Cholesterol

Cholesterol and Your Health

What is cholesterol?

Cholesterol is a waxy, fat-like substance. Your body uses cholesterol to make hormones and new cells, and to protect nerves. Cholesterol is made by your body. It also comes from certain foods you eat, such as meat and dairy products. Your healthcare provider can help you set goals for your cholesterol levels. He or she can help you create a plan to meet your goals.

What are cholesterol level goals?

Your cholesterol level goals depend on your risk for heart
disease, your age, and your other health conditions. The following are general guidelines:

Total cholesterol includes low-density lipoprotein (LDL), high-density lipoprotein
(HDL), and triglyceride levels. The total cholesterol level should be lower than 200
mg/dL and is best at about 150 mg/dL.
LDL cholesterol is called bad cholesterol because it forms plaque in your arteries. As plaque builds up, your arteries become narrow, and less blood flows through. When plaque decreases blood flow to your heart, you may have chest pain. If plaque completely blocks an artery that brings blood to your heart, you may have a heart attack. Plaque can break off and form blood clots. Blood clots may block arteries in your brain and cause a stroke. The level should be less than 130 mg/dL and is best at about 100 mg/dL.
HDL cholesterol is called good cholesterol because it helps remove LDL cholesterol from your arteries. It does this by attaching to LDL cholesterol and carrying it to your
liver. Your liver breaks down LDL cholesterol so your body can get rid of it. High levels of HDL cholesterol can help prevent a heart attack and stroke. Low levels of HDL cholesterol can increase your risk for heart disease, heart attack, and stroke. The level should be 60 mg/dL or higher.
Triglycerides are a type of fat that store energy from foods you eat. High levels of triglycerides also cause plaque buildup. This can increase your risk for a heart attack or stroke. If your triglyceride level is high, your LDL cholesterol level may also be high. The level should be less than 150 mg/dL.

What increases my risk for high cholesterol?

Smoking cigarettes
Being overweight or obese, or not getting enough exercise
Drinking large amounts of alcohol
A medical condition such as hypertension (high blood pressure) or diabetes
Certain genes passed from your parents to you
Age older than 65 years

What do I need to know about having my cholesterol levels checked?

Adults 20 to 45 years of age should have their cholesterol levels checked every 4 to 6 years. Adults 45 years or older should have their cholesterol checked every l to 2 years. You may need your cholesterol checked more often, or at a younger age, if you have risk factors for heart disease. You may also need to have your cholesterol checked more often if you have other health conditions, such as diabetes. Blood tests are used to check cholesterol levels. Blood tests measure your levels of triglycerides, LDL cholesterol, and HDL cholesterol.

How do healthy fats affect my cholesterol levels?

Healthy fats, also called unsaturated fats, help lower LDL cholesterol and triglyceride levels. Healthy fats include the following:

Monounsaturated fats are found in foods such as olive oil, canola oil, avocado, nuts,
and olives.
Polyunsaturated fats, such as omega 3 fats, are found in fish, such as salmon, trout, and tuna. They can also be found in plant foods such as flaxseed, walnuts, and soybeans.

How do unhealthy fats affect my cholesterol levels?

Unhealthy fats increase LDL cholesterol and triglyceride levels. They are found in foods high in cholesterol, saturated fat, and trans fat:

Cholesterol is found in eggs, dairy, and meat.
Saturated fat is found in butter, cheese, ice cream, whole milk, and coconut oil. Saturated fat is also found in meat, such as sausage, hot dogs, and bologna.
Trans fat is found in liquid oils and is used in fried and baked foods. Foods that contain trans fats include chips, crackers, muffins, sweet rolls, microwave popcorn, and cookies.

Lipid Profile

What is a lipid profile?

