When You Know Your Levels, You Level the Playing Field

Reviewed by Brunilda Nazario, MD on October 22, 2020

By Robert Eckel, as told to Janie McQueen

Your body needs cholesterol. The healthy kind, for example, helps your body make hormones and substances that aid digestion. But the “bad” cholesterol, or LDL -- low-density lipoprotein -- can increase your risk of having heart disease and stroke. That’s why it’s important to pay attention to all the numbers your cholesterol test reveals, not just the total.

The LDL Link

LDL cholesterol can cause serious health problems. It tends to build up in your artery walls, where it attracts white blood cells and leads to swelling and inflammation. Plaque also forms. As this process goes on, the plaque can grow and block blood flow.

A heart attack or stroke usually happens when this plaque lining is weak, and breaks. The blood clot that forms around the break can obstruct circulation to the heart or brain.

Running the Numbers

Your doctor or provider will check your cholesterol with a blood test. Sometimes they’ll ask you to fast for 12 hours before you get your blood drawn. It’s not always necessary, though.

The test will measure your total cholesterol, including LDL; HDL -- high-density lipoprotein (sometimes dubbed the “good” kind); and triglycerides, which are fats in your blood. Your doctor will study them and go over with you what all the numbers mean for your health.

Good Ways to Control Bad Cholesterol

Battle Plaque Buildup in Your ArteriesAtherosclerotic Cardiovascular Disease, or ASCVD, causes your arteries to narrow and harden. This increases your risk of heart attack or stroke, but it’s very treatable. Here’s how to lower your LDL.233


Atherosclerotic cardiovascular

disease, ASCVD for short,

can be caused

by unhealthy levels

of bad cholesterol or LDL

that form plaques on the walls

of your arteries

and make them

narrow and hardened.

High levels of bad cholesterol,

or LDL cholesterol, can increase

the chances you're going

to develop blockages

in your arteries

and plaque will form inside

of your arteries,

very similar to the way

that plaque can form

on your teeth

if you don't brush your teeth.

But there are a lot

of other factors

that also contribute

to development of ASCVD,

such as high blood pressure,

diabetes, obesity, lack

of exercise, and smoking.

Over time, plaque can build up

inside of your arteries

and can slow or even block blood

flow and oxygen coming

from your heart

to the rest of your body.

This can lead to development

of chest pains,

or in a worst case scenario,

can lead to heart

attacks or even a stroke.

SPEAKER 2: In the US,

there are over 800,000 heart

attacks each year,

one every 40 seconds.

SPEAKER 1: ASCVD can be genetic,

which means you may have

inherited some risk

for development of artery

blockages from your parents.

Now there's not a lot that you

can do with regard

to your family history,

but fortunately, there are

several lifestyle changes

that you can make to lower

your risk.

Number one, quit smoking.

Smoking is a known leading cause

of ASCVD because it damages

the lining of your arteries

and make it much more likely

that you will develop a blockage

in a heart artery.

Number two, a healthy diet.

One easy way to reduce your risk

is to change your diet.

It's important to eliminate

high fatty foods

such as greasy foods,

fried foods, burgers, pizza,


that are very high in sugar

content, and eliminate processed


Instead, you should try and mix

in healthier alternatives

such as fruits, vegetables,

nuts, and whole grains.

Number three, exercise.

Exercising is extremely


The American Heart Association

recommends that you exercise

for 150 minutes per week

at a moderate level

of intensity.

It's probably easier to think

about this as obtaining

30 minutes of moderate intensity

exercise five days a week.

That can include things

such as biking or power walking

or swimming.

They also recommend

that if possible, you obtain

75 minutes of strenuous exercise

such as going for a run, power

lifting, and strength training.

SPEAKER 2: ASCVD is manageable,

and these three steps will go

a long way in lowering your risk

of a heart attack or stroke.

If you have also been diagnosed

with diabetes,

you need to be even more


SPEAKER 1: Diabetes is

a major risk factor

for atherosclerotic

cardiovascular disease,

and it also greatly increases

the chance that your blockages

in your arteries will increase.

It is extremely

important, if you have diabetes

and ASCVD, that you follow up

very closely with your doctors

to make sure that the diabetes

is very well controlled.


a long-term challenge.

And while these lifestyle

changes will provide

significant benefits,

you'll still need to monitor

your progress along the way.

SPEAKER 1: It's very important

that you make

sure that your cholesterol

levels are rechecked regularly,

and that your other risk factors

for cardiovascular disease

are all controlled.

If you do this, there's

a good chance that we can keep

away a lot of the complications

that often occur

with atherosclerotic

cardiovascular disease.

Michael Lee, MD<br>Cardiologist<br>Medstar Cardiology Associates/delivery/aws/31/14/3114ba47-60e8-4b6c-a716-ba15fd5e61f4/dc5e70a8-15eb-4c02-add7-a667d942d56b_funded-briefbreakdown-ascvd-high-cholesterol_,4500k,2500k,1000k,750k,400k,.mp412/21/2020 09:36:0018001200photo of cholesterol/webmd/consumer_assets/site_images/article_thumbnails/video/funded_briefbreakdown_ascvd_high_cholesterol_video/1800x1200_funded_briefbreakdown_ascvd_high_cholesterol_video.jpg091e9c5e820b0d6a

Lifestyle changes and medication are the two key ways to keep your LDL cholesterol under control. Be sure to check with your doctor before you start a new routine. It’s also a good idea to get advice from a registered dietitian.

Some of the healthy habits you should adopt include reading food labels and choosing products lower in saturated fat. Eat lean poultry and fish as your major meat sources. Add lots of fruits, veggies, and whole grains to your plate, too. Stay active. A moderate level of physical activity should be enough to help keep your numbers down.

If your doctor still finds your LDL cholesterol is still too high, they might prescribe a statin drug. Sometimes other drugs can help keep your levels in check, too.

Above all, it’s essential to recognize how cholesterol factors into heart disease and stroke. Develop new behavior patterns -- and own them. As you make your changes, keep track of your levels. Continue to discuss your progress and management goals with your doctor.

Why High Cholesterol Remains a Problem

There are many things that can keep your numbers high. One is not owning up to cholesterol problems and making the necessary lifestyle changes. Another is not taking your meds as prescribed, or not working with your doctor to find other choices if side effects occur. Then there are things like eating out too much and not getting enough exercise.

High Cholesterol Runs in Families

Sometimes your cholesterol will run high no matter what you do or how healthy your diet is. Such is the case with familial hypercholesterolemia, or genetic high cholesterol. It’s common -- about one in 250 people have it.

The condition happens because of a mutated gene that gets passed down in families. It can cause your body’s LDL cholesterol numbers to shoot up twice as much as the average. The good news is that doctors can catch it early. It can even be diagnosed at birth or early childhood.

Although lifestyle upgrades, improving your diet, and getting more exercise can help, you may still need medication to bring your levels down to reduce your risks of heart disease.

WebMD Feature


Robert Eckel, MD, president of medicine and science, American Diabetes Association; past president, American Heart Association; clinical professor emeritus, medicine-endocrinology/metabolism/diabetes, University of Colorado School of Medicine.

MedlinePlus: “Cholesterol.”

Mayo Clinic: “Triglycerides: Why Do They Matter?”

American Heart Association: “HDL (Good), LDL (Bad) Cholesterol and Triglycerides,” “Familial Hypercholesterolemia.”

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