For a healthy life, you need a healthy heart. And the key to good cardiovascular health is healthy cholesterol levels.
Cardiovascular disease is the leading cause of death globally, and in the US, it is responsible for 1 in 4 deaths. The three leading risk factors include high blood pressure, smoking, and high cholesterol level.
While some risk factors cannot be controlled, such as your age and family history, other risk factors involving diet and lifestyle can be modified to ultimately lower your risk for heart disease.
Cholesterol is a waxy substance that moves through your blood vessels. While it has garnered a negative reputation, cholesterol can be useful for your health when consumed in the right quantities. The body relies on cholesterol as a fundamental building block for the body cells, hormones, and Vitamin D. It also helps with digestion.
Of course, too much of anything can contribute to health conditions, and the same is true for too much cholesterol. In the case of elevated blood cholesterol levels, the excess amount sticks to the walls of the blood vessels and forms a plaque, thereby, restricting blood flow. This phenomenon is known as atherosclerosis and can give rise to coronary artery disease.
There are two main types of cholesterol: high-density lipoprotein cholesterol (HDL) and low-density lipoprotein cholesterol (LDL). Another type of cholesterol is very low-density lipoprotein (VLDL). Triglycerides are fatty substances like cholesterol that also increase your risk of heart disease.
The term "lipids" encompasses cholesterol and triglycerides, and a standard lipid blood test covers triglycerides, total cholesterol, LDL cholesterol, HDL cholesterol, VLDL, and non-HDL cholesterol numbers (in mg/dl) along with the ratio between cholesterol and HDL. High levels of lipids in the blood is a condition known as hyperlipidemia.
A person's first cholesterol screening should ideally happen between the ages of 9 and 11 years. If you are above the age of 20 years, the National Heart, Lung, and Blood Institute advises that you get your cholesterol levels measured every 5 years.
If you fall in the high-risk group for heart disease, you must get a cholesterol test done more frequently. Your physician will order a blood test called a lipoprotein panel that provides information about your body's lipid profile. Blood will be drawn from a vein in your arm, and in most cases, you may be required to fast for 9-12 hours prior to the test.
Total cholesterol refers to the total amount of cholesterol circulating in your blood, and it is composed of your triglyceride, HDL cholesterol, LDL cholesterol measurements. A high total cholesterol level raises your risk of heart disease. However, when it comes to treating hyperlipidemia, specific LDL and HDL cholesterol levels tend to be more important. As per the Centers for Disease Control and Prevention (CDC) guidelines:
Normal cholesterol levels: less than 200 mg/dl (5.17 mmol/L)
Borderline high: 200 mg/dl to 239 mg/dl (5.17 to 6.18 mmol/L)
High/Dangerous: 240 mg/dl or higher (6.19 mmol/L)
Low-density lipoprotein (LDL) cholesterol is bad cholesterol. High LDL cholesterol levels are responsible for the fatty deposits in arteries (atherosclerosis) that have been implicated in coronary artery disease. When the arteries narrow, their blood flow capacity decreases, and organs are unable to receive the amount of blood and oxygen they need to function optimally. This particularly increases the risk of heart attack and stroke.
LDL levels are important when treating hyperlipidemia. The optimum LDL cholesterol level varies from person to person as it depends on your overall risk for cardiovascular events, such as heart attack or stroke. People at higher risk have a lower LDL cholesterol target. Your LDL goals are affected by factors such as smoking, high blood pressure, low HDL cholesterol, family history of early heart disease, and age.
Generally, in a healthy, low-risk individual, LDL levels under 100 mg/dl (2.6 mmol/L) are considered good. LDL levels above 160 mg/dl (4.1 mmol/L) are dangerous for your health.
High-risk persons may want to maintain their LDL levels at lower than 70 mg/dl (1.8 mmol/L).
