Cholesterol is an essential ingredient for human life, a building block for cells that’s used to create hormones, bile, and other vital substances. But too much cholesterol in your blood greatly increases the risk of a heart attack or stroke. Most healthy adults should aim for an LDL level under 130 mg/dL.
In most people, regular exercise and a healthy diet will lower cholesterol levels. Unfortunately, lifestyle changes frequently aren’t enough. Sometimes, it’s because people can’t commit to the radical changes needed. A vegan, plant-based diet offers the best shot at getting your cholesterol way down, but few are unwilling to stay away from animal products altogether. (We’re looking at you, cheese. So very, very longingly.)
In many cases, your genes also conspire to keep your cholesterol levels high. If you have a family history of high cholesterol, it’s possible no lifestyle change will ever get your levels into a healthy range. So what should you do? If your cholesterol level remains high despite the healthiest diet you can tolerate, you’ll have to decide whether you should take medicine.
- Who should consider meds
- So what medication should you take?
- Any options besides statins?
- What about omega-3s, fish oil, and niacin?
- I’m a Size 2, but My Cholesterol Was Approaching Stroke Levels
- But this trend is more common than you may think
- Here’s how it happened: Much of cholesterol is due to genetics
- So, essentially, I’m on meds for life
- Learn the facts about cholesterol
- Misconception: Cholesterol isn’t a concern for children
- Misconception: You don’t need a cholesterol check until middle age
- Misconception: Thin people don’t have high cholesterol
- Misconception: Only men need to worry about cholesterol
- Misconception: You should wait for your doctor to mention cholesterol
- Misconception: Diet and physical activity dictate your cholesterol level
- Misconception: With medications, no lifestyle changes are needed
- Misconception: If the Nutrition Facts label shows no cholesterol, a food is “heart-healthy”
- Misconception: Using margarine instead of butter will help lower cholesterol
- Why You Still Have High Cholesterol
- Getting High Cholesterol in Line
- Here’s Why Diet Isn’t The Only Possible Reason For High Cholesterol
- (1) LACK OF EXERCISE
- (2) GENETICS
Who should consider meds
If you fall into any of these categories, statins are likely to provide a significant benefit (i.e. longer life, and much lower risk of heart attack or stroke), so talk with your doctor about them if:
You already have plaque in your arteries.
Your LDL target will be even lower than 130 – it should be at least under 100 mg/dL, and ideally under 70 mg/dL.
You have diabetes.
Anyone with diabetes over the age of 40 should take a statin, since chronically high blood sugar greatly increases your risk of developing heart disease.
Your LDL is super high (>190 mg/dL).
You’re a time bomb. Statins will likely drop your levels way down into a safer zone.
Your age, blood pressure, smoking history, and cholesterol numbers point to a high chance of trouble.
Even if you don’t meet the above criteria, you may still have a high risk of developing a heart attack or stroke. Docs figure out how high using calculators that estimate your 10-year risk of having heart disease. (If you know your blood pressure and cholesterol numbers, you can plug them in here.) If your ten-year risk is more than 7.5%, you’d likely be safer with a statin.
Your arteries are filled with calcium.
If the calculator pegs your risk in a lower range, but you’re still concerned (e.g., every one of your male relatives has had a heart attack), you can get a scan to further assess your risk. A CAT scan of your heart, for example, can quantify its calcium burden, or “score,” and very abnormal results indicate a more urgent need to lower your cholesterol.
So what medication should you take?
Statins are, by far, the best and most-studied medications for lowering cholesterol. On average, they lower the risk of heart attack or stroke by 20 to 30 percent.
Although statins have a reputation for causing muscle aches, these concerns have been greatly overblown. In controlled experiments, statins cause cramps only slightly more often than sugar pills. Furthermore, fewer than one in five hundred patients experience actual muscle problems, and even fewer need to stop treatment.
In addition, high statin doses have been associated with a very small increase in the risk of developing diabetes (about 1 in 200), yet most doctors feel that this risk is far outweighed by the protection against heart attacks and strokes. Oh, and you’ll also have to give up grapefruit juice. It raises statin levels in your blood. We’re sure you can handle that.
Any options besides statins?
Statins have such well-documented benefits that other medications are typically used only as second-line treatments –– they’re brought on board because your cholesterol remains high even with optimal diet and a statin, or because you have intolerable side effects from statins. What you might get:
- A pill called ezetimibe (Zetia); this is the most common alternative. This medication blocks absorption of cholesterol from your intestines and can further lower your LDL level.