A lipid profile, or lipid panel, is a blood test to check your lipid levels. Lipids are fats that cannot dissolve in blood. High lipid levels increase your risk for heart disease and a heart attack or stroke. A lipid profile includes the following:

Total cholesterol is the main number used for cholesterol values.
- - Goal: Less than 200 mg/dL
  - Borderline high: 200 to 239 mg/dL
  - High: 240 mg/dL or higher
LDL (bad) cholesterol carries cholesterol and deposits it in the arteries. This can cause a blockage.
- - Goal: 100 mg/dL or lower
  - Near goal: 100 to 129 mg/dL
  - Borderline high: 130 to 159 mg/dL
  - High: 160 to 189 mg/dL
  - Very high: 190 mg/dL or higher
HDL (good) cholesterol removes cholesterol from your body.
- - Goal: 60 mg/dL or higher
  - Borderline risk: 40 to 59 mg/dL
  - High risk: 40 mg/dL or lower
Triglycerides are a different kind of fat than cholesterol.
- - Goal: 150 mg/dL or lower
  - Borderline high: 150 to 199 mg/dL
  - High: 200 to 499 mg/dL
  - Very high: 500 mg/dL or higher

How do I prepare for the test?

Do not eat or drink anything, except water, for 12 to 14 hours before the test. Ask your healthcare provider if you should take your medicines on the day of
your test.

What do I need to know about my test results?

Your healthcare provider will discuss your test results with you. If your test results are abnormal, you may need treatment to decrease your risk for heart disease.

Hyperlipidemia

What is hyperlipidemia?

Hyperlipidemia is a high level of lipids (fats) in your blood. These lipids include cholesterol or triglycerides. Lipids are made by your body. They also come from the foods you eat. Your body needs lipids to work properly, but high levels increase your risk for heart disease, heart attack, and stroke.

What increases my risk for hyperlipidemia?

Family history of high lipid levels
Diet high in saturated fats, cholesterol, or calories
High alcohol intake or smoking
Lack of regular physical activity
Medical conditions such as hypothyroidism, obesity, or type 2 diabetes
Certain medicines, such as blood pressure medicines, hormones, and steroids

How is hyperlipidemia managed and treated?

Your healthcare provider may first recommend that you make lifestyle changes to help decrease your lipid levels. Your provider may recommend you work with a team to manage hyperlipidemia. The team may include medical experts such as a dietitian, an exercise or physical therapist, and a behavior therapist. Your family members may be included in helping you create lifestyle changes. You may also need to take medicine to lower your lipid levels. Some of the lifestyle changes you may need to make
include the following:

Maintain a healthy weight.

Ask your healthcare provider what a healthy weight is for you. Ask him or her to help you create a weight loss plan if you are overweight. Weight loss can decrease your cholesterol and triglyceride levels.

Be physically active throughout the day.

Physical activity, such as exercise, lowers your cholesterol levels and helps you maintain a healthy weight. Get 30 minutes or more of aerobic exercise 4 to 6 days each week. You can split your exercise into four 10-minute workouts instead of 30 minutes at one time. Examples of aerobic exercises include walking briskly, swimming, or riding a bike. Work with your healthcare provider to plan the best exercise program for you. Also include strength training at least 2 times each week. Your healthcare providers can help you create a physical activity plan.

Do not smoke.

Nicotine and other chemicals in cigarettes and cigars can increase your risk for a heart attack and stroke. Ask your healthcare provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.

Eat heart-healthy foods.

A dietitian or your provider can give you more information on low-sodium plans or the DASH (Dietary Approaches to Stop Hypertension) eating plan. The DASH plan is low in sodium, processed sugar, unhealthy fats, and total fat. It is high in potassium, calcium, and fiber. It is high in potassium, calcium, and fiber. These can be found in vegetables, fruit, and whole grain foods. The following are ways to get more heart-healthy foods:

