National Cholesterol Education Month: Know Your Numbers, Protect Your Heart

Any time is the right time to take charge of your heart health to improve your quality of life. So how about right now? After all, it’s National Cholesterol Education Month, which raises awareness about the importance of maintaining healthy cholesterol levels. By understanding cholesterol, its risk factors, and management strategies, you can reduce your risks of heart disease and stroke.

Dr. Shant Manoushagian, a board-certified cardiologist with the Lee Health Heart Institute, offers expert advice and recommendations for ways to keep from developing high cholesterol and what to do if you have it.

What is cholesterol?

“Cholesterol plays a dual role in our bodies,” Dr. Manoushagian says. “On the one hand, it’s essential for building healthy cells, hormones, and vitamin D. On the other hand, too much of the wrong type of cholesterol can wreak havoc on our cardiovascular system.” 

A waxy, fat-like substance, cholesterol is found in all cells of the body. Contrary to popular belief, though, cholesterol isn't inherently bad, according to Dr. Manoushagian. in fact, he says it's essential for various bodily functions, including:

• Building cell membranes
• Producing hormones like testosterone and estrogen
• Aiding in the production of vitamin D
• Helping your body digest foods

However, cholesterol can pose significant health risks, especially to your cardiovascular system when levels become too high. 

Types of cholesterol

There are two main types of cholesterol:

• Low-density lipoprotein (LDL): Often called "bad" cholesterol, LDL can build up as plaque (which is made up of cholesterol, fat, blood cells, and other substances) in your arteries, leading to atherosclerosis (hardening of the arteries) and increasing your risk of heart disease and stroke, according to the Centers for Disease Control and Prevention.
  “Plaque narrows our blood vessels, restricting blood flow. Over time, it can trigger heart attacks, strokes, and other cardiovascular disasters,” Dr. Manoushagian says.
• High-density lipoprotein (HDL): Known as "good" cholesterol, HDL helps remove other forms of cholesterol like LDL from your bloodstream, transporting it back to the liver for disposal. Higher HDL levels are associated with better heart health.

Aim for these numbers, experts say

Keeping your cholesterol levels at healthy levels can keep your heart healthy. Doing so can lower your chances of getting heart disease or having a stroke. According to the American Heart Association, the following are some suggested cholesterol levels: 

• Total cholesterol: Less than 200 mg/dL is normal, 200–239 mg/dL is borderline high, and 240 mg/dL or higher is high
• LDL cholesterol: Less than 100 mg/dL is optimal, and lower is better
• HDL cholesterol: At least 40 mg/dL for men and 50 mg/dL for women
• Triglycerides: Less than 150 mg/dL
• Lipoprotein(a): 50 mg/dL or higher is considered high 

The AHA recommends that adults get their cholesterol checked every 4–6 years, starting at age 20, when cholesterol levels can begin to rise. However, those with risk factors or existing high cholesterol may need more frequent testing. 

The test only way to know whether you have high cholesterol is to get your cholesterol checked. Your doctor can do a simple blood test or blood draw, called a “lipid profile." 

“Your doctor will review your cholesterol numbers, along with your family history, age, sex, and other parts of your lifestyle or health, like smoking, that could increase your risk for high cholesterol,” Dr. Manoushagian says. 

According to the CDC, your doctor may also order a coronary artery calcium (CAC) scan to help understand your risk and determine the best way to manage your cholesterol levels.

“The goal is to develop a complete picture so your doctor and you can determine whether you should take steps like lifestyle changes or cholesterol-lowering medicine to lower your risk for heart disease and stroke,” Dr. Manoushagian adds.

Atherosclerosis from high cholesterol: a sneaky disease

High cholesterol often flies under the radar, Dr. Manoushagian says. It can lead to atherosclerosis, which he calls a progressive and painless condition.

“Atherosclerosis builds up slowly and silently, over time, and usually shows no symptoms until an artery is blocked or a plaque ruptures,” he says. “Symptom types depend on which arteries are affected and how much blood flow is blocked.”

Causes and risk factors of high cholesterol

Dr. Manoushagian says the leading causes and risk factors of high cholesterol include:

• Diet: Consuming foods high in saturated and trans fats can increase LDL cholesterol.
• Lack of physical activity: A sedentary lifestyle can lower HDL cholesterol.
• Obesity: Excess weight can increase LDL and lower HDL levels.
• Genetics: Some people inherit genes that cause their bodies to produce too much cholesterol.
• Age and gender: Cholesterol levels tend to rise as we age, and men generally have higher levels than women before menopause.
• Certain medical conditions: Diseases like diabetes and hypothyroidism can affect cholesterol levels.

He also notes that some people’s bodies make too much cholesterol regardless of what they eat or their lifestyle habits. This type of health issue typically runs in families.

Lowering your risk

Fortunately, you can make several lifestyle changes to lower your risk of developing high cholesterol:

• Adopt a heart-healthy diet: Focus on fruits, vegetables, whole grains, lean proteins, and healthy fats like those found in olive oil and avocados.
• Exercise regularly: Aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week.
• Maintain a healthy weight: Losing excess weight can help lower LDL and increase HDL levels.
• Quit smoking: Smoking lowers HDL cholesterol and increases the risk of heart disease.
• Limit alcohol consumption: Excessive alcohol intake can increase cholesterol levels and contribute to liver problems.

Managing high cholesterol

Dr. Manoushagian says if you've been diagnosed with high cholesterol, your doctor may recommend a combination of lifestyle changes and medical treatments. 

“The first line of defense against high cholesterol is often lifestyle changes, including those mentioned above for lowering risk,” Dr. Manoushagian says. 

Your doctor may also recommend:

• Reducing sodium intake
• Increasing fiber consumption
• Incorporating foods rich in omega-3 fatty acids, such as fatty fish, into your diet

Medications

Sometimes lifestyle changes aren’t enough. That’s when your doctor may prescribe medications to help lower your cholesterol levels:

• Statins: The most prescribed cholesterol-lowering medications, they work by blocking a substance your liver needs to make cholesterol.
• Bile acid sequestrants: These drugs help remove cholesterol from the blood by binding to bile acids in the intestines.
• Cholesterol absorption inhibitors: These medications reduce the amount of cholesterol absorbed from food.
• PCSK9 inhibitors: These newer drugs can dramatically lower LDL cholesterol levels and may be prescribed for people with genetic conditions causing very high cholesterol.

When it comes to cholesterol levels, heart health isn’t a game of chance—it’s a game of numbers. Dr. Manoushagian says seeing your doctor regularly and participating with your health care team in your cholesterol management and treatment decisions can empower you toward a heart healthy life.