High-density lipoprotein (HDL) cholesterol is good cholesterol. The higher the HDL levels, the lower your risk for cardiovascular disease. HDL's role is to remove LDL cholesterol and transport it from the arteries to the liver, where it can be broken down. That's how HDL prevents fatty buildups within the arteries. HDL levels are affected by exercise, and physically active people tend to have higher HDL numbers.
Healthy HDL levels are 60 mg/dl (1.55 mmol/L) or higher, while levels lower than 40 mg/dl (1.03 mmol/L) are considered substandard.
Non-HDL cholesterol is a combination of LDL cholesterol and other types of cholesterol, such as very low density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), and lipoprotein(a). It is obtained by subtracting the HDL cholesterol value from the total cholesterol measurement. Non-HDL cholesterol more accurately predicts a person's cardiovascular risk than LDL cholesterol alone.
Optimum non-HDL cholesterol can be calculated by adding 30 mg/dl (0.78 mmol/L) to your LDL cholesterol target.
Triglycerides form the most common type of fat in the body and are used to generate energy. In conjunction with LDL or HDL, high triglyceride levels can increase your risk for heart disease. The categories of triglyceride levels are as follows:
Cholesterol testing to measure triglyceride levels requires you to fast beforehand. High triglyceride numbers are associated with obesity, poorly controlled diabetes, and increased consumption of sugar, refined carbohydrates, and alcohol. Drug therapies to treat high cholesterol levels, particularly high triglyceride levels, include statins (e.g. simvastatin, atorvastatin, rosuvastatin).
Moderation is the key when it comes to the consumption of almost every component of our diet. The same is true for cholesterol. However, your blood cholesterol level is not just related to the cholesterol you directly consume in your diet. A number of other factors come into play. Fortunately for us, some of these factors are within our control and can be modulated to increase or decrease the chances of us developing high cholesterol levels. Whereas a few factors are completely out of our control, like genetics, and put some of us at an inherent disadvantage by predisposing us to higher blood cholesterol levels.
One of those uncontrollable risk factors is gender. Men, at any age, tend to possess lower HDL levels than women, which naturally elevated their cardiovascular disease risk. Menopausal women in their 40s or 50s (those who have reached the end of their menstrual periods) are also predisposed to high cholesterol levels. Research has revealed that women have higher levels of LDL in their blood as they approach menopause.
Another unmodifiable risk factor is age. As we grow older, our body’s ability to clear and control blood cholesterol levels diminishes. So with increasing age, our cholesterol levels also steadily increase, which increases our risk for cardiovascular events like heart attack and stroke.
Family members not only share a gene pool, but they also have overlapping behaviors, lifestyles, and environments, which ultimately impact their health and their risk for certain health conditions. Therefore, if you have a family history of high cholesterol and a direct blood relative of yours has suffered from early heart disease, you have an increased risk of developing high blood cholesterol.
In a rare inherited genetic disorder called familial hypercholesterolemia (FH), the body finds it harder to remove low-density lipoprotein cholesterol from the blood. Hence, from a young age, these individuals have high LDL levels clogging their blood vessels. This hereditary condition makes them prone to high cholesterol levels and drastically raises their chances of developing early heart disease, heart attack, stroke, etc. The risk continues to increase with age if left untreated.
As far as modifiable factors are concerned, diet is one of the most critical contributors. You are what you eat. Consuming a diet rich in trans fats, saturated fats, sugar, and cholesterol directly raises the body's total blood cholesterol and LDL cholesterol levels.
In addition to diet, your body weight and lifestyle habits also significantly affect your heart health. Unsurprisingly, your body weight influences your cholesterol levels. Being overweight or obese can make your triglyceride and LDL (bad) cholesterol levels rise while bringing down your HDL (good) levels. Obesity can also ultimately lead to heart disease, high blood pressure, and diabetes.
As per the American Heart Association (AHA), high cholesterol can be attributed to two interlinked lifestyle elements: lack of physical activity and high body weight. A 2019 study involving 425 older adults concluded that moderate and vigorous physical activity lowered blood pressure and increased HDL cholesterol levels. Hence, a sedentary lifestyle deprives you of the protective aspect of HDL cholesterol, while also predisposing you to obesity.
