Why you shouldn't ignore your cholesterol levels

What you need to know about good and bad cholesterol.

Why you shouldn't ignore your cholesterol levels

Cholesterol levels are an important indicator of overall health. It is well established that high cholesterol and heart disease are connected. Elevated levels of low-density lipoprotein (‘bad’ cholesterol) lead to the clogging of arteries which raises the risk of stroke, atherosclerosis and heart attacks. More than 102 million Americans have high cholesterol levels, according to the Centers for Disease Control and Prevention. Among them, 35 million are at risk of heart disease.

 

But what exactly is cholesterol? Is all cholesterol bad for human health? And how is high cholesterol treated?

 

What is cholesterol?  

Cholesterol is a type of lipid found in human blood. It’s a vital component of cell membranes. The body uses cholesterol to make hormones and vitamin D. And because it is such an important lipid, the human body makes all the cholesterol it needs. Food sources of cholesterol include animal products such as meat, eggs, fish and milk products (cheese and butter).

 

Doctors tend to distinguish between two types of cholesterol: high-density lipoproteins (HDLs) and low-density lipoproteins (LDLs). HDL is often referred to as ‘good’ cholesterol because it shuffles other types of cholesterol from the body to the liver where it can be removed. LDL is referred to as ‘bad’ cholesterol because it can clog the arteries leading to atherosclerosis. So, the main difference between good and bad cholesterol is that one promotes the removal of cholesterol from the body and the other type contributes to plaque formation.

 

Triglycerides are another type of fat found in the blood. When we eat more calories than we burn, the excess calories are converted into triglycerides and stored in fat cells, which serve as energy reserves throughout the day. That means triglycerides are important to sustain our body’s energy needs between meals. Problems arise when humans consume more energy than they require leading to high triglyceride levels which raise the risk of stroke, obesity, and metabolic syndrome.

 

Medications that affect LDL and triglyceride levels

High levels of LDL and triglycerides could also be side effects of certain medications, for example those used to lower high blood pressure. Medicines known to raise cholesterol and triglyceride levels are:

 

  • Beta-blockers
  • Diuretics
  • Estrogen and progestin
  • Retinoids
  • Steroids
  • Immunosuppressants
  • Certain HIV medications

 

The negative effects of high LDL levels

High LDL levels are an indicator that you have too much of the bad cholesterol in your blood. This can lead to plaque build-up in the arteries and eventually leads to the hardening of the arteries. When the arteries harden, blood that carries oxygen can no longer flow to the heart. As a consequence, the heart does not get enough oxygen which leads to angina or even worse, a heart attack.

 

How are cholesterol levels measured?

Usually, doctors will perform a blood test to measure LDL levels. The American Heart Association recommends that young adults get their cholesterol levels checked every four to six years, whilst those above the age of 40 years should get them checked more regularly.

It’s advised to measure both LDL and HDL levels. But cholesterol is just one aspect of heart health. Your doctor may also measure your blood pressure, calculate your body mass index and measure your fasting blood sugar level.

 

Your doctor will calculate your risk for cardiovascular disease using a standard lipid panel. This is fairly easy to read, and you can check your test results against the table below.

 

  Desirable Bordering high/low High/Low

Total Cholesterol

< 200 mg/dL

200-239 mg/dL

> 239 mg/dL

HDL Cholesterol

> 60 mg/dL

40-60 mg/dL

< 40 mg/dL

LDL Cholesterol

< 129 mg/dL

130-159 mg/dL

> 159 mg/dL

Triglycerides

< 150 mg/dL

150-199 mg/dL

> 199 mg/dL

 

How do you lower LDL cholesterol and triglyceride levels?

Although drugs are available to treat high cholesterol, lifestyle and diet changes are often unavoidable. If you’ve been diagnosed with borderline high or high levels of LDL or triglycerides here’s what you can do:

 

  • Eat a healthy diet that consists of plenty of fresh vegetables and fruits. Reduce your intake of trans fats (hydrogenated vegetable oils) and saturated fats (meat, butter, cheese). Instead, incorporate healthy fats into your diet (for example nuts and avocados). Try to avoid eating too much sugar and refined carbohydrates to lower triglyceride levels.
  • Exercise. A lack of exercise can lead to weight gain and raise blood LDL levels in the long-term. Daily exercise is important to maintain a healthy body weight and keep cholesterol levels low.
  • Lose weight. If you’re obese or overweight, you’re at higher risk of complications from high LDL levels. A combination of exercise and a healthy diet is the best approach to naturally shed the pounds.
  • Cigarette smoking has been shown to decrease HDL (good) cholesterol which is necessary for the removal of LDL from the body. Stop smoking to boost HDL levels.
  • Alcohol has also been linked to elevated triglyceride levels. Try to limit your intake of alcoholic drinks.

 

Medications to treat high cholesterol

Statins are prescription drugs used to reduce bad cholesterol and lower the risk of cardiovascular disease. The drugs reduce the liver’s ability to make cholesterol. This decreases the overall level of circulating LDLs in the bloodstream.

 

But the Collaborative Atorvastatin Diabetes Study found that statin treatment in diabetics reduced the risk of cardiovascular disease by only one-third, raising questions over their effectiveness in some patients. Another research study of 165,000 people by the University of Nottingham in the UK found that less than half of patients who were prescribed statins reduced their cholesterol levels to healthy levels within two years.

 

These findings do not mean that you should stop taking your cholesterol-lowering medication. Instead, speak to your doctor about combining your drug therapy with lifestyle changes. Lifestyle and dietary changes should be the first port of call if your total cholesterol levels are borderline high. If, after three months, LDL levels have not improved, your doctor may want to prescribe statins.  

 

How to raise HDL levels?

Lowering your intake of bad cholesterol is one approach to improving your overall health and heart disease risks. At the same time, you may want to boost your HDL levels. This can be achieved by stopping smoking, eating a diet high in fiber and low in trans and saturated fats, and exercising regularly.

 

References

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  2. Blesso, C. N., & Fernandez, M. L. (2018). Dietary Cholesterol, Serum Lipids, and Heart Disease: Are Eggs Working for or Against You?. Nutrients, 10(4), 426. https://doi.org/10.3390/nu10040426
  3. "How To Get Your Cholesterol Tested". in , , 2019, <https://www.heart.org/en/health-topics/cholesterol/how-to-get-your-cholesterol-tested#targetText=The%20American%20Heart%20Association%20recommends,experiencing%20cardiovascular%20disease%20or%20stroke.> [accessed 12 October 2019].
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  5. Herink M, Ito MK. Medication Induced Changes in Lipid and Lipoproteins. [Updated 2018 May 10]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK326739/
  6. Bitzur, R., Cohen, H., Kamari, Y., Shaish, A., & Harats, D. (2009). Triglycerides and HDL cholesterol: stars or second leads in diabetes?. Diabetes care, 32 Suppl 2(Suppl 2), S373–S377. https://doi.org/10.2337/dc09-S343
  7. Colhoun, H, D Betteridge, P Durrington, G Hitman, H W Neil, & S Livingstone et al., "Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial.". in The Lancet, 364, 2004, 685-696.
  8. Bittencourt, M, & F Cesena, "Statin dose in primary prevention: aim for the target!.". in Heart, 105, 2019, 969-971.
  9. Mannu, G. S., Zaman, M. J., Gupta, A., Rehman, H. U., & Myint, P. K. (2013). Evidence of lifestyle modification in the management of hypercholesterolemia. Current cardiology reviews, 9(1), 2–14. https://doi.org/10.2174/157340313805076313

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