Find out if your cholesterol level is in the healthy range and if not, what you should do about it.
Tip #1: Get Your Cholesterol Checked
It’s important to know what your risks are, and since heart attacks are associated with higher LDL and lower HDL, it is good to know these numbers. This is especially important as you get older, as heart attacks get much more frequent as people age.
Tip #2: Don’t Focus on the Total Cholesterol
Knowing your HDL and LDL will allow you to know your real risk. For low-risk people—or people without any risk factors (which I’ll get to in my next tip) the goal is to have an LDL under 160. But that goal changes as the number of risk factors goes up. For people with diabetes, for example, the LDL should be under 70.
As for your HDL level, you want that to be over 40, although over 50 is even better.
Tip #3: Know Your Other Risk Factors
Knowing your risk factors for heart disease —aside from cholesterol-- will tell you how closely you’ll need to monitor your cholesterol.
There are six major risk factors:
Strong family history of heart disease in your immediate family
Additionally, men are generally at higher risk for heart disease than women are.
The family history needs to be put in perspective. If your uncle Harry had a heart attack when he was 90, it’s doesn’t really increase your risk, but if your father had a heart attack at age 40, you should be far more concerned about cholesterol. I don’t treat cholesterol numbers without knowing the overall risk.
It’s like hurricanes. If you live in Florida, you worry about hurricanes, keeping tabs on the weather and having a house that can withstand high winds and water. If you live in Idaho, on the other hand, you don’t have to worry at all about hurricanes (although I guess your risk of being pelted with potatoes goes up).
Your doctor should figure out your real risk of heart disease. If he or she doesn’t calculate your risk, do it yourself and show them the results. Check out episode 37 for help on which tests diagnose heart problems.
Tip #4: Do What You Can to Have the Best Cholesterol Possible
There are many things you can do to lower your LDL and raise your HDL. These include:
Exercising (my QDT colleague, Get-Fit Guy, can help you)
Foods rich in saturated and trans-fats tend to raise the LDL, whereas foods rich in unsaturated fats can actually raise the HDL--the good cholesterol. In general, this means that you should minimize animal fats --- more common in red meats -- but don’t cut back on vegetable fats. Olive and canola oils are rich in the good unsaturated fats, and so are actually good to have. Also avoid “hydrogenated” oils, which are fats that have been turned from unsaturated to saturated fats by food manufacturers. They do this to make its consistency better, but it makes the food much less healthy.
Read labels. Know what you are putting in your mouth. Again, The Nutrition Diva is an excellent resource on this if you want more information.
Tip #5: Consider Cholesterol-Lowering Drugs if You are at Increased Risk
I only use medications when I feel the risk of taking them is outweighed by the risk of not taking them. Studies have shown that bringing the LDL down with specific medications in high-risk people lowers the risk of heart disease and death. Which people and which medicines? That’s what I did all my training to know. You’ll need to see your own doctor to find out if these medications are appropriate for you. In general, though, I think a person with a 10-year risk over 10% should be considered for treatment and someone over 20% should clearly be treated.
Are Cholesterol Drugs Dangerous?
Are cholesterol drugs dangerous? I don’t think they’re dangerous, but they do have significant risks. That’s why I have to have a license to prescribe them, and why they aren’t in the grocery store next to the candied yams. All drugs should be used only when the benefit significantly outweighs the risk.
Ultimately, the decision is between you and your doctor. As the person taking the medication, you should be aware of the risk you take by taking the medication and also the risk of not taking it. There is, in my opinion, pretty strong evidence that using “statin” drugs can significantly improve the survival and quality of life of high-risk people.
That’s it for this week’s article. I hope this answers your questions about cholesterol, and I hope it made Ralph happy as well. If you have questions you want answered, send them to firstname.lastname@example.org.
Catch you next time! Stay healthy!
Framingham Risk Calculator: http://hp2010.nhlbihin.net/atpiii/calculator.asp