3 Cardiologist Tips for People With High Cholesterol

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Keeping cholesterol managed is a crucial step in preventing heart problems. Put simply, cholesterol is fat, and it gets into the body in two ways. You can eat cholesterol in your diet, or your body makes it. Cholesterol is necessary in the body. It’s the basis of many hormones, of the blood-brain barrier, of your nervous system–everybody needs cholesterol. However, not all cholesterol is created equally. There are different types: low density lipoprotein (LDL), the “bad” cholesterol, and high density lipoprotein (HDL), the “good” cholesterol. HDL cholesterol can actually help remove LDL from your body and keep levels low. But excessive LDL cholesterol can build up in your arteries, damaging your heart and eventually causing severe problems, including a heart attack. We want to keep HDL levels high and LDL levels low, but this can be hard to do in many cases, whether it’s because high cholesterol runs in your family, you’re having trouble changing your diet, or medications aren’t working for you. Managing cholesterol can be tricky, so there are a few things I make sure my patients understand.

1. Understand lifestyle changes are just as important as medications.

Because cholesterol can be consumed through food, I always encourage patients to try to eat a heart-healthy diet full of fresh fruit, vegetables, and lean proteins. I also recommend exercising frequently, which can lower cholesterol and help you maintain a healthy weight. There’s a dietitian at my office who is very willing to help patients incorporate healthy choices into their daily habits, and I think that’s a great resource to use because making changes is really hard for everyone, and support is crucial. What we eat makes such a difference. You can take medication to help lower cholesterol, but what you’re eating is just as important as taking a pill or injection. People think it’s a free pass; they think since they’re on cholesterol medication, they can eat whatever they want. Unfortunately, that’s not the case. If you’re going to take your meds and then eat a double cheeseburger every day, you’re not doing yourself any favors. The medicines can only work effectively if you contribute and put in the hard work. It’s also important to keep other health conditions managed when you’re trying to lower high cholesterol. For example, I’m not going to have any success in lowering someone’s cholesterol if their blood sugars are super high and their diabetes isn’t well controlled. That’s why I encourage my patients to develop strong relationships with their other doctors, so they have the support and guidance they need to manage everything going on.

2. Recognize it’s a marathon, not a sprint.

I think it’s critical for people to realize chronic conditions like high cholesterol are dynamic; they change a lot. Don’t let one disappointment derail your hard work. Getting healthier is about making long-term changes that people can enact on a daily basis. I often tell patients something I have to remind myself about, too: you’re going to have a piece of cake on your birthday, or a cookie at a party. You shouldn’t feel guilty about that. You have to live your life. But it’s about the constant changes, the everyday choices you make. If you’re consistent with a heart-healthy diet, it’s not a problem to enjoy a treat sometimes. That mentality is important when it comes to your numbers, too; many of my patients come to see me very worried after the holidays, stressed that they gained a few pounds and their cholesterol went up. But you can’t let one bad lab value or one scale reading get you down. Short-term goals add up to long-term benefit, so try to give yourself grace and focus on making your next choice a healthy one. I can tell people they need to lose weight, eat healthier, exercise, and quit smoking until I’m blue in the face, but sometimes those are too overarching and there’s nothing tangible for patients to hold on to. Setting very small short-term goals can go a long way. For example, I might ask a patient to shoot for a two-pound weight loss by their next visit, or to go from smoking six cigarettes a day to three. I’ll write it in my notes to hold patients and myself accountable, so I know to ask them about it the next time we see each other. I’ll work with each patient to determine a realistic goal and then we’ll go from there. Keeping a journal and tracking the data can help you see the patterns and recognize your improvements, so I recommend patients record their weight and meals, but make sure you’re looking at the long-term patterns and not just at the small details. Your numbers are important, but the overall goal of lowering your risk of heart disease–including heart attack–is paramount.

3. Be open to new treatments that are changing the face of cholesterol management.

If your cholesterol is still high despite lifestyle changes–or if you just can’t make them stick–we’ll start with medications. Sometimes, high cholesterol runs in your family and as hard as you work, you might not be able to control it without meds. Whatever the reason, today we have medications that are more effective than ever at helping patients lower high cholesterol. We’ll typically start someone on a statin; for a long time, statins were the end of the line when it came to cholesterol drugs. Statins are effective for many people, but they aren’t always enough, and sometimes they can have side effects that are difficult for people to tolerate. However, newer injectable and oral medicines can give people fantastic results. It’s very gratifying to be able to offer these treatments to people who’ve hit a wall with their cholesterol management. I saw a patient last week who’d gotten her cholesterol down to much better levels while on a new drug, and I printed out her before and after numbers to show her. She was so excited to see the changes that she told me she was going to stick the report on her fridge. Things like that make me really happy; it’s like getting a good report card. You want to take it home and show it to everybody.

When it comes to managing cholesterol, I want my patients to remember everyone has different risk factors for heart disease. There are some we can modify, and some we can’t. We can’t change your genetics if you have a high risk of heart disease in your family. But we can change your diet, your weight, your smoking habit, and your medications. It’s easy to feel a bit bogged down with all the changes before you even start, but there is hope. By working with your doctor, using any resources available to you, and focusing on the big picture, you can make a significant impact on your health.

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THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.
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