September is Cholesterol Awareness Month. Should you care?
LDL, HDL, Triglycerides…these numbers contain important information about your risk of heart disease. But the terms can be confusing.
According to the National Cholesterol Education Program (a program of the National Heart, Lung, and Blood Institute) everyone over 20 years old should have a cholesterol screening at least every five years.
Here is a quick overview on the most commonly tracked heart health indicators and the NCEP recommended targets. (For those who question the role of cholesterol in heart disease, please see the comments at the end of this post).
Total cholesterol
What is it? Total cholesterol is a combination of LDL, HDL, and other cholesterol molecules. Although not as precise as the other measurements listed below, your total cholesterol number can reveal whether further screening is necessary.
What range should I aim for? The NCEP considers a total cholesterol of less than 200mg/dL to be ideal.
LDL cholesterol
What is it? When it comes to cholesterol, LDL is considered the “bad” kind or the type you want to decrease. This type of cholesterol tends to form a thick plaque within the inner lining of your blood vessels making them less flexible and more difficult for blood to travel through. Atherosclerosis, or a build up of LDL within the vessels, puts you at major risk for a heart attack or stroke.
What range should I aim for? There is no one size fits all range for LDL cholesterol goals. It depends on what other risk factors you may have. Risk factors for heart disease include age, age, heredity, smoking, sedentary lifestyle, and excessive alcohol use.
In general, if you don’t have heart disease or diabetes and have few other risk factors for heart disease, the NCEP recommends that you aim for an LDL level of less than 160 mg/dL.If you don’t have heart disease or diabetes but have two or more risk factors for heart disease, the NCEP goal for LDL is less than 130 mg/dL. If you have heart disease or diabetes, the NCEP suggests that you keep your LDL levels less than 100 mg/dL.
HDL cholesterol
What is it? HDL cholesterol is the “good” type that is protective against cardiovascular diseases. Scientists believe that HDL carries cholesterol away from your arteries (preventing plaque from forming) and back to your liver where it is removed from the body.
What range should I aim for? The higher your HDL level, the better. According to the NCEP, women should aim for an HDL level of 50 mg/dL or higher and men should shoot for 40 mg/dL or higher.
Triglycerides
What are they? Triglycerides are the most common form of fats in the body. They circulate in the blood and are used for energy or stored in fat tissue if you take in more calories than your body needs. A diet heavy in refined carbohydrates and alcohol and/or a sedentary lifestyle contribute to high triglycerides.
What range should I aim for? The NCEP recommends that you aim for a level of less than 150 mg/dL or less.
But what about the people who claim that cholesterol levels don’t matter?
Many have questioned the role of cholesterol levels in determining heart disease risk. They point out that many people with high cholesterol levels never have heart attacks and that, conversely, some people with normal cholesterol have fatal heart attacks.
It’s important to understand what a “risk factor” is (and isn’t). Having high cholesterol does not guarantee that you will develop heart disease. It also doesn’t mean that high LDL cholesterol levels cause heart disease or that LDL levels are the only (or most important) risk factor for heart disease.
It simply means that those with high LDL cholesterol (or low HDL) levels are statistically more likely to develop heart disease. If your cholesterol levels hint that you’re at elevated risk, that’s a great reason to get serious about heart-healthy diet and lifestyle changes—which can only make you healthier!
And here’s another very important point: If your cholesterol levels are low or normal because you take cholesterol-lowering drugs, you should still consider yourself at elevated risk. In other words, taking cholesterol-lowering drugs is not a substitute for appropriate lifestyle and diet modifications.
Here are steps everyone can take to reduce the risk of heart disease (and many other diseases as well):
• Get regular exercise
• Get most of your fats from monounsaturated fats (like olive oil)
• Eat a small portion of nuts on a daily basis
• Eat fish twice a week
• Quit smoking
• Eat a diet rich in fiber and antioxidants (read: fruits and vegetables!)
• Maintain a healthy weight
• Limit your intake of sugars and refined carbohydrates
If you do all of these things and still have high cholesterol levels, I think a strong argument could be made that your high cholesterol levels are not a signal of increased risk. But ultimately, that's something you'll have to negotiate with your doctor.
Read more (off-site): High cholesterol does not cause heart disease
Vote in our poll: Does cholesterol matter?
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Posted by: Andrew van Dyk | Sep 22, 2008 11:26:01 AM
For years I have been on Lipitor. 2 years ago I cut it out. I am not taking any medication for anything. I feel better and younger now than I did 10 years ago. I also have read that a higher Cholesterol level for seniors is a good thing!
I am 81.
Posted by: Stephan | Sep 12, 2008 8:03:24 PM
The NCEP panel is riddled with conflicts of interest. Here's the 9-member panel's conflict of interest disclosure:
http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3upd04_disclose.htm
In short, NCEP panel members are in bed with a number of statin manufacturers.
Posted by: Evita | Sep 10, 2008 5:40:34 PM
Hi Monica
Thank you for letting me know about this September venture!
My personal story with cholesterol was that at a young and slim age I found myself with elevated cholesterol. A year later after switching to an all plant based diet, my cholesterol dropped over 1.5 points!
Having said that I see how important it is for people to understand the research you point out here and hence will also introduce my readers to this on http://evolvingwellness.com
Thanks again.
