Preventing Heart Disease: Watch Your Cholesterol

At this very moment, your blood vessels are pulsing with the raw material that can cause a heart attack. Every drop of human blood contains cholesterol, a compound popularly referred to as a fat, which your body needs to form healthy cells and tissues. From birth on, your liver manufactures cholesterol, which is pushed out to the gut and reabsorbed back as part of a system for fat absorption. In addition, cholesterol in the food we eat gets absorbed into the body.

When too much cholesterol accumulates in the bloodstream, it can build up in the coronary arteries and block the flow of blood to the heart. But cholesterol doesn’t have to be a threat. With a few healthy lifestyle changes — and a little help from your doctor — you can lower your cholesterol levels and slash your risks for heart attack.

What’s a “healthy” cholesterol level?

When a doctor checks your cholesterol level, he or she will usually do a test that’s called a lipid panel, which includes measuring your total cholesterol and some of the other fats that are in the blood. This test requires a 14-hour fast to get an accurate reading of the blood fats. Unfortunately, there’s no sharp cutoff point between healthy and unhealthy levels, but ideally, your total cholesterol should be below 200 milligrams per deciliter. Anything between 200 and 239 mg/dL is considered borderline high, and a level of 240 mg/dL or above is high. Check with your doctor about what’s right for you.

Looking at a breakdown of your levels of the different types of cholesterol can be even more helpful. The lipid panel can better evaluate your risk for heart disease by measuring your levels of the two major forms of cholesterol, LDL cholesterol and HDL cholesterol. In common lingo, LDL is called the “bad” cholesterol, and HDL is known as the “good” cholesterol. That’s because LDL cholesterol is the substance that clogs arteries by delivering cholesterol to the cells and depositing it in the artery wall; HDL cholesterol, on the other hand, actually helps clear LDL cholesterol from the blood by trucking cholesterol back from the cells to the liver for disposal.

The basic goal is simple: You want to keep your LDL within the target level that’s right for you. Your target level depends on your situation: If you don’t already have coronary heart disease and if you have fewer than two of the major risk factors — obesity, high blood pressure, or a family history of premature heart trouble — your LDL cholesterol should be below 160 mg/dL (and preferably under 100). If you already have coronary artery disease or diabetes mellitus and your LDL is over 100, your doctor will probably recommend you take cholesterol-lowering drugs to get your LDL below the 100 mark. If you are at very high risk for a heart attack (you have coronary artery disease or diabetes AND multiple risk factors), doctors may recommend you use drug therapy to bring your LDL readings below 70 mg/dL.

Heart and stroke treatment guidelines adopted in 2013, in fact, suggest statins for people over 21 who have unusually high levels of “bad” LDL cholesterol (190 mg/dL or more).

You also want to keep your “good” HDL levels from getting too low. Your HDL should be at least 40 mg/dL, according to guidelines from the National Heart, Lung, and Blood Institute (NHLBI). Since lower levels of “good” cholesterol appear to cause greater risk of heart disease in women, the American Heart Association (AHA) recommends that women’s HDL be at least 50 mg/dl. An HDL level of 60 mg/dL or higher is considered protective against heart disease.

How can I improve my cholesterol levels?

In many people, cholesterol levels are a reflection of lifestyle. In some cases, however, lifestyle may not account for the level of cholesterol in a person’s blood, since that level is often influenced by “internal” factors such as genetics, liver disease or other conditions, or hormones. If you’re born with a problem in regulating your internal cholesterol production (which is where most cholesterol comes from), you’ll probably need medication to control it.

But high cholesterol levels are commonly associated with external factors such as excess weight, lack of exercise, a high-fat diet, and too much alcohol. The good news is that although unhealthy habits can wreak havoc on your cholesterol levels, a few positive changes can help bring them back under control. Here’s a look at the best ways to lower cholesterol:

  • If you smoke, stop. In addition to directly damaging your heart and arteries, cigarettes deplete your supply of HDL cholesterol.
  • Eat a heart-healthy diet. If you’re watching your cholesterol levels, you have to lower your intake of fat, especially saturated fat. Your body quickly turns saturated fat into LDL cholesterol. The AHA recommends that the amount of total fat you eat make up about 25 35 percent of your daily calories (under 30 percent if you are overweight), and only 7 percent of your daily calories should be from saturated fat. On a standard 2,000-calorie diet, that means restricting yourself to 55-77 grams of fat and 16 grams of saturated fat per day. If you already have heart problems, you may need to cut your fat intake even more, but only with your doctor’s guidance. Your physician may refer you to a registered dietician to assist you in modifying your diet.
  • The secret to lowering fat intake is to follow the advice we received from our parents and in turn give our children: watch what you put into your mouth. Before buying those tempting cookies, chips, and crackers in the grocery stories, read the product label: It will tell you many grams of saturated fat the food contains.
  • Of course, a lot of fast food doesn’t come with labels. If you want to find out how much saturated fat is found in a Big Mac, scone, or slice of pizza, check out the online version of Nutrition Action Health Healthletter (, which regularly analyzes the content of fast food and restaurant food.
  • The journal reports, for example, that scones, cinnamon rolls, croissants, and other baked goods full of butter and cream often contain more saturated fat than a hamburger with cheese! A simple rule is that in all but a few instances, lowering saturated fat will also lower cholesterol intake (most “sat fats” are found in animal products such as meat, butter, lard, milk, and eggs, which also contain cholesterol).
  • Another dangerous dietary villain is trans unsaturated fat or trans fat. Found in stick margarine, fried fast foods, and some snack foods like cookies, crackers, and donuts, trans fat gives your cholesterol level a double whammy: Not only does it increase your LDL cholesterol, but it also lowers your HDL cholesterol. A Harvard University study of more than 80,000 women suggested that replacing just 2 percent of trans fat calories with calories from healthier fats reduced the risk of heart disease by more than 50 percent. Read all processed food labels and look for “partially hydrogenated oils” — that’s the trans fats that you want to avoid. Look for products that contain olive oil instead. The AHA recommends limiting the amount of trans fats you consume to less than 1 percent of your daily calories — in fact, there is no safe level of trans fats known to be safe, according to the National Academy of Sciences.
  • You should also beware of eating too much dietary cholesterol. This is the type found in most animal products, especially egg yolks, meat, and seafood. Dietary cholesterol isn’t quite as dangerous to your heart as saturated fat or trans fat, but you should still be cautious. The AHA recommends you eat no more than 300 mg of cholesterol each day. In practice, that means eating no more than three egg yolks a week and avoiding cholesterol-packed foods such as fried meats. Those with heart disease need to keep cholesterol levels to 200 mg and only two egg yolks a week.
  • To fill the void left by fatty foods, you should eat plenty of whole grains and at least five to seven servings of fruits and vegetables every day. These foods protect the heart in several ways, including providing soluble fiber, a known cholesterol fighter. The AHA also recommends eating fish at least twice a week — fatty fish such as salmon contain omega-3 fatty acids, or “good fats,” which actually benefit the heart by lowering cholesterol. (If you don’t like fish, you may want to take over-the-counter fish oil supplements containing omega-3s — an option you can talk over with your physician.)
  • If you’re worried that it will be hard or complicated to go low-fat, consider this: Most people can cut their intake of artery-clogging saturated fat in half just by avoiding butter, margarine, fatty meats, and dairy products made from 2 percent or whole milk. (If you have to have margarine on your toast, use the soft kind rather than stick margarine, which may be high in trans fats.)
  • It’s also important to get moving. Regular workouts not only strengthen your heart but can also push your cholesterol levels in all the right directions. Your LDL cholesterol may drop, and your HDL cholesterol may rise. (LDL is primarily lowered by diet, and HDL is primarily increased by exercise, but we usually need to do both.) Staying active will also help you take off any extra pounds, an important step towards a healthy heart.

What can my doctor do to help?

Lifestyle changes can make a difference in cholesterol levels, but many people need medications to bring cholesterol completely under control. Drugs are especially important if you have other risk factors for heart disease or if you already have heart trouble.

In fact, NHLBI officials have urged doctors to take a more aggressive stance in treating high cholesterol, including prescribing cholesterol medication even if you’ve never had a heart attack. In July 2004, the National Cholesterol Education Program updated its guidelines advising doctors to prescribe cholesterol drugs for anyone who is at high risk for a heart attack if their LDL is above 100 mg/dL. High risk is defined as anyone who has coronary artery disease or diabetes or multiple risk factors that give them a greater than 20 percent chance of having a heart attack within 10 years. In addition, the new guidelines suggest that people at very high risk for heart disease (those who have coronary artery disease or diabetes AND multiple risk factors) take medication to lower their LDL below 70 mg/dL.

The most effective cholesterol medications available today belong to a group of drugs called statins. These drugs can dramatically lower cholesterol levels and have few side effects, although some patients complain of constipation, stomach pains, and cramps. In rare cases, a patient may develop significant muscle pain and weakness. (Report any unusual symptoms to your doctor; since some of these drugs interact with other medications, always mention any other drugs or herbs you’re taking as well.) A recent study of heart patients found that one statin drug cut the relative risk of heart attacks by more than 60 percent.

Your doctor can also help you track your cholesterol. Starting at age 20, adults should have their lipid panels levels checked at least once every five years. Men over 45 and women over 55 should be checked more often. If you already have high cholesterol or are at risk for heart disease, your doctor may want to measure your cholesterol more often.

What’s the right age to start thinking about cholesterol?

Heart attacks usually strike people in their 40s and older, but the clogging process starts decades earlier. Researchers at the University of Texas examined the arteries of 3,000 people aged 15 to 34 who died from an accident, homicide, or suicide. As reported in the American Journal of Clinical Nutrition, many of these people already had clumps of cholesterol in their arteries. Not surprisingly, the victims with the highest cholesterol levels in their blood also had the most serious buildup in their arteries.

The researchers concluded that the teen-age years are an excellent time to start protecting the heart. But don’t worry — even if your teens are a distant memory, it’s not too late to make some healthy lifestyle changes to bring your cholesterol count under control. When it comes to preventing heart attacks, a late start is much better than no start at all.


National Institutes of Health. “Update on Cholesterol Guidelines: More-Intensive Treatment Options for Higher Risk Patients.” July 12, 2004.

Expert Panel of Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Journal of the American Medical Association, May 16, 2001, Vol. 285 No 19 p. 2486-97

Ahmed SM. Management of dyslipidemia in adults. American Family Physician. May 1, 1998.

The American Heart Association. For Professionals: Cholesterol levels.

Bayer Voluntarily Removes Baycol, FDA Talk Papers, U.S. Food and Drug Administration, T01-34, Aug. 8, 2001

American Heart Association. What Are Healthy Levels of Cholesterol?

American Heart Association. Cholesterol.

American Heart Association. Cholesterol Levels.

American Heart Association. Fat.

American Heart Association. Our 2006 Diet and Lifestyle Recommendations.

Smith SC et al. AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update. Circulation. 113:2363-2372. May 2006.

McGill, H. et al. Origin of atherosclerosis in childhood and adolescence. American Journal of Clinical Nutrition. 2000; 72 (supp.): 1307-1315S.

Heart Disease: New Health and Stroke Guidelines. Guidelines Resource Center, 2013. American Health Association.

© HealthDay