- A newer—and much more expensive—class of medication known as a PCSK9 inhibitor (alirocumab (Praluent) and evolocumab (Repatha)), may be used if Zetia fails. These medications increase the amount of LDL your liver pulls out of your bloodstream. The effects are profound, as your LDL levels can easily drop by more than 50 percent. The side effects are also minimal. Indeed, if these medications were inexpensive pills, we’d probably recommend them for nearly all adults. Unfortunately, they are still quite pricey and also can only be taken as injections, about once every two or four weeks.
What about omega-3s, fish oil, and niacin?
These target triglycerides, which are also measured in the standard cholesterol panel. Triglycerides aren’t the same as cholesterol, but high levels have also been associated with heart disease and stroke.
Although omega 3 fatty acids (found in fish oil) and niacin can lower triglyceride levels, they haven’t been convincingly shown to lower the risk of heart attack or stroke. Although one recent experiment of a highly-purified fish oil did show some benefits in high-risk individuals, it also had some negative effects (like an increased rate of abnormal heart rhythms). As a result, doctors aren’t totally sold yet.
Christopher Kelly M.D. Christopher Rehbeck Kelly, M.D., M.S. Marc Sabin Eisenberg, M.D., F.A.C.C. Marc Sabin Eisenberg, M.D., F.A.C.C., is an associate professor of medicine at the Columbia University Medical Center and an attending physician at NewYork-Presbyterian Hospital/Columbia University Medical Center.
I’m a Size 2, but My Cholesterol Was Approaching Stroke Levels
Health and wellness touch everyone’s life differently. This is one person’s story.
For the first 37 years of my life, I had always been that girl.
It was — *humble brag time* — easy for me. No ice-cream, cake (yes, I have a sweet tooth), or lack of a vigorous workout could make me gain more than a pound or two, which always miraculously seemed to simply fall off when I wasn’t trying.
But last year, during a routine cholesterol test — my first, actually — I stumbled upon a dirty little secret that my body was hiding. Turns out, I’m what Google refers to as “skinny fat.” Translation: Inside my thin frame, I have a very unhealthy body.
We could all have health problems at any size, and we might not even know it.
On the outside, I look healthy and fit. I have a size 2 body. But I don’t actually fit the part society says a smaller body should.
Inside this body? I’m unbalanced and have major health issues. My cholesterol was so high, I was approaching stroke levels (per my father, a cardiologist, who interpreted the results for me).
But this trend is more common than you may think
A 2008 study found that about a quarter of Americans who aren’t overweight have some form of an unhealthy heart risk, like high cholesterol or high blood pressure.
Yup, turns out, high cholesterol can bury itself in any body: big or little, wide or narrow, over or underweight — or anything in between.
Within the skinny body, there could be veins and veins of fat. We just don’t think of it because our culture has continued to use images of skinny people to mean “healthy.”
Sure, smoking along with eating foods high in cholesterol like red meat or ice-cream severely impact your high cholesterol risk (my diet is super high on the latter), but apparently, since high cholesterol runs in my family, I was very likely to get it, skinny or not.
“High cholesterol does not discriminate against body type, and body weight does not determine if a person suffers from high cholesterol or high triglycerides (a type of fat in the blood),” says Peter Toth, director of preventive cardiology at CGH Medical Center in Sterling, Illinois.
“People who appear to be thinner assume they are not at risk. Therefore don’t heed the appropriate steps to take toward a healthier lifestyle, which may lead to higher cholesterol and triglyceride levels, and, ultimately, heart disease” he says.
Get your cholesterol tested early
- The American Heart Association recommends that you start getting cholesterol tests every four to six years, starting when you’re 20 (ooops, on my part!).
- If high cholesterol runs in your family, you should start even earlier and get tested more often.
It’s all so confusing.
Even marathon runners could be storing cholesterol and other heart-stopping issues within their perfectly toned bodies. Remember Jim Fixx, author of “The Complete Book of Running”? He died of a heart attack in 1984.
Well, that attack was due to blocked coronary arteries (he also had a family history of heart disease, had smoked earlier in life, and had a stressful career).
He’s not an anomaly though: a recent study in Missouri Medicine found that excessive exercise — or marathon running — can increase coronary plaque.
So when people talk about “skinny fat” — they mean it, literally! Within the skinny body, there could be veins and veins of fat. We just don’t think of it because our culture has continued to use images of skinny people to mean healthy.
