Managing Cholesterol for a Heart-Healthy Lifestyle

February 1, 2002

Mona A. Gupta, PharmD

Article

Heart disease is the single leading cause of death in the United States. The Framingham Heart Study, a 50-year study that identified the common factors or characteristics that contribute to heart disease, established that high blood cholesterol is a risk factor for coronary heart disease. Results of this study showed that the higher the cholesterol level, the greater the risk for coronary heart disease. A high cholesterol level leads to thickening or hardening of the arteries in the heart. This process, known as atherosclerosis, usually begins in childhood and slowly progresses with age. It is a complex process that involves accumulation of fats, cholesterol, and calcium to form plaques in the arteries of the heart, which can partially or completely block blood flow. When the artery wall is thickened over time, the decreasing diameter of the artery wall decreases the oxygen supply of the artery. When the oxygen supply to the heart muscle is reduced, a heart attack can occur. In addition, if the oxygen supply to the brain is cut off, a stroke can occur.

Despite its negative effects, cholesterol is vital for many important body functions. Cholesterol occurs naturally in all of your body?s cells, including the brain, nerves, muscle, skin, liver, intestines, and heart. Your body also uses cholesterol to produce many hormones, vitamin D, and bile acids that are important in digesting fat. However, your body requires only a small amount of cholesterol in the blood to provide these important functions. Excess cholesterol in the bloodstream is deposited in arteries, leading to narrowing and blockage of arteries, which in turn leads to symptoms of heart disease, heart attack, stroke, and other cardiovascular diseases.

Cholesterol

To prevent heart disease, it is vital to lower your cholesterol. An optimal cholesterol level is less than 200 mg/dL. It is important to maintain a healthy lifestyle to keep your cholesterol in the desirable range. You should have your cholesterol checked every 5 years if you are a man older than 45 years of age or a woman older than 55. Patients who have a cholesterol level between 200 and 239 mg/dL, a high-density lipoprotein (HDL) level less than 40 mg/dL, and no other risk factors should have their cholesterol checked every 1 to 2 years. Patients with a cholesterol level more than 240 mg/dL are definitely at high risk for heart disease. It is important for you to discuss your results with your doctor and to follow his or her advice.

LDL

Low-density lipoprotein (LDL) is considered to be the bad cholesterol. A high level of LDL reflects an increased risk for heart disease. With a high level of LDL, the cholesterol circulating in the blood slowly builds up on the walls of the arteries, decreasing the blood flow to the heart and the brain. It is important to keep your LDL as low as possible to lower your risk of heart disease. The optimal range for LDL is less than 160 mg/dL if you do not have any risk factors (heart disease, family history of heart disease, smoking, high blood pressure, obesity, etc). If you do not have heart disease but have two or more risk factors, then your LDL should be less than 130 mg/dL. If you have heart disease, then you should target your LDL to be less than 100 mg/dL.

HDL

HDL is known as the good cholesterol because a high level of HDL cholesterol protects against heart disease. HDL tends to carry cholesterol away from the heart arteries and back to the liver, where it is eliminated from the body. Your HDL level should be more than 40 mg/dL. It is important to get your HDL as high as possible, because this will help you to lower your total cholesterol.

Triglycerides

Triglycerides are the chemical form in which most fat exists in the body. They are present in blood plasma and form the plasma lipids. Many studies have shown that people with high triglyceride levels have an increased risk of heart disease. Therefore, it is important to decrease your triglycerides to lower your risk of heart disease. Patients with diabetes or who are overweight are likely to have high triglyceride levels. It is optimal to have your triglycerides less than 150 mg/dL.

Risk Factors for Heart Disease

The following are some risk factors for heart disease aside from a high cholesterol level. The more risk factors you have, the greater the risk of having a heart attack or a stroke. It is important to keep in mind that some of these risk factors can be changed or modified while others cannot. Trying to control as many of these risk factors as possible is the best way to reduce your risk of heart disease.

The following factors can be changed, treated, or modified by changing your lifestyle or by taking appropriate medications:

Smoking: Patients who smoke have twice the risk of heart disease than nonsmokers. Nearly one fifth of all deaths from cardiovascular disease, or about 190,000 deaths per year, are smoking related. Chronic exposure to environmental tobacco smoke (secondhand smoke) may also increase the risk of heart disease.
High blood pressure: High blood pressure increases the workload on the heart, causing it to enlarge and weaken over time. If you have high blood pressure, diabetes, high blood cholesterol, and smoke, your risk of heart attack increases several times.
Physical inactivity: It is vital to get regular, moderate-to-vigorous exercise to prevent heart disease. Exercising will make your heart muscles stronger and can help lower your LDL and increase your HDL. You should exercise at least three times a week at 30-minute intervals.
Obesity: Excess weight causes increased strain on the heart and can affect blood pressure, blood cholesterol, and triglyceride levels and worsen diabetes. Increased body fat increases your risk for heart disease even if you have no other risk factors.
Diabetes mellitus: The risk of developing heart disease is greatly increased for patients with diabetes. Two thirds of those with diabetes die of some form of heart disease. It is vital to monitor glucose level and keep your numbers in the acceptable range.

The following risk factors for heart disease cannot be changed:

Increasing age: Approximately four of five people who die of coronary heart disease are 65 years of age or older.
Gender: Men have a greater risk of heart attack than women, and they tend to have them earlier in life. Even after menopause, as a woman?s risk of death from heart disease increases, it still is not as high as it is for men.
Heredity: With a history of heart disease in your family, you are more likely to develop it yourself. Your genes play an important role in developing or protecting you from heart disease.

It is important to note that although the above three factors cannot be changed if you have them, you can greatly affect your health by focusing on the five factors that you can modify by taking better care of yourself:

Try to quit smoking with the help of a behavior modification program and discussing therapeutic options with your doctor or pharmacist.
Have your blood cholesterol checked regularly.
Get regular exercise at least three to four times a week and maintain a healthy weight.
Monitor your diabetes and blood pressure and take your prescribed medications.

In addition, the following guidelines will help you in lowering your cholesterol:

Limit your total fat intake to less than 30% of your total calories and limit total cholesterol to less than 300 mg/day.
Choose lean cuts of meat and trim fat.
Use skim or 1% fat milk and avoid butter, regular cheese, and whole milk.
Use cooking methods that reduce fat: bake, broil, steam, or grill.
Avoid saturated vegetable fats, such as coconut oil and palm oil.
Increase intake of whole-grain breads and cereals, fruits, and vegetables.

Adhering to these guidelines will help you reduce your risk of a heart attack, stroke, or other cardiovascular diseases. The changes you make today will go a long way to help you lead a healthy lifestyle.