealthy cholesterol levels, including following Therapeutic Lifestyle Changes, better known as TLC:

  • Implement the TLC diet – this is a low saturated fat, low-cholesterol eating plan that calls for less than 7% calories from saturated fat and less than 200 mg of dietary cholesterol daily. TLC diet recommends enough calories to maintain healthy weight and avoid weight gain.

Foods to aid in lowering cholesterol include foods low in saturated fat, including fat-free or 1% dairy products, lean meats, fish, skinless poultry, whole grains, and fresh fruits and vegetables. Limit high cholesterol foods like liver and other organ meats and full-fat dairy products.

If your LDL cholesterol is not lowered enough by lowering saturated fat and cholesterol intake, you can increase your diet’s soluble fiber. Good sources of soluble fiber include oats, oranges, pears, brussels sprouts, carrots, dried peas and beans.

  • Weight management – losing weight if you are overweight can help lower LDL cholesterol levels and is especially important for those having a cluster of risk factors that includes high triglyceride levels and/or low HDL levels plus being overweight with a large waist measurement (40+ inches for men; 35+ inches for women.) 
  • Physical activity – regular physical activity (30 minutes on most, if not all, days) is recommended for everyone. For adults, getting at least 2 hours and 30 minutes of moderate or 1 hour and 15 minutes of vigorous physical activity a week. For those aged 6-17, getting 1 hour or more of physical activity each day. 

Physical activity can raise HDL levels while lower LDL levels and is especially important for those with high triglyceride levels and/or low HDL levels who are overweight with large waist measurement.

  • Eliminate smoking -- Don’t smoke or quit if you do.

If the above measures don’t move your cholesterol levels into healthy ranges, your doctor may suggest adding drug treatment to your personal health plan while continuing recommended healthy lifestyle changes.

There are several types of drugs available to lower cholesterol, including statins, bile acid sequestrants, nicotinic acid, fibric acids and cholesterol absorption inhibitors. Your doctor will perform a comprehensive review of your overall health to help determine the best treatment approach. Depending on your specific cholesterol level lipoprotein profile, your doctor may recommend one or more of the above medicine types in a combination therapy.

Your Capital Women’s Care team is here to increase your awareness of your cholesterol numbers and discuss how they correlate to your personal cardiovascular and overall health. We can answer your questions, help you optimize your cardiovascular health and guide you through personalized treatment recommendations to get you on the right path to maintaining a healthier life.

Sources:

https://www.amgen.com/media/featured-news/2014/09/september-is-national-cholesterol-education-month/

https://www.cdc.gov/cholesterol/cholesterol_education_month.htm

https://www.cdc.gov/cholesterol/facts.htm

https://www.medicinenet.com/script/main/art.asp?articlekey=14638

https://www.heart.org/-/media/files/professional/million-hearts/national-cholesterol-education-month-ucm_500458.pdf?la=en

https://www.world-heart-federation.org/world-heart-day/

https://meridienresearch.net/september-national-cholesterol-education-month/

https://www.heart.org/en/healthy-living/healthy-lifestyle/my-life-check--lifes-simple-7/ls7-cholesterol-infographic

https://www.fda.gov/drugs/drug-safety-and-availability/cholesterol-and-statins-infographic

https://nationaltoday.com/national-cholesterol-education-month/

https://www.nhlbi.nih.gov/health-topics/all-publications-and-resources/high-blood-cholesterol-what-you-need-know

https://thefhfoundation.org/familial-hypercholesterolemia/what-is-familial-hypercholesterolemia

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