Posted by: Dave | Sep 9, 2008 9:48:43 AM
Alex,
There is no scientific evidence linking dietary cholesterol and disease.
Meat and egg substitutes are highly processed foods, and should be avoided. Pastured animal products are the best - most grain-fed animals eat the equivalent of human junk food, and are treated badly.
Legumes and grains both contain anti-nutrients and are relatively nutrient poor. If you use NutritionData.com and list foods ranked by nutrient, sticking to minimally processed foods, grains and legumes don't even crack the top 10 in most categories.
Posted by: Alex Baran | Sep 9, 2008 8:32:02 AM
The foods that don`t have cholesterol, are high in soluble fibers, and also contain antioxidants should be consumed in any diet and include: vegetables, fruits, legumes, grains, psyllium seeds, meat substitutes, egg substitutes and so on. I read about this at http://www.projectweightloss.com/index.php.
Posted by: Deborah Dowd | Sep 9, 2008 6:50:43 AM
While I have always had relatively good cholesterol numbers,mine really showed improvements last year after switching almost exclusively to olive oil for cooking and eating and taking fish oil capsules every day.
Posted by: Mark | Sep 8, 2008 6:24:08 PM
Monica, I was wondering if you had anything to say about omega 6 fats? I know that most people get too much of them, but assming that you make sure to have a good omega 6 to omega 3 ratio, what are the benefits of omega 6? What role do they play in the body?
Posted by: Dave | Sep 8, 2008 4:46:41 PM
Hi Monica. I would actually argue that cholesterol-lowering drugs are not only over-prescribed, but pointless. From my reading (admittedly limited), I don't believe you would find many scientists who believe that the actual chemical compound "cholesterol" has much of anything to do with heart-disease. LDL that has undergone damage either from oxidation or glycation (sugar) seems to play a major role because of its ability to cause inflammation. As I'm sure you know, LDL itself is not a type of "cholesterol", but rather a molecule that carries cholesterol in the blood. Statins lower LDL in an indirect fashion. The body tries very hard to regulate total cholesterol (similar to blood sugar). Statins block the manufacture of cholesterol, causing the liver to make more LDL receptors to scavenge cholesterol carried by LDL in the blood.
I think it's very important for people to understand this point. LDL reduction by statins is essentially a side-effect of blocking cholesterol manufacture. It's analogous to "fixing" a clanking noise in your car engine by clamping the gas line shut: no more clanking, but then the car doesn't work either. The body has good reasons for working hard to maintain cholesterol levels, because it is essential to cellular processes. Since there is little or no evidence that cholesterol itself has anything to do with the development of heart disease, blocking it's manufacture seems a questionable strategy.
So I think your advice to modify lifestyle and avoid drugs is right on. I believe diet recommendations could be wrapped up as just "eat whole foods", i.e. items that recognizably came from a plant or animal. Despite the marketing hype, "whole grain foods" are not whole foods, and are just another form of refined carbohydrate. I'd change the fat recommendation to "avoid polyunsaturated fat". Conventional wisdom on saturated fat is not supported by scientific evidence, e.g. the evidence connecting consumption of saturated fat to some disease endpoint is scant. If heart disease is indeed partly caused by oxidized LDL, this makes sense. Polyunsaturated fats are easily oxidized, saturated/monounsaturated fats are not. Polyunsaturated fats and refined carbohydrates are the main ingredients in processed foods. Both are likely to increase damage to LDL.
Posted by: Monica Reinagel | Sep 8, 2008 1:28:44 PM
Goober,
I agree with you that the NCEP guidelines are simplistic! A quick look at the links posted above by Dave Dixon or within the post itself confirms that there is much more to the story than cholesterol (and much more to the cholesterol story than just HDL and LDL).
I think the guidelines are simplistic by design. A more nuanced and complex discussion of heart risk factors might be more accurate (although much is still hypothesis). But I'm not sure it would necessarily be more helpful, at least in terms of a public health initiative.
Screening is a first step and casting a wide net (both by making it easy to get screened and by focusing on tests with a high sensitivy rather than tests with a high specificity) is desirable.
If a potential problem is detected, people will hopefully be working with a qualified health professional to gather more information (e.g., more tests) and to develop a holistic treatment and/or monitoring program.
And those health professionals will hopefully be well-informed, up-to-date, and not taking their marching orders directly from the pharmaceutical companies that sell cholesterol-lowering drugs.
Although its certainly not everything you need to know about your heart health, I think knowing your cholesterol levels is useful information to have. I also happen to believe that cholesterol-lowering drugs are over-prescribed.
That's why I suggest that anyone that is concerned about their heart disease risk (regardless of their cholesterol levels), they should start with the lifestyle modifications listed at the end of the post.
Posted by: Dave | Sep 8, 2008 12:31:32 PM
For those readers who would like an updated and more detailed discussion of LDL, HDL, etc:
http://www.cholesterol-and-health.com/LDL-HDL-Good-Cholesterol-Bad-Cholesterol.html
Posted by: Goober | Sep 8, 2008 12:30:17 PM
I think your numerical guidelines and overal generall discussion about LDL are simplistic, off the mark, and provide bad guidance overall.
You didn't say anything about particle size in regards to LDL. You also didn't mention that cholesterol lowering drugs only help those that have already had hear problems and only then becuase of the inflammation reducing properties of the statin--not because LDL is lowered.
The other discussions are relatively better.
