Cholesterol Primer

Here's what you need to know about lowering cholesterol
Health Center Cholesterol
JANUARY, 2008 — High cholesterol is a risk factor for many serious conditions. That's why it's critical to know all about this substance in your bloodstream that, in its bad form, can increase your risk of heart disease and diabetes and, in its good form, can reduce your risk of developing them.

Here's what you need to know.

What is cholesterol?
Cholesterol is a waxy fat-like substance produced by your body and found in the foods you eat. It's important in the building of cell membranes and some hormones and serves other needed bodily functions.

Cholesterol moves through the bloodstream by means of lipoproteins — proteins with fat content.

Total Cholesterol Ranges

  • Desirable total cholesterol: less than 200 mg/dL
  • Borderline-high cholesterol: 200 to 239 mg/dL
  • High cholesterol: 240 mg/dL and up

LDL Ranges

  • Optimal level of LDL: less than 100 mg/dL
  • Nearly optimal: 100 to 129 mg/dL
  • Borderline high: 130 to 159 mg/dL
  • High: 160 to 189 mg/dL
  • Very high: 190 mg/dL and above

Note: People with a known heart problem, diabetes, or both, should aim for numbers even lower than these. Talk to your doctor for more information.

Lipoproteins are classified according to density. Research has shown that low-density lipoproteins (LDL) are linked to increased risk of heart disease, while high-density lipoproteins (HDL) reduce your risk.

The likelihood of having high cholesterol goes up with age. Additional risk factors include diabetes, poor diet, obesity, smoking, alcoholism, high blood pressure and physical inactivity.

Additionally, heredity plays a key role in the cholesterol your body makes. An athlete with only 5 percent body fat but with the gene for "high cholesterol," may need to closely monitor his or her diet, eliminating fried foods, for example. If you don't know your family's cholesterol history, it's especially important to get tested.

Get a fasting blood test
The National Cholesterol Education Program (NCEP) guidelines recommend that people age 20 and older get a fasting blood test — meaning blood is drawn after 10 to 12 hours without food. The test measures your cholesterol in milligrams per deciliter of blood (mg/dL).

Called a lipid profile and used in the evaluation of coronary risk factors, this test will show your total cholesterol and levels of what Paul. D. Thompson, MD, director of preventive cardiology at Hartford Hospital in Hartford, CT, dubs the good, high-density lipoprotein (HDL); the bad, very high-density lipoprotein (VLDL/triglycerides); and the ugly, low-density lipoprotein (LDL). The basis of the total cholesterol count is defined as the sum of HDL, LDL and VLDL (very low density lipoprotein).

HDL: The "good" cholesterol
Cholesterol tends to get a bad rap, but not all cholesterol is harmful. "HDL has a protective effect over future heart disease," says cardiologist and author Steven Keteyian, Ph.D. It works in the body by carrying cholesterol away from the arteries to the liver, where it is passed from the body. For HDL cholesterol, the higher numbers the better, and low HDL, less than 40 mg/dL(more specifically, less than 37 mg/dL in men and less than 47 mg/dL in women) is cause for concern because it increases your risk of heart disease.

LDL: The "bad" cholesterol
LDL is the artery-clogging substance that doctors keep an eye on most. "If you have high cholesterol, often, but not always, it's due to high LDL," says Thompson.

With a high LDL level, fats stick to the lining of blood vessels, contributing to atherosclerosis, the build-up of plaque on the inner lining of medium- and large-size arteries. This constricts blood flow, making the arteries vulnerable to rupturing. Ruptures cause blood clots that can either travel to the heart and cause a heart attack, or to the brain and cause a stroke.

Take control
Heredity, age and gender all play a part in your cholesterol total. While you may not be able to control these factors, there are other risk factors you can control. Before prescribing medication for treating high cholesterol, doctors usually recommend certain changes in lifestyle, which can all contribute to improving cholesterol levels. Luckily, lowering cholesterol may be relatively easy. Here's what you can do:

1. Quit smoking
If you smoke, you've probably heard over and over how smoking clogs your lungs and arteries. But stopping smoking also can help your cholesterol. It's another reason to quit once and for all.

2. Lose weight
With most people, the chief way to control cholesterol is by weight loss, says Keteyian. Losing just 10 percent of your body weight can help to lower cholesterol levels along with reducing your risk of diabetes and lowering blood pressure.

3. Exercise
The biggest effect exercise has is boosting HDL cholesterol and lowering triglycerides. But to have a significant lowering effect, you'll need to be active for at least 30 minutes per day most days of the week.

4. Lower your fat intake
"To get your LDL down, the most important thing is to reduce your saturated fats, which are found in animal meats, milk and tropical oils," says Thompson. Focus on a diet rich in fruits and vegetables, low-fat dairy and other lean protein sources, and whole grains. Eliminate fried food and skip the fast food drive-thru: The trans fats or hydrogenated fats found in processed food raise LDL and decrease HDL.

5. Control alcohol intake
If you drink, don't have more than two drinks a day. Alcohol's effect on the liver is legendary, and with it comes a raised cholesterol total. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of hard liquor.

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