Cholesterol: What You Need to Know

Why Am I getting a Cholesterol Screen at my Annual Checkup?

What is cholesterol?

How could high cholesterol potentially affect me if not treated?

What is C-Reactive Protein and When should this test Also be Drawn?

Suggested to Lower Cholesterol Levels?

Cholesterol values

What are the risk factors for developing high cholesterol?

Are there different types of cholesterol?

What can I do to control my cholesterol and reduce my risk of heart disease?

Tips for improving your cholesterol

Tips for eating smart

Why Am I getting a Cholesterol Screen at my Annual Checkup?

The National Institute of Health, the American Heart Association and the American College of Obstetrics and Gynecology each advise that women have a full lipid panel at least every 5 years. Patients with heart disease, risk factors for heart disease or those presently under treatment for high cholesterol should have their cholesterol checked more often.

In the order of occurrence, heart disease is far more prevalent than breast cancer, cervical cancer, colorectal cancer or any of the other medical conditions that are screened at any annual exam. A very convincing argument could be made that the most important topic for discussion each year at a preventative annual physical is what the patient is doing to improve her cardiovascular health.

Cholesterol levels are affected by diet and activity levels, but genetics play a large role in whether you have a cholesterol or triglyceride problem that needs addressing. Since a high cholesterol problem can be silent until heart disease or other problems strike, the blood test is needed is screen those women who may have a serious problem with their cholesterol and need to lower their cholesterol to avert future heart problems.

There is strong evidence that lowering your cholesterol can prevent heart disease, and even in those patients that have established heart disease, aggressive lowering of their cholesterol can reduce the chances of future heart attacks or other vascular problems.

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What is cholesterol?

Cholesterol is a type of fat. Your body requires cholesterol to make hormones and to build nerve cells. However, when you consume more cholesterol than you need deposits of fat in the blood called plaque form inside the blood vessel wall. Over time the blood vessel wall thickens and the vessels become narrower. The narrowed vessel reduces the blood flow through the arteries, which could possibly lead to heart attack, stroke and high blood pressure.

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How could high cholesterol potentially affect me if not treated?

Coronary heart disease (CHD) is the leading cause of death in both men and women in the United States resulting in approximately 500,000 deaths annually. About 50% of men and 63% of women who die suddenly of CHD have no prior symptoms. High cholesterol or hyperlipidemia is an important modifiable risk factor for the development and progression of cardiovascular disease. Disease states that can occur as a result of high cholesterol include: high blood pressure, peripheral vascular disease, stroke, and heart attack. The causal link between high cholesterol, specifically LDL (low density lipoprotein) the bad cholesterol, and heart disease has been established. In addition, compelling evidence supports the link between low levels of HDL (high density lipoproteins) the good cholesterol and the development of heart disease. Clinical evidence conforms that treating risk factors such as high cholesterol can reduce heart disease morbidity and mortality. Cholesterol regulating therapy can reduce the relative risk for heart disease events by as much as 25%-35%.

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What is C-Reactive Protein and When should this test Also be Drawn?

Research over the past few years has intensified on the mechanism of plaque buildup in arteries and arterioles that can cause heart attacks and poor perfusion. It is now thought that inflammation can have a significant role in the blockage of arteries, as evidenced by patients that develop heart disease despite normal or low cholesterol levels. It is thought that a combination of plaque buildup and inflammation of arterial walls causes the eventual blockage or arteries that leads to a heart attack or stroke.

C-reactive protein is a protein made by our bodies during inflammatory reactions and in response to tissue injury. It can rise in a variety of acute and chronic inflammatory conditions including conditions as simple as poor gum or tooth hygiene. The test is inexpensive to draw and should be considered in all patients, particularly those with family histories of heart disease.

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Suggested to Lower Cholesterol Levels?

There is good evidence that cholesterol lowering drugs could significantly lower the risks of future heart disease in America and that between 20 and 30 million Americans should be on these drugs, that are not presently on them. The risk of future heart attacks in those patients that have suffered a heart attack has been shown to be considerably lower LDL cholesterol levels are brought down below 100. More recently, there is evidence that even lower LDL levels (approaching 65) improve survivability and reduce the risk of future attacks even better.