Here’s how it happened: Much of cholesterol is due to genetics
Your body produces cholesterol, and some people simply make more of it.
“So if you have a genetic predisposition to high cholesterol, yours will likely be elevated no matter how much you weigh,” says Susan Besser, family physician with Mercy Personal Physicians in Baltimore. “No amount of dieting will fix it.”
The opposite may also be true — you may be overweight, but if you have the high-cholesterol gene, you’re more likely to have normal cholesterol levels, she says.
And trust me, genetics matter a lot
My doctor immediately wanted to put me on cholesterol-lowering medication, but I requested a chance to lower it myself. I was already taking a few pills daily to prevent migraines, so I didn’t want to be adding more to my nighttime routine.
I’ve been writing about health and wellness for more than a decade, so I knew exactly what I should be doing to lower my cholesterol. I just couldn’t believe that I had to do it.
I’ve always had a diet high in dairy, so I switched to almond milk, and I lowered my intake of ice-cream (it’s my weakness). I doubled the length of my dogs’ walks, feeling proud that I was making all of us healthier.
And then I took another cholesterol test six months later. It hadn’t budged.
So I started taking statins (cholesterol meds).
Fortunately, I had no side effects (they’re not very common), and my cholesterol dropped down to normal in six months. I added dairy and ice-cream back into my diet because… why not? — everything was going well.
Everything was going so well, in fact, that I decided that I didn’t need cholesterol medication anymore.
After all, I’m skinny and I’m 38, and if the cholesterol medication worked so quickly, then there was no reason why I shouldn’t start taking it when I’m 50 or maybe even 60, when heart problems are more likely.
I quit, without the approval (or knowledge) of my docs. My cholesterol jumped back up again immediately. And then I got yelled at by my father and by my doctors.
Apparently, my logic was a bit off.
“If you’re already at a healthy weight and eating a healthy diet, you’ll usually need to be put on statins to manage cholesterol levels,” says David Albert, cardiologist and chief medical officer of AliveCor, explaining why some people with genetic cholesterol components simply need the meds.
High cholesterol can also do long-term damage, even if you’re able to lower it immediately with medication.
So yes, I could stop taking it for 10 years, but the damage that I would be doing to my body during that decade would be much more significant than if I didn’t take my meds.
My body would be storing all the extra cholesterol in my blood vessels, making the openings smaller and decreasing my blood flow. And if my blood flow got blocked, then my organs wouldn’t get nutrition or oxygen.
This could all lead to heart attacks and strokes, Besser explains further.
“Additionally, this cholesterol that is lining the walls of the vessels can break off and float further down the blood stream until it gets stuck,” Besser says. “When that happens — it’s called an occlusion — there is a sudden lack of oxygen to the area. This can cause a lot of damage to the part of the body fed by the blood — back to heart attack or stroke or damage to the organ affected.”
So, essentially, I’m on meds for life
There’s no amount of exercise, diet, or healthy lifestyle that will change this outcome.
It really makes me rethink society’s assumption that overweight bodies are automatically unhealthy — and vice versa.
We could all have health problems at any size, and we might not even know it. A cholesterol screening never crossed my mind (I’ve actually never been sick in my entire life, so this cholesterol test was part of my first visit to the doctor for a first-time check-up), but I’m oh-so-grateful for it.
I’m also okay with being on the meds. It’s all part of staying healthy despite my medicine cabinet now looking like one owned by an 80-year-old. But perhaps, now I’ll survive to be 80.
I can live with that.
Danielle Braff is a former magazine editor and newspaper reporter turned award-winning freelance writer specializing in lifestyle, health, business, shopping, parenting, and travel writing.
High levels of cholesterol can put you at risk for a host of life-threatening cardiovascular (heart and circulatory system) diseases. To reduce the risk of these diseases, your goal is to lower total cholesterol and to aim for high levels of good cholesterol and low levels of bad cholesterol. And one of the best routes to a healthier heart is a cholesterol-lowering diet.
Your doctor will determine if you are a candidate for cholesterol-lowering medication based on your blood cholesterol profile. But even those on medication can benefit from lifestyle changes such as a healthy diet, regular exercise, weight loss, and smoking cessation.
