High-Risk Cholesterol: Myth vs Facts?

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1. All high cholesterol levels put you at risk for disease.

   Your body needs cholesterol to create cell membranes and hormones. But there are two kinds of cholesterol: "good" (HDL) and "bad" (LDL). It's the bad LDL cholesterol that builds up in your arteries, leading to heart disease. Good cholesterol actually helps remove bad cholesterol from the blood. A higher HDL is better; aim for 60 mg/dL or more. A lower LDL is best; aim for less than 100 mg/dL. A healthy low-fat diet and exercise naturally help you manage cholesterol. Medications help when diet and exercise alone are not enough.

2. There are noticeable symptoms of high-risk cholesterol.

   One in five Americans has high cholesterol. Unfortunately, many don't know it because there are usually no symptoms. Some people only learn they have high cholesterol after a heart attack or stroke. Not sure whether you have high-risk cholesterol? Get routine cholesterol screenings every five years -- starting in your 20s. Men over 45 and women over 55 need cholesterol testing more often because the risk of heart disease rises as we age. People with borderline high cholesterol may need cholesterol tests every one to two years.

3. Medication is the only way to manage high-risk cholesterol.

   The main ways to reduce high-risk cholesterol are through diet, exercise, and medication. Maintain a healthy weight, get 30 minutes of physical activity most days, and eat right by reducing saturated fats to less than 7% of your calories. Other dietary tips: Consume fewer than 200 milligrams of cholesterol daily; reduce trans fatty acids (hydrogenated oil) found in many packaged foods; get 10 grams of soluble fiber and 2 grams of plant sterols daily; and, boost the amount of omega-3 fatty acids to1 gram daily by eating fish and/or taking fish oil supplements. If diet and exercise alone don't lower your cholesterol enough, your doctor will probably recommend medication, also.

4. High-risk cholesterol raises your chances of type 2 diabetes.

   High-risk cholesterol can play a part in the development of type 2 diabetes. Good (HDL) cholesterol below 35 mg/dL is one diabetes risk factor. Other risk factors are being overweight, having a family history of diabetes, being inactive, and having high blood pressure. Type 2 diabetes, like high-risk cholesterol, can be "silent." You may not know you have it. Learn your diabetes risk: Get a fasting blood sugar test starting at age 45 -- sooner if you're overweight. Then get a blood sugar test every three years thereafter.

5. your total cholesterol is normal, you're not at risk for heart attack or stroke.

   Even with normal total cholesterol -- less than 200 mg/dL -- high LDL cholesterol or low HDL cholesterol raises your risk of heart disease and stroke. That's why it's important to know all your cholesterol numbers. To reduce disease risks, get your cholesterol checked and then follow your doctor's orders. Strive for an LDL less than 100 mg/dL, and HDL at least 60 mg/dL.

6. Tobacco and alcohol can affect your cholesterol.

   Alcohol and tobacco can change your cholesterol -- one perhaps for the better, the other for the worse. Some studies suggest a moderate amount of alcohol (about one drink daily for women, two for men) may raise good cholesterol. It's well-proven that smoking can lower good cholesterol. If you don't already drink, there's no need to start just for the cholesterol effect. A healthy diet by itself raises good cholesterol. But if you smoke, try to quit. Not only will you help your cholesterol, but you'll also reduce your risks of heart disease and cancer.

7. You should get your first cholesterol test at age 45.

   Everyone should get a cholesterol test at least every five years, starting in their 20s. Called a fasting lipid profile, it's a simple blood test done after you've not eaten for 9-12 hours. The results of the test break down your cholesterol into triglycerides, HDL, LDL and total cholesterol. Healthy figures are: less than 150 mg/dL for triglycerides; HDL of 60 mg/dL or higher; LDL lower than 100 mg/dL; and total cholesterol below 200 mg/dL. If you have questions about high-risk cholesterol or about how diet and exercise affect cholesterol, talk to your doctor.

Reviewed by Michael W. Smith, MD, January 2007.

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SOURCES: American Heart Association web site: "Physical Activity." National Heart, Lung, and Blood Institute web site: "High Blood Cholesterol: What You Need To Know." WebMD Medical Reference from Healthwise: "High Cholesterol: Medications," "High Cholesterol: Coronary Artery Disease."

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