Patients who smoke, have high blood pressure or are obese, or who have a strong history of heart disease should consult a physician about beginning medical therapy if the total cholesterol of 240 or higher or the LDL of 135 or higher can not be brought down by diet and exercise.

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Cholesterol values:

Total cholesterol

LDL Cholesterol – Primary target of Therapy (bad cholesterol)

HDL Cholesterol (good cholesterol)

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What are the risk factors for developing high cholesterol?

• A diet high in saturated fat and cholesterol
• Cigarette smoking
• Obesity
• Age – women older than 55 years
• Genetics: Family history of heart disease (first degree relative before 65 yrs.)
• Physical inactivity
• Diabetes
• HDL cholesterol <35mg/dl

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Are there different types of cholesterol?

When your total cholesterol level is high your health care provider may check the LDL (low density lipoprotein), HDL (high density lipoprotein), and triglyceride level in your blood. Both LDL and HDL carry cholesterol through your blood. The LDL’s (bad cholesterol) are able to carry a lot of cholesterol, but they leave behind fatty deposits that collect on your artery walls and contribute to heart disease. The HDL’s (good cholesterol) do the exact opposite of the LDL’s. They clean the artery walls and remove the extra cholesterol from the body, which lowers the risk of heart disease. It is good to have low levels of LDL and high levels of HDL. Triglycerides are another form of cholesterol that deposits fat in the arteries and the lower the triglyceride level the better.

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What can I do to control my cholesterol and reduce my risk of heart disease?

Lifestyle changes to reduce your LDL level

• Decrease saturated fats to <7% of calories
• Decrease cholesterol <200 mg/day
• Increase soluble fiber in your diet
• Weight management
• Increase physical activity

Lifestyle changes to increase your HDL level

• First reach your LDL goal, then
• Intensify weight management and increase physical activity

Lifestyle changes to decrease your triglyceride level

• Primary goal is to reach your LDL goal
• Intensify weight management
• Increase physical activity

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Tips for improving your cholesterol

• Reduce the amount of cholesterol in your diet. The American Heart Association recommends eating no more than 250-300mg of cholesterol per day.
• Fats should contribute no more than 30% of your daily calories. Only 10% of the fat you eat should be saturated fat, the remaining calories should come from unsaturated fats.
• Monitor your caloric intake.
• Aerobic exercise 3-4 times a week for 20-30 minutes.
• If you smoke, quit.
• Know your family history, high cholesterol may run in families.           

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Tips for eating smart

• Limit saturated fats, like dairy fats (ice cream & butter), and palm & coconut oil often found in baked goods. Polyunsaturated and monounsaturated fats are better than saturated fats. Monounsaturated fats are found in olive oil, canola oil, and avocados. Polyunsaturated fats are found in fish and some vegetable oils. Saturated fat raises your blood cholesterol because it makes it hard for the body to clear the cholesterol away
• Limit foods high in cholesterol such as egg yolks, organ meats (liver), and shellfish.
• Eat more fruits and vegetables.
• Eat more broiled or grilled fish and skinless chicken breasts.
• When you eat beef, pork, or lamb choose the leanest cuts & eat smaller portions.
• Eat a variety of fiber rich foods, like oats, dark breads and apples.
• Choose low fat or non-fat dairy products.
• Avoid fried foods.
• Everyone age 20 and older should have their cholesterol measured at least once every 5 years. It is best to have a blood test called a "lipoprotein profile" to find out your cholesterol numbers. This blood test is done after a 9- to 12-hour fast and gives information about your:




- Total cholesterol - LDL (bad) cholesterol - the main source of cholesterol buildup and blockage in the arteries - HDL (good) cholesterol - helps keep cholesterol from building up in the arteries - Triglycerides - another form of fat in your blood

If it is not possible to get a lipoprotein profile done, knowing your total cholesterol and HDL cholesterol can give you a general idea about your cholesterol levels. If your total cholesterol is 200 mg/dL* or more or if your HDL is less than 40 mg/dL, you will need to have a lipoprotein profile done. See how your cholesterol numbers compare to the tables below.

*Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood.

*HDL (good) cholesterol protects against heart disease, so for HDL, higher numbers are better. A level less that 40 mg/dL is low and it increases your risk for heart disease.

Triglycerides can also raise heart disease risk. Levels that are borderline high (150-199 mg/dL) or high (200 mg/dL or more) may need treatment in some people. 

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