Understanding

Cholesterol

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Understanding Cholesterol

You probably know that fried chicken, French fries and a loaded double cheeseburger are not the best foods to put in your body. Why? Because foods like these are packed with unhealthy fats and cholesterol. While our bodies need a certain amount of cholesterol to work properly, too much of the “bad” type can be dangerous. Over time, cholesterol and fat can collect in the inner walls of the arteries—including the ones that supply blood to the heart. This buildup can cause a narrowing of the arteries, which is a major cause of cardiovascular disease. People with high levels of low-density lipoprotein (LDL), also called the “bad” cholesterol, are at greater risk for cardiac events.

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The good news is that high cholesterol is often preventable and treatable. Studies show that keeping LDL-C low can not only prevent someone from developing clogged or narrowed arteries in the first place (primary prevention), doing so also helps reduce the likelihood of a heart attack, stroke or related death among people who already have heart disease (secondary prevention). The opposite is true too; those with high levels of high density lipoprotein (HDL), or the “good” cholesterol, tend to have cleaner arteries and lower risk of heart attack and stroke. That’s because HDL-C act like scavengers, helping to find harmful cholesterol and removing it from your arteries. The challenge is that there are often no signs or red flags of having too much bad cholesterol until it starts to affect your arteries. For this reason, it is important to know your cholesterol numbers. Increasingly, research shows that keeping LDL-C levels low is an essential part of staying heart healthy. Adopting a healthy diet, getting regular exercise, keeping weight well managed, and, in some cases, taking medication can go a long way to help. Cholesterol is a waxy, fat-like substance that travels through the blood in carrier vehicles called lipoproteins. It is made by the liver and serves a variety of functions.

Understanding Cholesterol

What is CHOLESTEROL?

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How do I know which foods have saturated or trans fats? • First, read food labels.

A fat-like substance in your blood. Too much cholesterol can clog your arteries

• Second, pay attention to what it looks like when it’s left out. Saturated fats, such as butter or shortening are usually solid at room temperature. On the other hand, olive oil remains liquid and is considered a healthier type of dietary fat (monounsaturated).

and increase risk for heart attack or stroke. For example, it helps create the outer coating of our cells and aids the body in making vitamin D and certain hormones. Cholesterol is also found in many of the foods we eat. Excess amounts of dietary fats and harmful cholesterol can lead to problems. Saturated and trans fats raise LDL-C levels in the blood, thereby increasing the risk of heart disease. Foods that are high in animal fat (full-fat milk, cheese, meat) and/or prepared with butter, shortening or partially hydrogenated oils and sweets (cookies and cakes) are often the main culprits. There is some evidence that trans fats can carry a double-whammy— raising LDL-C and lowering HDL-C.

LDL

"Bad" Cholesterol

• Third, steer clear of hydrogenated or partially-hydrogenated oil. Whether in a liquid or solid form, these are bad for you. Only use specifically labeled “nonhydrogenated” oil.

FOOD TIPS HDL

"Good” Cholesterol

HDL-RAISING:

Olive oil, avocados, walnuts

LDL AND TRIGLYCERIDELOWERING: Oatmeal, apples, oranges, salmon, tofu

LDL-RAISING:

TRIGLYCERIDES/5

Egg yolks, fatty meats, shellfish, dairy products, processed snacks

TRIGLYCERIDE-RAISING:

TOTAL CHOLESTEROL

Excessive drinking, simple carbs/starches, sugars, animal products

What raises LDL can also raise Triglycerides.

Understanding Cholesterol

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What does it feel like?

What puts you at risk?

Many people don’t know that they have high levels of harmful cholesterol. That’s because there are usually no signs or symptoms associated with an early build up of fatty plaques in the arteries. It’s not until there may be a significant blockage (70% or more) of the artery that someone might notice something is wrong. For example, they may have chest pain, pain in the arms or jaw, nausea, sweating, or shortness of breath—these usually occur when the blood supply to the heart is being slowed or blocked. Unfortunately, these blockages, or plaques, can rupture and cause major problems, even when they are much smaller, without causing any prior symptoms. That is why, for some people, the first sign may be a heart attack or stroke.

High LDL-C and total cholesterol are generally related to:

Elevated levels of LDL-C can: • Cause irritation or swelling of the artery walls • Promote the formation of blood clots • Reduce or block the flow of blood through the arteries • Damage the inner lining of the artery That’s why—even if you’re feeling good—it’s a good idea to get your cholesterol checked. Your doctor will consider your cholesterol numbers along with any other factors that make heart disease or stroke more likely to occur (e.g., age, diabetes, high blood pressure, smoking).

• Poor lifestyle habits—eating food rich with unhealthy fats and carbohydrates, not exercising regularly, being overweight/ obese or smoking • Low HDL-C levels • Older age • High blood pressure • Family history of early heart disease • Diabetes • Being African American

Understanding Cholesterol

Keeping tabs on your cholesterol A simple blood test—called a lipid panel—is used to check the amount of cholesterol in your blood. Cholesterol is measured in milligrams (mg) per deciliter (dL) of blood—mg/dL. The test provides four measures:

• Total or overall cholesterol • LDL or “bad” cholesterol

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Improving your cholesterol numbers Your treatment plan will be based on your doctor’s assessment of your overall risk for cardiovascular disease—for example, whether you already have atherosclerosis or have a high chance of developing it (based on a standard risk assessment). Recommended treatments will also depend on:

• HDL or “good” cholesterol

• Your cholesterol levels

• Triglycerides

• Other existing conditions

It’s important to track your cholesterol over time, especially because there are often no signs and symptoms of early build up of fat and cholesterol in the artery walls. Talk with your health care provider about how often your cholesterol should be checked.