Decrease the total amount of fat you eat. Choose lean meats, fat-free or 1 % fat milk, and low-fat dairy products, such as yogurt and cheese. Limit or do not eat red meat. Red meats are high in fat and cholesterol.
Replace unhealthy fats with healthy fats. Unhealthy fats include saturated fat, trans fat, and cholesterol. Choose soft margarines that are low in saturated fat and have little or no trans fat. Monounsaturated fats are healthy fats. These are found in olive oil, canola oil, avocado, and nuts. Polyunsaturated fats are also healthy. These are found in fish, flaxseed, walnuts, and soybeans.
Eat 5 or more servings of fruits and vegetables every day. They are low in calories and fat, and a good source of essential vitamins. Include dark green, red, and orange vegetables. Examples include spinach, kale, broccoli, and carrots.
Eat foods high in fiber. Fiber can help lower your cholesterol levels. Choose whole grain, high-fiber foods. Good choices include whole-wheat breads or cereals, beans, peas, fruits, and vegetables.
Limit sodium (salt) as directed. Too much sodium can affect your fluid balance and blood pressure. Your healthcare provider will tell you how much sodium and potassium are safe for you to have in a day. He or she may recommend that you limit sodium to 2,300 mg a day. Your provider or a dietitian can help you find ways to limit sodium. For example, if you add salt while you cook, do not add more salt at the table. Check labels to find low-sodium or no-salt-added foods. Some low-sodium foods use potassium salts for flavor. Too much potassium can also cause health problems.
Ask your healthcare provider if it is okay for you to drink alcohol. Alcohol can increase your cholesterol and triglyceride levels. Your provider can tell you how many drinks are okay to have within 24 hours and within 1 week. A drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1 ½ ounces of liquor.

Heart Healthy Diet

What is a heart healthy diet?

A heart healthy diet is an eating plan low in unhealthy fats and sodium (salt). The plan is high in healthy fats and fiber. A heart healthy diet helps improve your cholesterol levels and lowers your risk for heart disease and stroke. A dietitian will teach you how to read and understand food labels.

What diet guidelines should I follow?

Choose foods that contain healthy fats.
- - Unsaturated fats include monounsaturated and polyunsaturated fats. Unsaturated fat is found in foods such as soybean, canola, olive, com, and safflower oils. It is also found in soft tub margarine that is made with liquid vegetable oil.
  - Omega-3 fat is found in certain fish, such as salmon, tuna, and trout, and in walnuts and flaxseed. Eat fish high in omega-3 fats at least 2 times a week.
Get 20 to 30 grams of fiber each day. Fruits, vegetables, whole-grain foods, and legumes (cooked beans) are good sources of fiber.
Limit or do not have unhealthy fats.
- - Cholesterol is found in animal foods, such as eggs and lobster, and in dairy
    products made from whole milk. Limit cholesterol to less than 200 mg each day.
  - Saturated fat is found in meats, such as bacon and hamburger. It is also found in chicken or turkey skin, whole milk, and butter. Limit saturated fat to less than 7% of your total daily calories.
  - Trans fat is found in packaged foods, such as potato chips and cookies. It is also in hard margarine, some fried foods, and shortening. Do not eat foods that contain trans fats.
Limit sodium as directed. You may be told to limit sodium to 2,000 to 2,300 mg each day. Choose low-sodium or no-salt-added foods. Add little or no salt to food you prepare. Use herbs and spices in place of salt.

What can I include in my heart healthy plan?

Ask your dietitian or healthcare provider how many servings to have from each of the following food groups:

Grains:
- - Whole-wheat breads, cereals, and pastas, and brown rice
  - Low-fat, low-sodium crackers and chips
Vegetables:
- - Broccoli, green beans, green peas, and spinach
  - Collards, kale, and lima beans
  - Carrots, sweet potatoes, tomatoes, and peppers
  - Canned vegetables with no salt added
Fruits:
- - Bananas, peaches, pears, and pineapple
  - Grapes, raisins, and dates
  - Oranges, tangerines, grapefruit, orange juice, and grapefruit juice
  - Apricots, mangoes, melons, and papaya
  - Raspberries and strawberries
  - Canned fruit with no added sugar
Low-fat dairy:
- - Nonfat (skim) milk, I% milk, and low-fat almond, cashew, or soy milks fortified with calcium
  - Low-fat cheese, regular or frozen yogurt, and cottage cheese
Meats and proteins:
- - Lean cuts of beef and pork (loin, leg, round), skinless chicken and turkey
  - Legumes, soy products, egg whites, or nuts

What should I limit or not include in my heart healthy plan?