Indeed, one of the best ways to prevent and control high cholesterol is by eating healthy, exercising, and losing weight (if you’re too heavy). The American Heart Association (AHA) recommends a diet that includes plenty of fruits, vegetables, whole grains, low-fat dairy, and lean protein, with a limit of 300 mg of cholesterol per day, and less than 30% of its calories from fat. The WebMD Weight Loss Clinic recommends a heart-healthy diet to all its members.
To ensure heart health and help lower cholesterol, here are some recommendations about foods and nutrients to include in your diet:
- Fiber. Fiber is not only important for lowering your cholesterol, it can also help you lose weight. Both soluble fiber (found in oats and beans) and insoluble fiber (in fruits, vegetables, fruits and grains) can help lower cholesterol. Fiber binds and helps carry excess cholesterol from your body. The Institute of Medicine recommends 21-38 grams of fiber per day for adults. Start your day with a bowl of oatmeal topped with fresh fruit to get a jump on meeting your daily requirement.
- Soy. A daily 25 grams of soy protein can help lower cholesterol by decreasing its production in the liver and by removing “bad” cholesterol from the blood. In fact, the FDA has decided to allow soy-rich food products to carry labels touting their cholesterol lowering benefit. Read the labels of soy products — like soymilk, soy yogurt, tofu, soy nuts, edaname — to make sure you are getting enough to help lower cholesterol levels.
- Sterols and stanols. Plant substances called sterols and stanols can interfere with cholesterol absorption and reduce your total cholesterol levels. The main way to get them in your diet is in special margarines like Take Control and Benecol. Minute Maid also promises an orange juice that will contain these cholesterol-lowering substances. Read the labels to determine if you’re getting enough to achieve the desired effect.
- Monounsaturated and polyunsaturated fats. You know these as the “good fats” found in foods like corn oil, soybean oil, sunflower oil, olive oil, canola oil, avocados, nuts, and seeds. Choosing these fats over saturated and trans fats will help lower your cholesterol level. Keep in mind that you should limit total fats in your diet — but when you do have them, opt for these healthier choices.
- Red wine. Music to your ears? It’s true: a glass of red wine is believed to help lower cholesterol levels. Red wines contain substances called saponins that can bind to cholesterol and prevent its absorption into the bloodstream. So follow the Mediterranean lifestyle and enjoy a glass with dinner once in a while. (Just be careful not to overdo it.)
- Omega-3 fatty acids. These fatty acids make the blood less likely to form clots that can cause heart disease. How to get them? The American Heart Association (AHA) recommends that healthy adults consume two servings a week of fish, especially fatty fish like salmon and lake trout. Other sources of omega-3s are nuts, seeds, soybeans, canola, walnut, flaxseeds, and oils made from these products.
- Eggs. In 2002, the AHA revised its recommendation on eggs, after decades of research showed that they are not the villains in heart disease. The AHA no longer makes a recommendation about how many egg yolks you should eat per week, as long as your average daily intake of cholesterol is less than 300 mg. Eggs are powerhouses of nutrition, an excellent and inexpensive source of protein. Most healthy adults can enjoy one daily.
Learn the facts about cholesterol
How much do you know about cholesterol? Here are some common misconceptions – and the reality behind them.
Misconception: Cholesterol isn’t a concern for children
High cholesterol can be inherited. This is referred to as familial hypercholesterolemia.
Children who have this genetic disorder are at very high risk of heart disease. This problem is underdiagnosed and undertreated worldwide. Once identified, children with this condition may require aggressive treatment with medications.
Cholesterol testing should be considered for children and adolescents with elevated risk. That includes children with:
- A parent or grandparent who had evidence of coronary atherosclerosis, peripheral vascular disease or cerebrovascular disease.
- A parent or grandparent who had a coronary artery procedure.
- A parent or grandparent who had a heart attack or sudden cardiac death before age 55.
- A parent who has a history of high total cholesterol levels (240 mg/dL or higher).
Regardless of their risk, all children benefit from a healthy diet and lifestyle. Establishing the habits of healthy eating and physical activity early on can reduce the risk of cardiovascular problems over time.
Compelling evidence shows that the atherosclerotic process (buildup of plaque in arteries) begins in childhood and progresses slowly into adulthood. Later in life, this often leads to coronary heart disease, the leading cause of death in the United States.
To reduce your child’s risk, it’s important to:
- discourage cigarette smoking
- encourage regular aerobic exercise
- identify and treat high blood pressure
- help your child maintain a healthy weight
- diagnose and treat diabetes
- encourage a healthy diet
Children two and older should be encouraged to eat a diet that emphasizes fruits, vegetables, fish, whole grains and low sodium, with few sugar-laden foods and drinks.
