By Judith Hurley, R.D.
It’s hard to miss the message that too much fat and cholesterol are bad for your heart. Food packages read contains no cholesterol, and newspapers routinely carry the latest research findings linking a high-cholesterol diet with heart disease. Yet heart disease is still the number one cause of death for both men and women.
According to health experts, you can help keep your health on track by getting your cholesterol checked. The National Cholesterol Education Program recommends that adults ages 20 and older have a cholesterol test every five years. That’s because high cholesterol has no symptoms, so you won’t know if you have it unless you get tested.
The greater the cholesterol buildup in the blood, the greater the risk for heart disease or heart attack. If your cholesterol is high, you can take steps to lower it through diet, exercise and, if necessary, medication.
Start by learning about cholesterol, how it forms in your arteries and what you can do to lower it. This guide can help you make a heart-smart plan to keep your cholesterol level in check.
Cholesterol is a soft, waxy, fatlike substance. It is found in animal foods, such as meat, dairy products and eggs, and is also manufactured by the body. Although some cholesterol is essential to health, too much is a problem. Excess cholesterol sticks to blood vessel walls, narrowing the passage. When the large blood vessels to the heart become narrowed, the heart can’t get enough blood and oxygen. This can cause chest pain or even a heart attack or stroke.
A simple blood test will determine your cholesterol levels. A total cholesterol level of 200 milligrams per deciliter (mg/dl) or less is optimal. Between 200 and 239 is considered borderline-high, and 240 or greater is high.
Get your total cholesterol checked. Write the total here: _______
But there’s more to the picture. Cholesterol travels in two directions. “Bad cholesterol,” or LDL cholesterol, is deposited on artery walls. “Good cholesterol,” or HDL cholesterol, travels away from the arteries. Because it’s important to know how much of each type a person has, many doctors order a “cholesterol panel” or “lipid profile” rather than just a single “total cholesterol” test.
To protect the heart, the National Cholesterol Education Program currently recommends that LDL cholesterol be no higher than 160 in people at low risk for heart disease, no higher than 130 in people at moderate risk, and below 100 in people at high risk. Heart disease risk factors include male gender, age over 45, tobacco use and high blood pressure. Experts recommend an LDL cholesterol level below 70 for people at very high risk — those with heart disease or diabetes and other risk factors. HDL cholesterol should be at least 40, and 60 or greater is optimal.
Get your HDL and LDL cholesterol checked. Write the totals here:
HDL _______
LDL _______
Doctors often look at the ratio of total cholesterol to HDL cholesterol. The goal is to have a ratio of no more than 5-to-1, or no more than five times as much total cholesterol as HDL cholesterol. According to the American Heart Association, a ratio of 3.5-to-1 is optimal.
Find out your ratio. Write it here: _______
How do your levels compare to the recommended cholesterol guidelines? If you need to lower your cholesterol, start by taking the steps outlined below.
For people at risk for heart disease, the National Cholesterol Education Program and the American Heart Association recommend making therapeutic lifestyle changes (TLC). These changes include consuming a diet with less than 7 percent of calories from saturated fats and less than 200 mg of cholesterol every day.
Both saturated fats and dietary cholesterol raise LDL cholesterol, although saturated fat is the biggest culprit. Saturated fats and cholesterol are found in animal foods such as meat, whole milk, cheese, eggs, butter and cream. Experts recommend limiting meat consumption to no more than three 3-ounce servings a week and consuming low-fat or nonfat dairy products.
What do you eat most often that is high in saturated fat?
Write down what you plan to cut back on: __________________________________________________
When it comes to raising LDL cholesterol, experts have recently recognized a new culprit called trans fat. Trans fat is created when vegetable oil undergoes a process called hydrogenation, which makes it solid at room temperature and therefore less likely to become rancid. Trans fat is found in many of the packaged foods in supermarkets, where a long shelf life is needed. Read food labels carefully, especially on baked goods like pastries, crackers and cookies, and avoid foods containing hydrogenated or partially hydrogenated vegetable oils. Some food labels list the actual grams of trans fat in a serving, but food manufacturers are not required to do this until 2006, when a new regulation takes effect. Some food manufacturers are starting to make products without trans fat, so look for these new items in the grocery store.
What do you eat most often that is high in trans fat?
Write down how you plan to cut back on trans fat: __________________________________________________
The TLC approach also encourages eating plenty of “heart-healthy” foods. Oats, beans, soy products, tree nuts (like walnuts and pecans), fruits, vegetables and margarines containing plant sterols are all foods in this category. They contain fiber, heart-healthy oils, antioxidants or other plant chemicals that help lower cholesterol.
List three “heart-healthy” foods you plan to add to your diet this month:
1. __________________________________________________
2. __________________________________________________
3. __________________________________________________
Other lifestyle changes that help lower LDL cholesterol and raise HDL cholesterol are quitting smoking, losing weight and getting regular aerobic exercise. If diet and lifestyle changes aren’t enough, you may need medication. Several medications are available, and you can work with your doctor to choose the one that’s right for you.
To find out more about cholesterol and what you can do to lower it, visit the following Web sites:
National Heart, Lung, and Blood Institute www.nhlbi.nih.gov
American Heart Association www.americanheart.org
Here’s a brief primer on medicines that are used to help manage cholesterol. It’s a good idea to talk with your doctor about the prescriptions and over-thecounter drugs you are taking and any potential food or drug interactions.
- Statins, such as lovastatin and simvastatin, slow the body’s production of cholesterol. They also help the liver remove harmful LDL cholesterol from the blood.
- Bile acid sequestrants, such as cholestyramine and colestipol, latch on to cholesterol in the digestive tract and carry it out of the body in the stool. These drugs also lower harmful LDL cholesterol. They come as tablets or as a powder to mix into water or juice.
- Niacin is a water-soluble B vitamin. In high doses, one form of niacin called nicotinic acid lowers total cholesterol and reduces triglyceride, another type of fat in the blood. Nicotinic acid also raises beneficial HDL cholesterol. High-dose niacin comes in three forms: immediate release, timed release and extended release. Niacin should be taken only when prescribed by a doctor, as it may cause side effects.
- Fibrates help lower triglycerides, which also increase the risk for heart disease. Fibrates, such as gemfibrozil, increase HDL cholesterol, but they aren’t very effective for lowering LDL cholesterol.
Although rare, side effects do occur with some drugs, so be sure to tell your doctor about any unusual symptoms. Also, be sure to have any laboratory tests that your doctor recommends.
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