Do you know what your cholesterol levels mean, or the difference between good and bad cholesterol? Clearing up your confusion and understanding the dangers of high cholesterol can help you keep your levels within a healthy range, lowering your chances of heart disease, heart attack, and stroke. Meanwhile, everyone 20 years and older should get a cholesterol test once every five years — it’s a simple blood test that your primary care physician can order to determine if you have high cholesterol levels.
Sorting Out Cholesterol Myths
First, it’s important to separate fact from fiction about cholesterol.
- Cholesterol is a bad thing. Your body needs cholesterol to function; it keeps cell membranes stable and aids in the production of certain hormones. “Patients need to understand that cholesterol is required for health,” says John Willard, MD, medical director for cardiovascular services at Texas Health Harris Methodist Hospital in Fort Worth. Cholesterol only becomes a problem when too much of it circulates in the blood and builds up inside arteries, leading to a condition known as atherosclerosis. If too much cholesterol builds up, that artery becomes blocked, and a heart attack or stroke can occur.
- Everyone should aim for the same cholesterol levels. “There’s not one particular number for everyone,” Dr. Willard says. “It depends entirely on what your risk factor profile is.” People with no risk factors — such as being a smoker, having diabetes, or having high blood pressure — should try to get their levels of LDL, or “bad” cholesterol, under 160 mg/dL. High LDL cholesterol is a risk factor for heart disease. High levels of HDL, or “good” cholesterol, on the other hand, protect against heart disease and are desirable. However, if you have two or more risk factors for heart disease, your LDL cholesterol should be under 130 mg/dL. Those who already have heart disease, or those who have diabetes, should aim even lower, for LDL levels under 100 mg/dL.
- High cholesterol is caused mostly by diet. The biggest factor in a person’s cholesterol levels is heredity, Willard says. The liver is supposed to remove excess cholesterol from the body, but genetics play a large part in its ability to keep cholesterol at a healthy level. “If your liver works perfectly, you’re one of the lucky people who can eat whatever you want and your cholesterol will be perfect,” Willard says. “Most of us have varying degrees to which it’s not quite as effective as it needs to be.” For those people whose livers are just slightly under par, a healthier diet can be the solution, reducing cholesterol levels by 10 to 15 percent.
- It’s always better to control your cholesterol through diet alone than with medications and diet. While this may be an option for people whose cholesterol levels are only slightly elevated, those with significantly high cholesterol levels or a history of vascular disease (like atherosclerosis) may need something extra, like a statin, to lower their cholesterol. “If they try to control it just through diet, they’re not going to reach their target,” Willard says. “Plus, these meds have additional healthy effects. They decrease inflammation and the risk of having a heart attack, independent of what their cholesterol levels are.” While there are potential side effects to statin drugs, like muscle damage, they are extremely rare. “If you look at the number of patients having adverse effects, those numbers are tiny compared to those that have heart attacks because their cholesterol wasn’t controlled,” Willard says.
- Margarine is better for cholesterol levels than butter. Margarine is made from vegetable oil, so it contains no cholesterol, unlike butter, which is made from dairy products. However, Willard says, margarine is also high in trans fatty acids — substances that raise your LDL cholesterol while lowering the levels of HDL cholesterol in your blood, putting you at risk for heart disease and stroke. A healthier option: monounsaturated fats like olive oil and canola oil, which can lower your “bad” cholesterol levels. Willard also recommends trans fat-free spreads with low cholesterol content; Smart Balance is an example of such a product.
- Children can’t have high cholesterol. “Like adults, if their liver works partially, their cholesterol may be elevated, but not so bad that they have the onset of vascular disease as children,” Willard says. However, he adds, when children with high cholesterol become adults, they are more likely to experience cardiovascular problems at a younger age than their peers. As with adults, children can lower their high cholesterol levels somewhat by exercising regularly and following a diet rich in fruits, vegetables, and foods low in saturated fat. In rare cases, children can also have a potentially fatal disease known as familial hypercholesterolemia, an inherited condition in which the liver is unable to remove cholesterol from the bloodstream. This disease may be suspected if a one or both parents have very high cholesterol levels, or if the child has a total cholesterol level of over 250.