Diet

• Personal choice Trying to lower elevated levels of LDL-C most often comes down to making healthier lifestyle choices. In fact, the choices we make everyday can influence our cholesterol.

Here are four things that can make a difference:

Eat A

HeartHealthy

• Previous treatments tried (if applicable)

Lose

Weight

Don't

Smoke!

Regular Exercise

Get

1. Eat a heart-healthy diet (like the Mediterranean or DASH diet) 2. Exercise regularly (at least 30 minutes a day in 3- to 10-minute intervals) 3. Stay at a healthy weight and lose any extra pounds 4. Don’t smoke, and stay away from secondhand smoke

Medication

Many people with elevated LDL-C also need to take medication.

Understanding Cholesterol

CardioSmart.org/Cholesterol

What lifestyle changes should you make? Adopting a heart healthy diet and getting regular exercise are the most important steps you can take to prevent or control cholesterol problems and heart disease. Here are some general tips:

• Get physical. Aim to get 30 minutes of (moderate-intensity) activity at least five times a week. Activities might include a brisk walk, jogging, riding a bike, swimming—even gardening or heavy housework. If you have a hard time carving out 30 minutes all at once, remember even 10-minute bursts of activity are helpful. Consider wearing a device that keeps track of the number of steps you take each day so that you know your starting point. • Take time to read and understand food labels, and pay special attention to the amount of saturated fats, trans fats, and carbohydrates. • Try to avoid full-fat dairy products and processed foods with partially or fully hydrogenated oils. • Substitute butter or margarine for healthier fats such as olive oil, avocados and a handful of almonds (remember, fat that becomes solid on the counter should probably be avoided). Nuts, fish, certain oils (olive, canola, and peanut oils) and other foods rich in omega-3 fatty acids are good choices.

• Consider keeping a food diary so you can see what you are eating and what dietary habits you might need to change. • Ask about seeing a dietitian or nutritionist who can help you meal plan and provide dietary strategies for lowering LDL-C or triglycerides or to boost your HDL-C. • As with any goal, start small. Make sure you are setting yourself up for success. • Limit alcohol. Too much alcohol can raise LDL-C and triglyceride levels.

Understanding Cholesterol

CardioSmart.org/Cholesterol

How is it treated? Many people who have excess LDL-C also need to take lipid-lowering medications at some point. This is especially true for people with atherosclerotic cardiovascular disease or those who are at high risk for developing it. Statins—in combination with lifestyle changes—are still the drug treatment of choice. Research has shown that the use of statins can reduce the risk of cardiac events like heart attack, stroke, and related death. There are at least 7 statins available, and they work in different ways; for example by:

• Reducing the amount of cholesterol made by the liver • Removing cholesterol from the blood • Reducing cholesterol in plaque • Reducing inflammation from plaque • Preventing plaque from dislodging or forming a clot that may block an artery

No matter which medication your doctor prescribes, take your medications exactly as directed—that’s the only way to make sure they work as intended. If you have side effects or concerns, talk with your doctor before making any changes. Your local pharmacist is a good resource if you have questions.

Did You Know?

As with any medication, it is important to tell your doctor about any side effects or problems.

• People with high total cholesterol are twice as likely to develop heart disease

Other (non-statin) medications include:

• About 1 in 3 American adults has high LDL-C

• PCSK9 inhibitors • Cholesterol absorption inhibitor/ Ezetimibe • Bile-acid-binding sequestrants or resins • Fibrates and high-dose omega-3 fatty acids for treating severe high levels of Triglycerides • Niacin

• Recent studies suggest cholesterol levels fluctuate based on the time of year. Cholesterol levels tend to be more unfavorable in the colder months.

Understanding Cholesterol

CardioSmart.org/Cholesterol

Questions to ask: Your health care team will work with you to help prevent or treat high cholesterol and support your overall cardiovascular health. Here are some questions you may want to ask:

• What is my cholesterol? • What’s the difference between LDL-C and triglycerides? • Will exercise and diet alone be enough to lower my cholesterol? • How much exercise should I be getting? What types of activities are best for me? • Are there foods I should avoid/eat more of? • Do I need medication? If so, which medication and why? • When can we expect to see a difference? • What side effects should I watch for? • I know statins are usually the first drug therapy, but what can you tell me about non-statin medications? • What can I do to raise my “good” cholesterol? • How often do I need to get my cholesterol level checked? • What about my other risk factors for cardiovascular disease?

Helpful resources To learn more about cholesterol, visit CardioSmart.org/Cholesterol You can also find resources at: National Heart, Lung, and Blood Institute nhlbi.nih.gov

For more information, visit

CardioSmart.org/Cholesterol Information provided for educational purposes only. Please consult your health care provider regarding your specific health needs. ©2016, American College of Cardiology