Research has shown that high cholesterol — at any age — can increase your lifetime risk for heart disease and stroke.
Nearly one of every three American adults have high levels of LDL, the so-called “bad” cholesterol, which can build up and narrow arteries. That’s nearly 95 million people.
So whether you’re 19 or 59, new guidelines on lowering cholesterol may apply to you. The guidelines were released by the American Heart Association and the American College of Cardiology late last year.
The first step for prevention and treatment is the same as its been: it’s all about lifestyle. Your best bet to prevent heart disease and stroke is to eat healthier and get regular exercise.
“High cholesterol treatment is not one size fits all, and this guideline strongly establishes the importance of personalized care,” said Dr. Michael Valentine, president of the American College of Cardiology.
But what does that mean for you?
You need to talk to your doctor about your personal risk for heart attack and stroke and how your cholesterol levels factor into that risk, said Dr. Thomas Kottke, a cardiologist and medical director for well-being at HealthPartners.
No more fasting labs for cholesterol test
One of the changes you’re likely to notice you will no longer have to fast for several hours before getting a cholesterol test.
This will make it easier for you and your doctor to monitor your cholesterol levels, because the test can be taken at any time.
Labs used to have to calculate the your LDL cholesterol levels, the “bad” cholesterol.
“Now we can measure LDL directly,” Kottke said.
Everyone should be eating a heart-friendly diet to control cholesterol
“Diet remains the fundamental intervention for prevention of heart disease,” Kottke said.
The good news, he said, is a diet which prevents heart disease also helps prevent cancer.
“60 percent of cancers are preventable,” Kottke said. “Also, it’s a diet that makes weight control easier.”
Basically, pile on the vegetables and add some fruits,” Kottke said. Get your protein from fish, including tuna and salmon, nuts and other sources.
“The way I do it practically is to have two vegetarian meals a day,” Kottke said.
One of those can easily be breakfast, he said — for adults as well as kids.
Fruit juice can be a source of fruit, but make sure you’re not drinking “fruit-flavored” juice, which doesn’t have the same benefits Kottke also recommends fruit and vegetables, perhaps in smoothie form, whole grains, and nuts for protein.
“You don’t have to eat meat to get protein,” Kottke said.
Chickpeas, the primary ingredient of hummus, and any kind of beans are also good sources of protein.
When he goes out to eat, he generally chooses some kind of fish and tries to stay away from desserts.
You also don’t have to eat everything on your plate, as American portion sizes have been growing dramatically over the last 40 years, according to the American Heart Association.
Be sure to go by serving size. For example, a serving size of meat, poultry or fish is about the size of a deck of cards.
Cholesterol numbers don’t tell the whole story
It’s hard to tell a patient’s risk of heart attack or stroke simply by looking at their three cholesterol levels: HDL – the “good” cholesterol, LDL, and triglycerides, the main form of fat in our body.
Family history, personal health behaviors, including smoking and inactivity, and other factors can affect your personal risk level.
“We do predict risk in populations,” Kottke said. “But there are people who have high cholesterol and don’t have coronary artery disease.”
The decision about what to do about cholesterol levels should be between you and your doctor, Kottke said.
Hydration is key
“You can get by with simple water,” Kottke said. “For kids, they don’t need sports drinks. There’s a tremendous about of fructose.”
Most people don’t need those extra electrolytes and other items promised by sports drinks.
“They aren’t active enough,” Kottke said. “There’s too many calories in the sports drinks for the kid athlete and probably the average adult athlete.”
Save money by not relying on supplements
Kottke said we shouldn’t turn to dietary supplements or vitamins to get the nutrients we need.
“A question that puzzles us is why foods are protective, but then when we isolate out what we think the protective compound in food is, it usually as no effect,” Kottke said. “So just eat food.”
People are often told fish oil supplements can help with cholesterol. Mostly they don’t help, Kottke said. You’d have to take very high doses to see an impact if there was one. He suggests getting those omega-3 fatty acids by eating fish.
He suggests replacing chicken with salmon in your meal plans. For instance, instead of adding chicken to a salad, add salmon.
Statins can help people with heart disease
For people who have already had a heart attack or has heart disease, lipid-lowering drugs, including statins, are recommended to lower the risk of another incident.
Many statins are now available in generic form, and so very inexpensive.
The evidence is less clear for elderly patients.
Statins do have side effects.
“Some people ache,” Kottke said. The cause is mysterious, because it didn’t come up during drug trials.
If that happens, Kottke suggests trying a lower dose of statin. That can usually take care of the ache without losing the benefit of the statin.
“A low-dose statin is better than not taking one at all,” Kottke said, for people with heart disease.
There are other drugs available on the market which lower cholesterol. Kottke suggests discussing them with your doctor.
CT scans can show heart disease
Scans look for calcium in the blood vessels of your heart, Kottke said.
Injured tissue calcifies, he said. That’s basically what happens to your vessels when you have heart disease, cholesterol-containing deposits build up, injuring, narrowing and blocking your vessels.
CT scans can see that calcium. If you have any calcium in the heart, you have coronary artery disease.
These scans can be useful if a patient’s risk factors may not already warrant the use of cholesterol-lowering medication, but there is some question about their risk for a heart attack, Kottke said.
He does not advocate CT scans for everybody. It may not be covered by health insurance and could cost hundreds of dollars.