Page Contents:

• What is Cholesterol?
• How Cholesterol Causes Trouble
• Understanding Your Numbers
• What Makes Bad Cholesterol (LDL) High
• How to Lower Bad Cholesterol
• Improving Good Cholesterol
• Should Medication be Prescribed?

What is Cholesterol?

Cholesterol is a type of fat that our bodies need to maintain function of the nervous system, skin, muscles, liver, intestines and heart. Dietary cholesterol comes from foods of animal origin, including meat, eggs, dairy products, fish and poultry, while blood cholesterol is made by the liver.
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How Cholesterol Causes Trouble

There are two types of cholesterol: LDL (low-density lipoproteins, or bad cholesterol) and HDL (high-density lipoproteins, or good cholesterol). LDL is the most important component of your cholesterol. When elevated, LDL can put you at risk for heart attack and stroke by leaving deposits in your blood vessels and causing blockage. Triglycerides, which are a form of fat that affects your cholesterol level, may also cause problems when levels are elevated.
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Understanding Your Numbers

Risk Factors

Your goal cholesterol depends on the following risk factors:

• Smoking
  
• Having high blood pressure
  
• Having a family history of early heart disease
  • A father or brother diagnosed with heart disease before age 55
    
  • A mother or sister diagnosed with heart disease before age 65
• Age
  • Being a male over 45 years of age, or a female over 55 years of age
• Low HDL
  • Good cholesterol lower than 40

High Risk Factors

If you have a personal history of diabetes, coronary heart disease (CHD), carotid artery disease, peripheral arterial disease, or an abdominal aortic aneurysm, you are automatically considered high risk.

Total Cholesterol

• Cholesterol below 200 mg/dL is considered a desirable level.
  
• Cholesterol from 200 to 239 mg/dL is considered borderline risk.
  
• Cholesterol above 239 mg/dL is considered an undesirable risk.

Triglycerides

• Triglycerides below 150 mg/dL are considered a desirable level.
  
• Triglycerides from 150 to 199 mg/dL are considered borderline high.
  
• Triglycerides above 199 mg/dL are considered an undesirable risk.

HDL or Good Cholesterol

• HDL below 40 mg/dL is considered too low and increases your risk.
  
• HDL above 45 mg/dL is considered a desirable level.
  
• HDL above 60 is considered protective.

LDL (Bad Cholesterol)

LDL is the most important number when considering your cholesterol goal.

• If you have one or less of the risk factors listed above, your goal LDL is 160 or lower (ideally less than 130).
• If you have two or more of the risk factors listed above, your goal LDL is 130 or lower.
  
• If you have any of the high risk factors listed above, your goal LDL is less than 100 (optional goal less than 70).
  
• If you have multiple risk factors and coronary heart disease, your optional goal LDL is less than 70.

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What Makes Bad Cholesterol (LDL) High

• Genetics
  
• Diet
  
• Smoking
  
• Being overweight
  
• Lack of exercise

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How to Lower Bad Cholesterol

• Eat a diet low in saturated fat
  • Eating a diet low in saturated fat is one of the best ways to lower LDL cholesterol. This does not mean you have to give up your favorite foods. Instead, you can choose smaller portions, use leaner cuts of meat and eat more fiber-rich foods that make you feel full and help move cholesterol out of the body. Eating five servings a day of fruits and vegetables is an excellent way to cut back on fats. Avoid saturated fats such as ice cream, butter, palm and coconut oils. Eat more fish and skinless chicken breasts. Avoid fried foods. Choose low fat and non-fat dairy products. For further guidance, see a dietitian.
    
  • For those with high triglycerides, eating a diet low in saturated fat combined with eating a moderate amount of carbohydrates can lower triglyceride levels. Diets high in carbohydrates (more than 60 percent) can cause elevated triglyceride levels in those susceptible.
  
  
• Quit Smoking
  • Quitting smoking can help lower blood cholesterol levels and your risk for heart attack and stroke.
  
  
• Lose weight
  • If you are overweight, it is important to lose weight to lower your cholesterol. Ask your primary care physician for a referral to see a nutritionist for guidance and support.
  
  
• Exercise
  • Even mild regular exercise has been shown to lower LDL levels and raise HDL levels.

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Improving Good Cholesterol

Having a high HDL (good cholesterol) protects you from heart disease. Exercise is one of the best ways to increase your HDL. Consuming one alcoholic drink per day has also been shown to increase HDL. However, excessive alcohol consumption may damage organs and is discouraged. Ask your physician what constitutes moderate alcohol consumption and whether this is a reasonable option for you.
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Should Medication be Prescribed?

Unless you are in a high-risk category, such as having a history of heart attack or stroke, and require immediate treatment, most people are recommended to change their lifestyle (see above) for four to six months before starting medications. Please discuss with your physician which option is best for you.

Common Medications

The most common medications used are in a class called Statins, which block the liver's production of excess cholesterol. Medications for cholesterol are generally long-term medications. They have to be taken every day, often for the rest of your life.

They are well tolerated, but may interact with other medications. Do not drink grapefruit juice while taking these medications, as it blocks their metabolism. Rarely, these medications can cause liver (hepatitis) or muscle damage. If you develop generalized muscle aches while taking these medications, stop taking the medications and call your doctor.

Although many patients are reluctant to take medications, the risk of having high cholesterol, which can lead to heart attack and stroke, is much greater than the rare side effects that occur with these medications.

To enroll in a class or schedule an appointment with a registered dietitian, call the Palo Alto Medical Foundation's Education Division at 650-853-2960.
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