Cholesterol: An introduction and Control Measures

If you’re reading this, you probably care about your health and the role cholesterol can play. That’s an important first step.

So, what is cholesterol? What does it do?

Cholesterol is a waxy substance. It’s not inherently “bad.” Your body needs it to build cells and make vitamins and other hormones. But too much cholesterol can pose a problem.

Cholesterol comes from two sources. Your liver makes all the cholesterol you need. The remainder of the cholesterol in your body comes from foods from animals. For example, meat, poultry and dairy products all contain dietary cholesterol.

Those same foods are high in saturated and trans fats. These fats cause your liver to make more cholesterol than it otherwise would. For some people, this added production means they go from a normal cholesterol level to one that’s unhealthy.

Some tropical oils – such as palm oil, palm kernel oil and coconut oil – contain saturated fat that can increase bad cholesterol. These oils are often found in baked goods.

…What if you no longer had to accept heart problems as a given, simply because you’re getting older?

Why cholesterol matters

Cholesterol circulates in the blood. As the amount of cholesterol in your blood increases, so does the risk to your health. High cholesterol contributes to a higher risk of cardiovascular diseases, such as heart disease and stroke. That’s why it’s important to have your cholesterol tested, so you can know your levels.

The two types of cholesterol are: LDL cholesterol, which is bad, and HDL, which is good. Too much of the bad kind, or not enough of the good kind, increases the risk cholesterol will slowly build up in the inner walls of the arteries that feed the heart and brain.

Cholesterol can join with other substances to form a thick, hard deposit on the inside of the arteries. This can narrow the arteries and make them less flexible – a condition known as atherosclerosis. If a blood clot forms and blocks one of these narrowed arteries, a heart attack or stroke can result.

When it comes to cholesterol, remember: check, change and control. That is:

  • Check your cholesterol levels. It’s key to know your numbers and assess your risk.
  • Change your diet and lifestyle to help improve your levels.
  • Control your cholesterol, with help from your doctor if needed 

High cholesterol is one of the major controllable risk factors for coronary heart disease, heart attack and stroke. If you have other risk factors such as smokinghigh blood pressure or diabetes, your risk increases even more.

The more risk factors you have and the more severe they are, the higher your overall risk.

Atherosclerosis and cholesterol

Plaque (fatty deposits) build up in your arteries is called atherosclerosis. These deposits are made up of cholesterol, fatty substances, cellular waste products, calcium and fibrin (a clotting material in the blood).

As plaque builds up, the wall of the blood vessel thickens. This narrows the channel within the artery – reducing blood flow. That lessens the amount of oxygen and other nutrients reaching the body.

Where plaque develops, and the type of artery affected, varies with each person. Plaque may partially or totally block blood flow through large- or medium-sized arteries in the heart, brain, pelvis, legs, arms or kidneys. This can lead to conditions such as:

  • Coronary heart disease (plaque in arteries in or leading to the heart)
  • Angina (chest pain from reduced blood flow to the heart muscle)
  • Carotid artery disease (plaque in neck arteries supplying blood to the brain)
  • Peripheral artery disease, or PAD (plaque in arteries of the extremities, especially the legs)
  • Chronic kidney disease

…What if you no longer had to accept heart problems as a given, simply because you’re getting older?

Plaque presents a double threat

Plaque itself can pose a risk. A piece of plaque can break off and be carried by the bloodstream until it gets stuck. And plaque that narrows an artery may lead to a blood clot (thrombus) that sticks to the blood vessel’s inner wall.

In either case, the artery can be blocked, cutting off blood flow.

If the blocked artery supplies the heart or brain, a heart attack or stroke occurs. If an artery supplying oxygen to the extremities (often the legs) is blocked, gangrene, or tissue death, can result.

How it starts and how it progresses

Atherosclerosis is a slow, lifelong progression of changes in the blood vessels that may start in childhood and get worse faster as you age.

The cause of atherosclerosis isn’t completely known.

Many scientists believe plaque begins when an artery’s inner lining (called the endothelium) becomes damaged. Four possible causes of such damage are:

Smoking plays a big role in the progression of atherosclerosis in the aorta (the body’s main artery), coronary arteries and arteries in the legs. Smoking makes fatty deposits more likely to form, and it accelerates the growth of plaque.

Cholesterol: The good and the bad

Two types of lipoproteins carry cholesterol to and from cells. One is low-density lipoprotein, or LDL. The other is high-density lipoprotein, or HDL. A test measures the amount of each type of cholesterol in your blood.

LDL (bad) cholesterol

LDL cholesterol is considered the “bad” cholesterol, because it contributes to fatty buildups in arteries (atherosclerosis). This narrows the arteries and increases the risk for heart attackstroke and peripheral artery disease (PAD).

HDL (good) cholesterol

HDL cholesterol can be thought of as the “good” cholesterol because a healthy level may protect against heart attack and stroke. 