Misconception: You don’t need a cholesterol check until middle age
The American Heart Association recommends that all adults 20 and older have their cholesterol (and other risk factors) checked every four to six years. Work with your doctor to determine your risk for cardiovascular disease and stroke.
Misconception: Thin people don’t have high cholesterol
Overweight people are more likely to have high cholesterol, but thin people can be affected as well. A person with any body type can have high cholesterol.
People who don’t easily gain weight are often less aware of how much saturated and trans fat they eat. Nobody can “eat anything they want” and stay heart-healthy.
Have your cholesterol checked regularly regardless of your weight, physical activity and diet.
Learn more about how to improve your cholesterol levels.
Misconception: Only men need to worry about cholesterol
Both men and women tend to see higher triglyceride and cholesterol levels as they get older. Weight gain also contributes to higher levels.
But it is true that premenopausal women may have some protection from high LDL (bad) levels of cholesterol, compared to men. That’s because the female hormone estrogen is highest during the childbearing years and it tends to raise HDL (good) cholesterol levels. This may help explain why premenopausal women are usually protected from developing heart disease.
On the other hand, postmenopausal women may find that, despite a heart-healthy diet and regular physical activity, their cholesterol still rises. For this reason, women nearing menopause should have their cholesterol levels checked and talk with their doctor about their risk factors and treatment options.
At one time, it was thought that hormone replacement therapy might lower a woman’s risk of heart disease and stroke. But recent studies have shown that HRT does not reduce the risk of heart disease and stroke in postmenopausal women. The American Heart Association does not endorse HRT as a means for lowering cardiovascular risks.
Misconception: You should wait for your doctor to mention cholesterol
Your health is your responsibility.
Starting at age 20, ask your doctor to test your cholesterol, assess your risk factors and estimate your risk for a heart attack or stroke.
Once you know your risk, you can take action to lower it. Your doctor may recommend diet and lifestyle changes – and possibly medication as well. Follow all of your doctor’s instructions and have your cholesterol and other risk factors rechecked every four to six years.
Questions to ask your doctor about cholesterol (PDF).
Misconception: Diet and physical activity dictate your cholesterol level
Diet and physical activity do affect overall blood cholesterol levels, but other factors inform your levels as well.
Being overweight or obese tends to increase bad cholesterol (LDL) and lower good cholesterol (HDL). Getting older also causes LDL cholesterol to rise. For some, heredity may even play a role.
That said, a heart-healthy diet and regular physical activity are important to everyone for maintaining cardiovascular health.
Understand the sources of cholesterol.
Misconception: With medications, no lifestyle changes are needed
Medications can help control cholesterol levels, but making diet and lifestyle changes is the best way to reduce heart disease and stroke risk. To lower your cholesterol, eat a heart-healthy diet and get 40 minutes of moderate- to vigorous-intensity aerobic exercise, three to four times a week.
It’s also very important to take your medication exactly as your doctor has instructed.
Learn more about cholesterol medications.
Misconception: If the Nutrition Facts label shows no cholesterol, a food is “heart-healthy”
A food’s Nutrition Facts label can be helpful for choosing heart-healthy foods, if you know what to look for.
Many foods marketed as “low-cholesterol” have high levels of saturated or trans fats, both of which raise blood cholesterol. Even foods billed as “low-fat” may have a surprisingly high fat content.
Look for how much saturated fat, trans fat and total calories are in a serving. (Even check the serving size itself, which may be smaller than you expect.) Ingredients are listed in descending order of use, so choose products where fats and oils appear near the end of the ingredients list.
Learn more about fats.
Misconception: Using margarine instead of butter will help lower cholesterol
It’s true: Butter has a high amount of saturated fat and some trans fat. That raises LDL (bad) cholesterol and contributes to atherosclerosis. But many hard margarines have a high amount of trans fat as well as saturated fat. That’s still bad.
The healthiest choice is a liquid margarine, or a soft margarine in a tub. These are made with vegetable oils. They have less partially hydrogenated fat and saturated fat than solid spreads like hard stick margarine and butter. Look for margarines that say 0 g trans fat on the Nutrition Facts label.
Switching from butter to soft margarine is a good step. But it’s one that, by itself, probably won’t reduce your cholesterol to healthy levels.
Learn more about eating a heart-healthy diet.
