Cholesterol Management

About one in five Americans has high cholesterol. Improving your cholesterol profile can have a substantial impact on your health. Managing your cholesterol profile to produce a 10% reduction in total cholesterol can produce a 20%–30% reduction in the risk for heart attack.

The National Cholesterol Education Program (NCEP) has created guidelines that provide an easy way to set your cholesterol goals based on your risk for heart disease. The guidelines published in July 2004 are summarized in the Cholesterol and Triglyceride Levels table to the right. That is why the NCEP recommends that everyone age 20 and older undergo a fasting lipid profile test (also termed a full lipid profile or lipoprotein analysis) every five years. This test not only determines total cholesterol, but also measures LDL, HDL, and triglyceride levels. Not going to the doctor is not an excuse. There are several over the counter testing products that can provide a total cholesterol level, which if the result places you in any category other than desirable, you should consult with physician for a full lipid profile and crafting a plan. For those in the health risk categories, there are testing devices similar to diabetes testers that can provide quick self-test results almost as good as the physician tests.

Total Cholesterol
This number is the sum of cholesterol carried in all cholesterol-bearing particles in the blood, including HDL, LDL, and VLDL. Although the total cholesterol level closely parallels the LDL level in most people, there are enough exceptions to that rule to make it useful to test separately for LDL, HDL, and triglycerides. The NCEP guidelines advise aiming for a total cholesterol level below 200 mg/dL.

LDL
LDL is clearly the most significant of the blood lipids in terms of raising your risk for heart disease. Therefore, lowering elevated LDL is generally the primary target of therapy. Your particular LDL target depends on your cardiovascular health and your genetic and family history odds of having a heart attack in the next 10 years. Levels range from below 70 mg/dL or lower for those at very high risk to less than 160 mg/dL for people at lowest overall risk. You can lower LDL levels by reducing the amount of saturated fat, trans fat, and cholesterol in your diet; eating more complex carbohydrates, such as fruits and vegetables; eating more fiber; reducing body fat; and exercising regularly. There are also supplements and certain foods that may assist. When these good habits aren’t sufficient to reach your cholesterol goal, cholesterol-lowering medications are recommended.

HDL
The more HDL in your bloodstream, the lower your chances of having a heart attack. Studies from the Framingham Heart Study and elsewhere suggest that every one-point rise in HDL results in a 2%–3% reduction in the risk for heart attack. The NCEP guidelines consider levels of 60 mg/dL or above protective against heart disease, while levels of less than 40 mg/dL are regarded as too low and increase your risk. However, some clinicians use the ratio of total cholesterol to HDL cholesterol to help identify people who need cholesterol-lowering therapy. The less HDL you have relative to total cholesterol, the greater your risk for heart disease. To boost your HDL, your best bets are to lose weight, eat well, engage in more physical activity, and more importantly if you are a smoker, stop smoking.

Triglycerides
The main form of stored fat, both in the food we eat and in the body’s adipose (fat) tissue, is triglycerides. The chylomicron, the largest and least dense of the lipoprotein particles, carries most of the triglycerides in the bloodstream. In general, triglyceride levels have less of an impact on heart disease risk than LDL or HDL levels. However, when triglyceride levels are very high, risk for heart disease does increase. Often people with low HDL cholesterol levels also have high triglycerides, and this combination seems an especially important predictor of heart disease risk. The NCEP guidelines define normal triglyceride levels as below 150 mg/dL. High triglyceride levels can result from obesity, physical inactivity, cigarette smoking, alcohol abuse, uncontrolled diabetes, and even certain medications, as well as some genetic disorders. Triglycerides can be lowered using the same steps that help bring down LDL cholesterol: eating a healthier diet, exercising more often, losing weight, and, if necessary, taking medications to lower LDL, triglycerides, or both.

Foods and Supplements to Assist

Note that the title to this section involved the word assist. It does not say anything about replacing the steps to a better diet, more exercise, and if in risk categories, seeing your physician. Saying that, there are a number of specific foods or supplements have been touted as sure-fire ways to lower cholesterol. Some of these show promise; others don’t.

Alcohol in moderation
Margarines with beta-sitostanol
Co-enzyme Q10
Dietary Fiber
Omega-3 and Fish Oils
Soy Protein
Anti-Oxidants
Garlic, either as a supplement in capsule form or as a regular spice in food