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5 Things to Know About Cholesterol

When you find out you have high cholesterol, it may be hard to understand since it’s something you can’t see or feel. But having high cholesterol can have serious implications on your heart health.

Here are some of the basics you need to know as you work to lower your high cholesterol.

1. Your body needs cholesterol

“You need cholesterol…it’s a vital component of cell membranes,” said Dr. Adam Cohen, a cardiologist on staff at Abington Hospital - Jefferson Health. Cholesterol is created two ways: about 70 percent is created by your liver and the other 30 percent is taken in through your diet, he explained.

How much cholesterol your body produces is influenced by genetic components as well.

2. Understand what your cholesterol test results mean

When you have a blood test to determine what your cholesterol levels are, your results contain multiple numbers you need to know.

“The basic lipid profile consists of four important numbers: total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides,” Dr. Cohen said.

High triglycerides, which are another type of fat found in the blood, tend to be associated with a lot of carbohydrate consumption, or too much sugar, as well as obesity, poorly controlled diabetes, underactive thyroid, kidney disease and alcohol consumption, according to Dr. Cohen.

3. Cholesterol comes in good and bad

Cholesterol comes in a lot of different varieties, some of which are beneficial and some that are harmful – Dr. Cohen noted that they’re often referred to as “good” and “bad” types of cholesterol.

“You need cholesterol for healthy cells, but the problem is you don’t want to have too much of it,” he said.

Low-density lipoprotein (LDL) cholesterol is considered the bad cholesterol.

“(LDL) is the kind that circulates in the blood and adheres to the walls of arteries in the heart, brain, legs or anywhere else in the body,” he said. “High levels of bad cholesterol are associated with various types of cardiovascular disease, such as heart attack and stroke.”

If you have high LDL cholesterol, it can attach to the wall of arteries – when it adheres to the wall, it can cause a plaque buildup in the artery, causing it to harden and narrow. It can clog up the flow of blood, reducing oxygen to key organs like the heart and brain.

“High density lipoprotein (HDL) cholesterol’s job is to take some of that cholesterol that’s circulating in the blood and bring it back to the liver to be excreted,” Dr. Cohen explained. “Increased levels of HDL have generally been associated with lower risks of heart disease.”

4. Your cholesterol levels are sensitive to diet and exercise

If you have high cholesterol and are trying to reduce it, you want to watch for foods high in saturated fats and trans fats.

“That includes things like red meat, cheese, fried foods, processed foods, pastries, cakes and cookies,” he said. “You want to avoid animal oils so you don’t want to cook in butter; use olive oil or canola oil instead.”

You should also reduce or eliminate whole-fat dairy products and animal fats, particularly beef, duck, and lard.

“You can get leaner or skim versions, like chicken, turkey, and lean cuts of meat,” he said. “In addition, portion in control is an essential element of a heart-healthy diet – it’s not only what you eat, but how much.”

Not all fats are bad, though – some fats, like unsaturated fats, are good for you and are healthy. These fats are commonly found in fish, like salmon, and nuts like almonds and walnuts.

“Being sedentary and inactive can adversely impact your cholesterol levels and your heart in general,” Dr. Cohen said. “Get regular aerobic exercise – I recommend 30 or 40 minutes at least four times a week.”

You should also stop smoking since smoking lowers your HDL cholesterol, in addition to its many other harmful effects.

5. Medication may be an option if you’re considered “high risk”

“You can look at two people with the exact same cholesterol profile and one may need medication and the other doesn’t,” Dr. Cohen said. “You want to take into consideration all traditional risk factors as well as considering more advanced markers for atherosclerosis in select populations.”

He looks at all of a person’s risk factors of developing heart disease in addition to their cholesterol level to determine if medication is warranted.

“Medicines aren’t a substitute for lifestyle change,” he said. “They’re not a cover up for all of the other things you should do – they’re an add-on treatment to a rigorous lifestyle program.”

For about two decades, statins have been the mainstay of treatment for lowering cholesterol.

“This class of drugs has been enormously successful in reducing the burden of cardiovascular disease in a wide array of patients,” Dr. Cohen said.

However, for some people, these drugs are either inadequate at reducing LDL cholesterol or patients may have some side effects to statins. In the last few months, Dr. Cohen said there was a new class of drugs approved to help treat high cholesterol, called PCSK9 inhibitors, when statin therapy is inadequate.

“These are medications that have been recently approved to be used in addition to statins for people who are taking them, but whose cholesterol is still not controlled,” he said.

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