Why You Still Have High Cholesterol
Tell friends or even strangers you need to lower your cholesterol and they will likely offer you advice. But cholesterol advice can be confusing, especially when it comes to which foods to eat and which to avoid. And, let’s face it, the friends and strangers you ask may facilitate common cholesterol myths.
One such cholesterol myth is that all cholesterol is bad for you when actually the body needs cholesterol. The body is pretty good at making cholesterol without any help from your diet — about 75 percent of the cholesterol circulating in your blood is produced by your body. Cholesterol carried by low-density lipoprotein (LDL) particles is known as “bad” cholesterol because it tends to build up inside blood vessels. Cholesterol in the form of high-density lipoprotein (HDL) particles, known as “good” cholesterol, carry cholesterol out of the bloodstream and into the liver, where it’s excreted.
The causes of high cholesterol vary: Diet, obesity, or genes could be to blame. If your attempts to get your levels in check don’t seem to be working, here are some possible reasons why.
You switched to solid margarine instead of butter.
You might have thought reducing your butter intake would help lower your cholesterol, and you’re correct. But swapping butter with solid margarine, which contains trans fats, won’t work. Trans fats — which may also appear on food labels as hydrogenated, or partially hydrogenated, oils — are created when hydrogen is added to vegetable oils to make them solid. They’re bad for cholesterol, so stay away from any butter substitute that contains them.
You stopped eating foods that contain cholesterol but not ones with saturated fats or trans fats.
It’s not enough to avoid foods that are high in cholesterol, like calves liver and shrimp scampi. Saturated fats and trans fats are both bad for cholesterol. Trans fats are found in foods like french fries, doughnuts, prepackaged snack foods, and many baked goods. Saturated fats are found in animal proteins, like meat and full-fat dairy products. Try getting more of your protein from fish and beans and consider using almond and/or soy milk products instead of dairy products. When you do eat meat, make sure it’s a lean cut and keep your portion to about the size of a deck of cards.
You take medication to lower your cholesterol so you don’t watch what you eat or exercise.
A combination of exercise (30 minutes a day, most days of the week), a healthy weight, and a heart-healthy diet remains the best way to lower bad cholesterol and raise good cholesterol, even if you take medication, too. No amount of cholesterol-lowering meds can give you a green light to indulge.
You heard eggs really aren’t that bad for cholesterol so you eat them every day for breakfast.
The truth is that you still need to watch your egg count. One egg yolk contains 200 milligrams of cholesterol. The limit, if you are at your target LDL cholesterol level, is 300 mg a day. If your LDL is high, you need to stay under 200 mg. So if you have that egg for breakfast, eliminate red meat for the rest of the day. If you love a good omelet, switch to egg whites, which have no cholesterol.
You watch what you eat and exercise, so you won’t consider medication.
Even if you do everything right, you can’t change your genes. Heredity is a major risk factor for high cholesterol. If your body simply produces more cholesterol than it should, it often takes medication to bring it to acceptable levels. Familial hypercholesterolemia can be inherited from one or both parents and can put you at risk for a heart attack at a young age. So if you have a family history of heart disease or high cholesterol, you may need to work a little harder than everyone else and have your numbers checked regularly. Stick with it and work closely with your doctor, especially if he or she says you need medication to boost your other efforts.
Getting High Cholesterol in Line
Update your cholesterol-lowering strategy with these tips:
- Reduce your total fat intake to 30 percent of your total calories.
- Replace saturated fats with unsaturated fats. Saturated fats are fats that come from animals and are solid at room temperature. Unsaturated fats are liquid at room temperature and come from plants.
- Maintain a healthy weight and exercise regularly.
Here’s Why Diet Isn’t The Only Possible Reason For High Cholesterol
High cholesterol, a well-known risk factor for heart disease and stroke, affects about 1 in every 3 American adults. That’s arguably a pretty large proportion of adults who have high cholesterol – and it raises the question: why is high cholesterol so common?
Dietary habits, as many people know, are often responsible for high levels of cholesterol: eat a lot of foods high in saturated fat – cheeseburgers, for instance – and your cholesterol levels might swing upwards. (We know, they’re delicious.)
But diet isn’t always the whole picture when it comes to cholesterol levels: high cholesterol can make an unwelcome appearance even if you’re very careful about eating a healthy, balanced diet.
