High Cholesterol: 7 Things Doctors Want You to Know
- 1. “You need cholesterol, but you can have too much of a good thing.”“Cholesterol is an important substance for life but, in Western lifestyle environments, our cholesterol is often too high,” says Christopher Granger, MD, a cardiologist with Duke University Hospital in Durham, N.C. When doctors tell you your cholesterol is “too high,” they mean your LDL (bad) cholesterol, a substance that can create plaques—sticky deposits—that block your arteries. On the other hand, your HDL cholesterol, “is protective and makes sure the levels of LDL cholesterol in the body are maintained at a healthy level,” says Dr. Granger.
- 2. “We look at more than just the total cholesterol number.”“If you look at total cholesterol, it’s not all that informative, because you need to have all the numbers to interpret them accurately,” says Nisha Jhalani, MD, a clinical cardiologist at New York Presbyterian - Columbia University Medical Center in New York. For instance, a person with diabetes needs a much lower LDL number than a person of average risk. "It’s very individualized. If you look at the most recent guidelines, it’s not about the cholesterol number itself, it’s the person's 10-year risk of heart disease,” adds Dr. Jhalani.
- 3. “It’s not always what you eat that gives you high cholesterol.”“Most of us have an average genetic risk for high cholesterol, but a small segment of the population—about one in 200—has an extremely high genetic predisposition to have high cholesterol,“ says Joshua Knowles, MD, a cardiologist at Stanford University Medical Center in Stanford, Calif., and chief medical advisor of the FH (Familial Hyperlipidemia) Foundation. If you fall into that category, a healthy diet and lifestyle may not be enough, but cardiologists can still get your bad cholesterol number down, though it may take multiple medications to achieve the goal.
- 4. “You’d be amazed at what a few lifestyle changes can do to lower your cholesterol.”“Maintaining a healthy weight, eating a diet that is low in saturated fat and processed foods, and exercising on a daily basis for 30 or 45 minutes, these are all things that can have profound effects on your cholesterol,” says Dr. Knowles. In particular, these practices can raise your HDL levels, which in turn can lower your LDL levels. “The primary determinant of the cholesterol level is not how much cholesterol you eat. It’s much more determined by how much saturated fat you eat, and trans fats also appear to be harmful, “ adds Dr. Granger.
- 5. “If lifestyle changes don’t work, we have excellent medications to lower cholesterol.”“Statins have the best evidence for showing plaque stabilization as well as regression. We know that statins can decrease your risk of hardening of the arteries throughout your body,” says Dr. Jhalani. “For people who have persistently high cholesterol, other risk factors for heart disease, or established heart disease, the statins are very safe and effective. For the appropriate person, statins are lifesaving drugs—very effective in preventing death, heart attack and stroke,” notes Dr. Granger.
- 6. “Ask your parents whether high cholesterol runs in your family.”“A family history of heart disease can portend increased risk for individual patients. “This should be a way in to talk to your family and learn what happened to mom and dad and what happened to your grandparents,” says Dr. Knowles. If you think high cholesterol might be a family trait, make sure you tell your doctor. “It can help them pick out people who might be at substantially increased risk of heart disease. It's free, and it’s easy.”
- 7. “Get screened for high cholesterol early. Most heart disease is preventable.”“There’s a misconception that high cholesterol and heart disease are problems of middle age,“ notes Dr. Jhalani. “People who are predisposed to high cholesterol and heart disease should be screened as early as their childhood. Atherosclerosis (hardening of the arteries) starts in childhood and reaches a problem level later.” Dr. Knowles urges everyone to have a conversation with their physician. “The tools are available to every physician in America for people to know their cardiovascular risk and the role that cholesterol plays." Adds Dr. Granger: “The critical thing for people to understand is that with a healthy lifestyle, most heart disease can be prevented.”