Cholesterol is a waxy, fat-like substance that the body needs to build cells, but too much can form plaques and clog arteries, raising risk for diseases of heart and blood vessels. It travels in blood via lipoproteins, with LDL (low-density) being “bad” (plaque buildup) and HDL (high-density) being “good” (carries cholesterol to the liver). Sources include liver production and animal foods, with saturated/trans fats increasing levels, controlled by diet, exercise, and sometimes medication.
General Facts
As one ages, blood cholesterol levels tend to rise. That’s because after age 40 the liver loses some of its ability to clear these waxy substances from the blood. Weight gain, menopause and various age-related health conditions, including type 2 diabetes, also contribute to the increase. The body needs some cholesterol to build the structure of cell membranes, make certain hormones and help with metabolism. But when blood cholesterol levels are too high, fats and other substances can build up in the blood vessels. This plaque buildup can narrow or clog the arteries that carry oxygen-rich blood to many organs. In addition, the plaque can rupture, leading to a blood clot that can completely block blood flow to the heart or brain.
Know your numbers: Cholesterol travels through the blood attached to protein transporters, called lipoproteins. The names of some of the following blood markers are based on those specific lipoproteins.
• Low-density lipoprotein (LDL) cholesterol. When LDL cholesterol is too high, it tends to build up in the walls of arteries, making them hard and narrow. An LDL level below 100 milligrams per deciliter (mg/dL) is considered satisfactory in most normal people. In people with heart disease, less than 70 mg/dL is a good target.
• High-density lipoprotein (HDL) cholesterol — Some experts refer to HDL as the “good” cholesterol because it absorbs cholesterol in the blood or artery wall and brings it to the liver, which flushes it from the body. For women, a level above 50 mg/ dL is considered heart healthy. For men, above 40 mg/dL is healthy.
• Triglycerides — Though they’re not technically cholesterol, these blood fats also may raise the risk of heart disease. Less than 150 mg/dL is optimal.
• Total cholesterol — Total cholesterol is calculated based on the sum of LDL and HDL cholesterol plus 20% of triglyceride levels. A total combined level below 200 mg/dL often is desirable.
Depending on one’s family health history and risk factors such as lipoprotein (a), called Lp(a), is associated with an increased risk of heart disease. People of African and South asian descent are more likely to have elevated Lp(a) levels.
The National Institutes of Health recommends that people age 65 and older have yearly blood work to keep track of their cholesterol levels. But some people skip this important screening, often due to one or more widespread following myths.
Common myths listed:
Myth 1: Cholesterol isn’t as big a deal as people say. Fact: High cholesterol, especially high LDL cholestero1, is one of five modifiable risk factors that account for 50% to 70% of all heart disease-related events and deaths. The other risk factors include smoking, diabetes, high blood pressure and obesity. In a review of research that included 14 studies and more than a million study participants, both total cholesterol and LDL cholesterol were associated with an increased risk of death from cardiovascular disease. The higher the levels of these, the greater the risk of heart disease-related death. Additionally, in people who have a genetic variant that causes very high LDL levels of 190 mg/dL or higher, the risk of heart attack is 20 times higher than for people without this gene variant.
Myth 2: The side effects of statins outweigh their benefits Fact: Statins are common cholesterol-lowering medications that reduce the amount of cholesterol made by the liver. They were developed in the 1980s. Examples include atorvastatin (Lipitor), rosuvastatin (Crestor) and simvastatin (Zocor). These medicines block a substance that the liver needs to make cholesterol. They also may protect against cardiovascular disease in other ways, including: • Stabilizing existing plaques, helping to prevent dangerous blood clots. • Improving the function of the lining of the arteries, called the endothelium. • Reducing inflammation.
When prescribed for people with an elevated risk of heart disease, statins not only prevent heart attacks and strokes but also reduce the risk of premature death. However, research shows that only about half of the people eligible to take statins actually do so. Often, that’s because of fears about side effects. Many people worry that a statin will cause muscle pain or cramping. These fears may stem from news coverage on findings from observational studies where 10% to 25% of people taking the medications reported muscle-related side effects. While those study results are concerning, further research has found that it’s likely that muscle-related symptoms weren’t caused by statin medication. In more-recent randomized controlled trials — which are the gold standard for determining cause and effect — participants were either prescribed a statin or a fake medicine (placebo). But none of the participants knew whether they were taking the statin or the placebo. In these newer studies, muscle pain was a common complaint even in people given the placebo. Because of these results, it appears that the expectation of the side effects makes it more likely to occur. If one taking a statin is followed by muscle pain, the side effect can often be resolved by switching to a different type of cholesterol-lowering medication.
Myth 3: Butter, lard and coconut oil are good for you. Fact: Butter, lard and coconut oil all contain saturated fat. Though some internet influencers claim that this type of fat poses no harm, research tells a different story. Dozens of studies link saturated fats with increased cholesterol levels and a higher risk of heart disease. The American Heart Association recommends capping dietary saturated fat levels at 6% of your total calories.
Myth 4: Emotional stress has nothing to do with cholesterol levels or heart disease. Fact: Emotional stress worsens heart health in several ways, most of which compound the adverse effects of high blood cholesterol. When one is stressed, blood pressure and heart rate go up. The heart also contracts more forcefully. This stress-induced increase in arterial pressure can inflame and damage the lining of one’s arteries (endothelium). The damage can lead to erosion or a tear in the artery lining with subsequent blood clotting, dramatically restricting the flow of oxygen-rich blood to the heart muscle. Stress also can indirectly affect heart health. When one is under a lot of stress, exercising is less likely. Also, one is more likely to smoke or consume fries, chips and other fatty, highly processed foods that nudge cholesterol upward. To manage stress, pay attention to how your thoughts and behaviors make you feel. Then see if you can recognize, modify and reduce some of those triggers. Ask yourself, “What can I stop doing, and what can I let go of?” Consider adding calming activities to your daily plans. Many studies show that spending time in nature can reduce stress, decrease blood pressure and improve well-being. For many people, the sounds, sights and smells of green spaces — such as forests, wetlands, city parks and gardens —have a powerfully calming effect. As little as 10 minutes in a green space can make a significant difference in your mood and stress level, whether you’re taking a stroll or sitting down and enjoying the view. If you want to experience an even greater drop in stress, try spending 20 to 30 minutes at a time in a natural setting. Also, regular exercise has, in itself, strong anti-anxiety effects.
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