What You Need to Know About Cholesterol

You’ve probably been told to get your cholesterol numbers checked. But what exactly is cholesterol – and what should you be doing about it?

Cholesterol is a waxy, fat-like substance within the human body, and it’s vital to many bodily functions. You can’t live without it. Cholesterol also exists in certain foods we eat, particularly those from animals – meat, dairy products and eggs.

So if cholesterol is natural and necessary, what’s the fuss?

Too much cholesterol circulating in your bloodstream can ultimately clog the insides of your arteries, leading to a heart attack, stroke or blockages in the arteries of your legs.

Edward Kersh, M.D., FACC, a cardiologist formerly in the Sutter network, emphasizes that cholesterol is not the only factor leading to heart disease. However, high levels of cholesterol, combined with other risk factors such as smoking, high blood pressure, diabetes and a family history of heart problems, can definitely set the stage for heart disease.

“Good” Cholesterol and “Bad” Cholesterol

Most people know in general that cholesterol is bad for them, and that it’s important to reduce your intake of foods such as butter, bacon and red meat. But discussions can become confusing when talking about the need to have high levels of “good” cholesterol in your system. Why are there two types of cholesterol and why should I have higher levels of one than the other?

Cholesterol can’t dissolve in the blood and moves through your body via two “packages” – high-density lipoproteins (HDL) and low-density lipoproteins (LDL). The balance of HDL (good cholesterol) and LDL (bad cholesterol) really identifies your heart disease risk. LDL leads to a buildup of plaques within your arteries, while HDL helps to remove excess cholesterol from your body. In other words, the “bad” cholesterol can lead to a heart attack or stroke, while the “good” cholesterol works to prevent plaque buildup by shipping off the “bad” cholesterol to your liver for elimination.

What Should My Cholesterol Level Be?

Cholesterol levels are measured through a simple blood sample. The current recommended levels of cholesterol in the blood are:

• Total blood cholesterol lower than 200 mg/dL
•  LDL cholesterol less than 100 mg/dL
•  HDL cholesterol greater than 60 mg/dL - this is the one where higher is better!
•  Triglycerides – should be under 150 mg/dL

Dr. Kersh notes that your doctor may recommend different targets for you based on your age and other risk factors. For example, in patients who have already had a heart attack, many cardiologists recommend getting the LDL level in the blood below 70 mg/dL.

Dr. Kersh suggests that everyone should have a lipid panel done to measure cholesterol levels by the age of 35. After that, you and your doctor can set a screening schedule based on your measurements, family history and other risk factors.

Assessing Your Heart Disease Risk

In 2013, a new set of guidelines for assessing and treating high cholesterol was issued by the American College of Cardiology and the American Heart Association. These guidelines assess a number of risk factors to estimate a person’s 10-year risk of having heart disease. “Based on the risk assessment, a patient and doctor can discuss next steps, including the possible advantage of taking statin drugs to reduce heart attack risk,” Dr. Kersh says.

“Statin therapy has been proven to reduce the risk of atherosclerosis (clogged arteries) and the risk of heart attack or stroke,” Dr. Kersh says. He notes that the national rates of atherosclerotic heart disease have gone down dramatically in recent years, in part due to more extensive use of statin drugs.

But statin drugs aren’t for everyone, and they certainly aren’t the only way to lower your cholesterol levels or lower your heart disease risk. Adopting a heart healthy diet, getting regular exercise, reducing stress, quitting smoking and losing excess pounds are proven ways to reduce your risk, not just of heart disease, but high blood pressure, diabetes and other conditions.