Dietary habits are often responsible for high levels of cholesterol: eat a lot of foods high in saturated fat – cheeseburgers, for instance – and your cholesterol levels might swing upwards. But diet isn’t always the whole picture when it comes to cholesterol levels.
Here’s why: there are other potential drivers of high cholesterol, such as a lack of exercise and one’s genetics. (So it can be helpful to check your cholesterol levels regardless of your dietary habits – something you can now do from the convenience of home.)
Let’s take a closer look at both of these non-dietary reasons for high cholesterol.
(1) LACK OF EXERCISE
Truth be told, it’s not always easy to find the time – or the motivation – to consistently exercise. But take note: regular physical activity is an absolute must if you want to safeguard your body’s health and well-being. Exercise, after all, has many benefits – both physiological and psychological (“there is irrefutable evidence,” wrote one group of researchers, that regular physical activity can help prevent many chronic diseases and premature death).
Regular physical activity is an absolute must if you want to safeguard your body’s health and well-being.
On the flip side, a lack of exercise frequently comes with a variety of health consequences – some of them rather severe. One health consequence, for example, is an increased risk of gaining an unhealthy amount of weight.
Over the long term, a lack of exercise can lead to obesity – which, in turn, can significantly lift cholesterol levels. In fact, up to 70% of patients with obesity have abnormalities in their cholesterol and triglyceride levels. Importantly, when obesity causes high cholesterol levels, it’s – more often than not – the levels of “bad cholesterol” (LDL cholesterol) that tick upward. But levels of “good cholesterol” – or HDL cholesterol – on the other hand, are often low.
And there’s more: obesity can elevate the amount of small dense LDL particles in the bloodstream. These LDL particles – very small in size, as their name suggests – can easily slip into the walls of your arteries (the vessels that carry blood from the heart to the rest of the body), prompting a buildup of plaque. The affected arteries frequently harden and narrow as a result, significantly slowing the flow of blood – a condition known as atherosclerosis. Alarmingly, the risk of suffering from a stroke or heart attack shoots up when your arteries are in this condition.
Small dense LDL particles can easily slip into the walls of your arteries, causing a buildup of plaque. The affected arteries frequently harden and narrow as a result (illustrated here), significantly slowing the flow of blood. Source: National Library of Medicine (US). Genetics Home Reference. Illustration: Plaque in an artery wall. (Cited Jan 31, 2019.)
With all this in mind, then, if you are overweight or obese it’s important to routinely check your cholesterol levels (which you can do at home with EverlyWell’s Cholesterol and Lipids Test). And if your cholesterol levels are in fact too high, consult with your health care provider on the next steps to take that’d be best for you.
Has someone in your family had a heart attack even though they were fairly young? If your answer is “Yes,” you could be at a risk for “familial hypercholesterolemia” – an inherited, genetic disorder that’s characterized by high cholesterol levels at a young age and a higher-than-normal risk of heart disease. (Also: if you answered “Yes” to that question, consider checking your cholesterol levels with an at-home test kit – and, of course, consult with your doctor.)
If someone in your family has had a heart attack even though they were fairly young, you may be at a risk for “familial hypercholesterolemia” – an inherited, genetic disorder that’s characterized by high cholesterol levels at a young age.
In women, for example, untreated familial hypercholesterolemia leads to a 30% risk of a coronary event (such as a heart attack) by age 60. That risk climbs to 50% in men by age 50.
So what is it exactly about this genetic disorder that causes cholesterol levels to reach disturbingly-high levels?
To answer that, we need to talk about something called “LDL receptors.” LDL receptors are special devices on the surface of many of your body’s cells. Their job description is straightforward: to catch particles of LDL cholesterol flowing in the bloodstream and take them inside the cell (where the LDL cholesterol is broken down).
In this way, LDL receptors continually clear LDL cholesterol from the bloodstream – so there’s much less LDL cholesterol around to gum up the arteries with plaque.
But if you have familial hypercholesterolemia, your cells don’t have very many of these receptors – so particles of LDL cholesterol build up in your bloodstream faster than they can be cleared away.
How do you know if you’ve inherited this disorder?
A cholesterol level that’s much higher than average for your age is one clue (note that you can check your cholesterol levels at home with a physician-approved test kit).
You can check your cholesterol level at home with a physician-approved test kit to see if it’s higher than average for your age.
However, if you’re concerned about familial hypercholesterolemia, you should definitely consult with your doctor – since only a qualified health care professional will be in a position to make an accurate diagnosis.