High blood cholesterol is another major risk factor for heart disease that you can do something about. The higher your blood cholesterol level, the greater your risk for developing heart disease or having a heart attack.
To prevent these disorders, you should make a serious effort to keep your cholesterol at healthy levels. Cholesterol lowering is important for everyone – women and men; younger, middle-aged, and older adults; and people with and without heart disease.
Cholesterol and Your Heart
The body needs cholesterol to function normally. However, your body makes all the cholesterol it needs. Over a period of years, extra cholesterol and fat circulating in the blood build up in the walls of the arteries that supply blood to the heart.
This buildup, called plaque, makes the arteries narrower and narrower. As a result, less blood gets to the heart. Blood carries oxygen to the heart; if enough oxygen-rich blood cannot reach your heart, you may suffer chest pain. If the blood supply to a portion of the heart is completely cut off, the result is a heart attack.
Cholesterol travels in the blood in packages called lipoproteins. LDL carries most of the cholesterol in the blood. Cholesterol packaged in LDL is often called bad cholesterol, because too high a level of LDL in your blood can lead to cholesterol buildup and blockage in your arteries.
Another type of cholesterol is HDL, also called good cholesterol. That’s because HDL helps remove cholesterol from the body, preventing it from building up in your arteries.
High blood cholesterol itself does not cause symptoms, so if your cholesterol level is too high, you may not be aware of it. That’s why it is important to get your cholesterol levels checked regularly. Starting at age 20, everyone should have their cholesterol levels checked by means of a blood test called a lipoprotein profile.
Be sure to ask for the test results, so you will know whether you need to lower your cholesterol. Ask your doctor how soon you should be retested.
Total cholesterol is a measure of the cholesterol in all of your lipoproteins, including the “bad” cholesterol in LDL and the “good” cholesterol in HDL. An LDL level below 100 mg/dL is considered “optimal” or ideal. As you can see in the accompanying table, there are four other categories of LDL levels.
The higher your LDL number, the higher your risk of heart disease. Knowing your LDL number is especially important because it will determine the kind of treatment you may need.
Your HDL number tells a different story. The lower your HDL number, the higher your heart disease risk. Your lipoprotein profile test will also measure levels of triglycerides, which are another fatty substance in the blood.
What’s Your Number?
Blood Cholesterol Levels and Heart Disease Risk
|Total Cholesterol Level||Category|
|Less than 200 mg/dL*||Desirable|
|200–239 mg/dL||Borderline high|
|240 mg/dL and above||High|
|LDL Cholesterol Level||Category|
|Less than 100 mg/dL||Optimal (ideal)|
|100–129 mg/dL||Nearly optimal|
|130–159 mg/dL||Borderline high|
|190 mg/dL and above||Very high|
HDL Cholesterol Level
An HDL cholesterol level of less than 40 mg/dL is a major risk factor for heart disease. An HDL level of 60 mg/dL or higher is somewhat protective.
Heart Disease Risk and Your LDL Goal
In general, the higher your LDL cholesterol level and the more other risk factors you have, the greater your chances of developing heart disease or having a heart attack. The higher your overall risk, the lower your LDL goal level will be. Here is how to determine your LDL goal:
Step 1: Count your risk factors. Below are risk factors for heart disease that will affect your LDL goal. Check to see how many of the following risk factors1 you have:
- Cigarette smoking
- High blood pressure (140/90 mmHg or higher, or if you are on blood pressure medication)
- Low HDL cholesterol (less than 40 mg/dL)2
- Family history of early heart disease (your father or brother before age 55, or your mother or sister before age 65)
- Age (55 or older if you’re a woman; 45 or older if you’re a man)
Step 2: Find out your risk score. If you have two or more risk factors on the above list, you will need to figure out your “risk score.” This score will show your chances of having a heart attack within the next 10 years.
Note that there are separate risk “scorecards” for men and women.
Step 3: Find out your risk category. Use your number of risk factors, risk score, and medical history to find out your category of risk for heart disease or heart attack.
|If You Have||Your Category Is|
|Heart disease, diabetes, or a risk score of more than 20 percent*||High risk|
|Two or more risk factors and a risk score of 10–20 percent||Next highest risk|
|Two or more risk factors and a risk score of less than 10 percent||Moderate risk|
|Zero or one risk factor||Low-to-moderate risk|
A Special Type of Risk
Nearly 25 percent of Americans have a group of risk factors known as metabolic syndrome, which is usually caused by overweight or obesity and by not getting enough physical activity. This cluster of risk factors increases your risk of developing heart disease and diabetes, regardless of your LDL cholesterol level. You have metabolic syndrome if you have three or more of the following conditions:
- A waist measurement of 35 inches or more for a woman or 40 inches or more for a man
- Triglycerides of 150 mg/dL or more
- An HDL cholesterol level of less than 50 mg/dL for a woman and less than 40 mg/dL for a man
- Blood pressure of 130/85 mmHg or more (either number counts)
- Blood sugar of 100 mg/dL or more
If you have metabolic syndrome, you should calculate your risk score and risk category as indicated in Steps 2 and 3 above. You should make a particularly strong effort to reach and maintain your LDL goal. You should also emphasize weight control and physical activity to correct the risk factors of the metabolic syndrome.
Your LDL Goal
The main goal of cholesterol-lowering treatment is to lower your LDL level enough to reduce your risk of heart disease or heart attack. The higher your risk category, the lower your LDL goal will be.
To find your personal LDL goal, see the table below:
|If You Are in This Risk Category||Your LDL Goal Is|
|High Risk||Less than 100 mg/dL|
|Next highest risk or moderate risk||Less than 130 mg/dL|
|Low-to-moderate risk||Less than 160 mg/dL|
How to Lower Your LDL
There are two main ways to lower your LDL cholesterol – through lifestyle changes alone, or through lifestyle changes combined with medication. Depending on your risk category, the use of these treatments will differ.
- Lifestyle changes
One important treatment approach is called TLC, which stands for “Therapeutic Lifestyle Changes.” This treatment includes a low saturated fat and low-cholesterol diet, regular moderate-intensity physical activity, and weight management. Everyone who needs to lower their LDL cholesterol should use this TLC program. Maintaining a healthy weight and getting regular physical activity are especially important for those who have metabolic syndrome.
If your LDL level stays too high even after making lifestyle changes, you may need to take medicine. If you need medication, be sure to use it along with the TLC approach. This will keep the dose of medicine as low as possible, and will lower your risk in other ways as well. You will also need to control all of your other heart disease risk factors, including high blood pressure, diabetes, and smoking.
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