Another lifestyle habit that increases your risk of developing high cholesterol and heart disease is smoking. Smoking decreases your HDL levels and damages your blood vessels, thereby turning them into deposit sites for fatty plaques.
You can practice a number of measures to lower and regulate your blood cholesterol levels.
Give up unhealthy eating habits: Stop eating bad fats! Avoiding fried foods rich in saturated fats and trans fats, and foods derived from animal products (cheese, fatty meats, dairy desserts, etc.) is the first step towards a healthier, low cholesterol diet.
Limit saturated fat intake, and switch to low-fat foods such as lean meats, seafood, low-fat milk, cheese, yogurt, whole grains, fruits, and vegetables. Introducing food items rich in fiber and unsaturated fats can also help lower your LDL and triglyceride levels while raising your HDL levels.
Maintain a healthy body weight: Pick a workout plan to lose weight if you are overweight and through a combination of adequate physical activity and diet management, attain a healthy weight and BMI. According to research data, a reduction of 5-10% of body weight may significantly lower LDL cholesterol levels in individuals at higher risk of heart disease. Similarly, another study concluded that a weight loss of just 1-3% may raise HDL cholesterol levels.
Adopt lifestyle changes: Incorporate healthy eating and exercise habits into your daily routine. The next time you go grocery shopping, check the nutritional constituents of the food you purchase. Shift to a low-fat diet and make sure that you design your meals to hit all the key nutrients. Reserve at least 20 minutes every day for moderate-intensity exercises such as brisk walking, cycling, or any other sport.
Quit smoking: If you are a smoker, get rid of that pack! Quitting will lower your risk of high cholesterol and subsequent heart disease. Research shows that your HDL levels can increase by as much as 30% within only three weeks of halting smoking.
Take medications if necessary: When lifestyle changes alone prove inadequate in lowering your blood cholesterol levels, consult your doctor and get a prescription for cholesterol-lowering medications.
Currently, there are several types of cholesterol-lowering drugs available, such as statins (first-line treatment for high triglycerides), bile acid sequestrants (bile acid-binding drugs that reduce the absorption of fat from food), and selective cholesterol absorption inhibitors. Patients with familial hypercholesterolemia may have to undergo a treatment known as lipoprotein apheresis, which removes all the LDL cholesterol from their blood.
Cholesterol is an essential molecule that our body needs for proper functioning. The problem arises when its levels rise beyond our body's requirements and overpower the body's clearing mechanism. By restricting blood flow through the blood vessels, high cholesterol levels wreck not only our heart but also organs like the brain.
If left unmanaged, high cholesterol can lead to heart disease, heart attack, or stroke. However, through dietary changes, bodyweight management, regular physical activity, and other lifestyle modifications, we can regulate our blood cholesterol levels and limit our risk of cardiovascular events.
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For people aged 19 or younger, normal healthy total cholesterol levels are less than 170 mg/dl (4.4 mmol/L) and for people aged 20 or older, the levels should be between 125 and 200 mg/dl (3.2-5.17 mmol/L).
Healthy ranges for adults: LDL < 100 mg/dl (2.6 mmol/L), HDL >40 mg/dl (1.03 mmol/L) (for men), HDL >50 mg/dl (1.3 mmol/L) (for women)
Healthy ranges for children: LDL < 110 mg/dl (2.8 mmol/L), HDL>45 mg/dl (1.16 mmol/L)
Total cholesterol amounts less than 5.17 mmol/L (200 mg/dl) are considered to be healthy. Therefore, by this standard, a total cholesterol level of 5.4 mmol/L (209 mg/dl) would be borderline high.
A healthy amount of LDL cholesterol for a low-risk individual is less than 100 mg/dL (2.6 mmol/L). Similarly, for this person, HDL cholesterol levels greater than or equal to 60 mg/dL (1.55 mmol/L) would be considered good.