HDL carries LDL (bad) cholesterol away from the arteries and back to the liver, where the LDL is broken down and passed from the body. But HDL cholesterol doesn’t completely eliminate LDL cholesterol. Only one-third to one-fourth of blood cholesterol is carried by HDL.

Triglycerides

Triglycerides are the most common type of fat in the body. They store excess energy from your diet.

A high triglyceride level combined with high LDL (bad) cholesterol or low HDL (good) cholesterol is linked with fatty buildups within the artery walls, which increases the risk of heart attack and stroke

…What if you no longer had to accept heart problems as a given, simply because you’re getting older?

Lifestyle and Prevention

You can make lifestyle changes to improve your cholesterol numbers.

Your body naturally produces all the LDL (bad) cholesterol it needs. An unhealthy lifestyle makes your body produce more LDL cholesterol than it needs. This is the cause of high LDL cholesterol for most people.

Behaviors that can negatively affect your cholesterol levels include:

  • Unhealthy diet
  • Lack of physical activity
  • Smoking or exposure to tobacco smoke
  • Being overweight or obese

Heredity can play a role

Some people inherit genes from their mother, father or even grandparents that cause them to have too much cholesterol. This is called familial hypercholesterolemia (FH). The severity of FH is related to the duration and degree of LDL cholesterol in the blood. FH is dangerous because it can cause premature atherosclerotic heart disease.

If you have a family history of FH or problems related to high cholesterol, get your levels checked.

Know your numbers. And what to do about them.

When it comes to cholesterol, it’s important to know your numbers. Hyperlipidemia means your blood has too many lipids (or fats), such as cholesterol and triglycerides. One type of hyperlipidemia, hypercholesterolemia, means you have too much non-HDL cholesterol and LDL (bad) cholesterol in your blood. This condition increases fatty deposits in arteries and the risk of blockages.

Another way your cholesterol numbers can be out of balance is when your HDL (good) cholesterol level is too low. With less HDL to remove cholesterol from your arteries, your risk of atherosclerotic plaque and blockages increases.

If you’re diagnosed with hyperlipidemia, your overall health and other risks such as smoking or high blood pressure will help guide treatment. These factors can combine with high LDL cholesterol or low HDL cholesterol levels to affect your cardiovascular health. Your doctor may use the ASCVD Risk Calculator to assess your risk of a coronary event in the next 10 years.

The good news is, high cholesterol can be lowered, reducing risk of heart disease and stroke. If you’re 20 years or older, have your cholesterol tested and work with your doctor to adjust your cholesterol levels as needed.

Often, changing behaviors can help bring your numbers into line. If lifestyle changes alone don’t improve your cholesterol levels, medication may be prescribed. Lifestyle changes include:

Eating a heart-healthy diet

From a dietary standpoint, the best way to lower your cholesterol is reduce your intake of saturated fat and trans fat. The American Heart Association recommends limiting saturated fat to less than 6% of daily calories and minimizing the amount of trans fat you eat.

Reducing these fats means limiting your intake of red meat and dairy products made with whole milk. Choose skim milk, low-fat or fat-free dairy products instead. It also means limiting fried food and cooking with healthy oils, such as vegetable oil.

A heart-healthy diet emphasizes fruits, vegetables, whole grains, poultry, fish, nuts and nontropical vegetable oils, while limiting red and processed meats, sodium and sugar-sweetened foods and beverages.

Many diets fit this general description. For example, the DASH (Dietary Approaches to Stop Hypertension) eating plan promoted by the National Heart, Lung, and Blood Institute as well as diets suggested by the U.S. Department of Agriculture and the American Heart Association are heart-healthy approaches. Such diets can be adapted based on your cultural and food preferences.

To be smarter about what you eat, pay more attention to food labels. As a starting point:

  • Know your fats. Knowing which fats raise LDL cholesterol and which ones don’t is key to lowering your risk of heart disease.
  • Cook for lower cholesterolA heart-healthy eating plan can help you manage your blood cholesterol level.

Becoming more physically active

A sedentary lifestyle lowers HDL cholesterol. Less HDL means there’s less good cholesterol to remove bad cholesterol from your arteries.

Physical activity is important. At least 150 minutes of moderate-intensity aerobic exercise a week is enough to lower both cholesterol and high blood pressure. And you have lots of options: brisk walking, swimming, bicycling or even yard work can fit the bill.

Quitting smoking

Smoking and vaping lowers HDL cholesterol.

Worse still, when a person with unhealthy cholesterol levels also smokes, risk of coronary heart disease increases more than it otherwise would. Smoking also compounds the risk from other risk factors for heart disease, such as high blood pressure and diabetes.

By quitting, smokers can lower their LDL cholesterol and increase their HDL cholesterol levels. It can also help protect their arteries. Nonsmokers should avoid exposure to secondhand smoke.

Losing weight

Being overweight or obese tends to raise bad cholesterol and lower good cholesterol. But a weight loss of as little as 5% to 10% can help improve cholesterol numbers.

…What if you no longer had to accept heart problems as a given, simply because you’re getting older?