Unhealthy fats and oils:
- - Whole or 2% milk, cream cheese, sour cream, or cheese
  - High-fat cuts of beef (T-bone steaks, ribs), chicken or turkey with skin, and organ meats such as liver
  - Butter, stick margarine, shortening, and cooking oils such as coconut or palm oil
Foods and liquids high in sodium:
- - Packaged foods, such as frozen dinners, cookies, macaroni and cheese, and
    cereals with more than 300 mg of sodium per serving
  - Vegetables with added sodium, such as instant potatoes, vegetables with added sauces, or regular canned vegetables
  - Cured or smoked meats, such as hot dogs, bacon, and sausage
  - High-sodium ketchup, barbecue sauce, salad dressing, pickles, olives, soy sauce, or miso
Foods and liquids high in sugar:
- - Candy, cake, cookies, pies, or doughnuts
  - Soft drinks (soda), sports drinks, or sweetened tea
  - Canned or dry mixes for cakes, soups, sauces, or gravies

How is high cholesterol treated?

Treatment for high cholesterol will also decrease your risk of heart disease, heart attack, and stroke. Treatment may include any of the following:

Lifestyle changes may include food, exercise, weight loss, and quitting smoking. You may also need to decrease the amount of alcohol you drink. Your healthcare provider will want you to start with lifestyle changes. Other treatment may be added if lifestyle changes are not enough. Your healthcare provider may recommend you work with a team to manage hyperlipidemia. The team may include medical experts such as a dietitian, an exercise or physical therapist, and a behavior therapist. Your family members may be included in helping you create lifestyle changes.
Medicines may be given to lower your LDL cholesterol, triglyceride levels, or total
cholesterol level. You may need medicines to lower your cholesterol if any of the
following is true:
- - You have a history of stroke, TIA, unstable angina, or a heart attack.
  - Your LDL cholesterol level is 190 mg/dL or higher.
  - You are age 40 to 75 years, have diabetes or heart disease risk factors, and your LDL cholesterol is 70 mg/dL or higher.
Supplements include fish oil, red yeast rice, and garlic. Fish oil may help lower your
triglyceride and LDL cholesterol levels. It may also increase your HDL cholesterol level. Red yeast rice may help decrease your total cholesterol level and LDL cholesterol level. Garlic may help lower your total cholesterol level. Do not take any supplements without talking to your healthcare provider.

What food changes can I make to lower my cholesterol levels?

A dietitian can help you create a healthy eating plan. He or she can show you how to read food labels and choose foods low in saturated fat, trans fats, and cholesterol.

Increase the amount of high-fiber foods you eat. High-fiber foods can help lower your LDL cholesterol. Aim to get between 20 and 30 grams of fiber each day. Fruits and
vegetables are high in fiber. Eat at least 5 servings each day. Other high-fiber foods are whole-grain or whole-wheat breads, pastas, or cereals, and brown rice. Eat 3 ounces of whole-grain foods each day. Increase fiber slowly. You may have abdominal discomfort, bloating, and gas if you add fiber to your diet too quickly.
Eat healthy protein foods. Examples include low-fat dairy products, skinless chicken and turkey, fish, and nuts.
Limit foods and drinks that are high in sugar. Your dietitian or healthcare provider can help you create daily limits for high-sugar foods and drinks. The limit may be lower if you have diabetes or another health condition. Limits can also help you lose weight if needed.

What lifestyle changes can I make to lower my cholesterol levels?

Maintain a healthy weight. Ask your healthcare provider what a healthy weight is for you. Ask him or her to help you create a weight loss plan if needed. Weight loss can decrease your total cholesterol and triglyceride levels. Weight loss may also help keep your blood pressure at a healthy level.
Be physically active throughout the day. Physical activity, such as exercise, can help lower your total cholesterol level and maintain a healthy weight. Physical activity can also help increase your HDL cholesterol level. Work with your healthcare provider to create an program that is right for you. Get at least 30 to 40 minutes of moderate physical activity most days of the week. Examples of exercise include brisk walking, swimming, or biking. Also include strength training at least 2 times each week. Your healthcare providers can help you create a physical activity plan.
Do not smoke. Nicotine and other chemicals in cigarettes and cigars can raise your
cholesterol levels. Ask your healthcare provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.
Limit or do not drink alcohol. Alcohol can increase your triglyceride levels. Ask your healthcare provider before you drink alcohol. Ask how much is okay for you to drink in 24 hours or 1 week.