Cholesterol and Your Health

Why is my cholesterol level important?

Cardiac disease is the number one killer of women. Too much cholesterol leads to narrowing or “hardening” of the arteries and eventually cardiac disease. Cholesterol is a fatty substance that is generated from the liver, but also enters the body through dietary sources. All women should have their cholesterol levels checked at regular intervals throughout their lives, in addition to participating in a healthy lifestyle in order to minimize their risk of cardiac disease.

What is cholesterol?

Cholesterol is a fat like substance that is present in all cells of the body. Since it is a fat like substance, it does not mix with blood, which is water like substance. Cholesterol is therefore packaged by the body into lipoproteins. These packets allow cholesterol to be carried to the cells of the body where it is needed. There are two major types of lipoproteins: LDL (low density lipoproteins) also referred to the “bad cholesterol” due to the fact that elevated levels of LDL leads to plaque buildup in the arteries of the body and thus cardiac disease, and HDL (high density lipoproteins) also referred to as the “good cholesterol” since it carries cholesterol from other parts of the body to the liver, where it is removed from the body, and thus elevated levels lead to a lower risk of developing cardiac disease. Cholesterol is used to make hormones, vitamin D and substances that are involved with digestion. Additional important fat components in the blood are triglycerides, which are usually analyzed and evaluated with cholesterol.

What affects cholesterol levels?

Cholesterol levels are primarily affected by the food we eat, genes, age and gender. They are also affected by weight and activity.  Fats in the diet can alter cholesterol levels, LDL cholesterol levels are raised most by saturated fats. Examples of foods containing a high proportion of saturated fats include: dairy products, animal fats, fatty meat, coconut oil, palm kernel oil, chocolate and some prepared foods. Trans fatty acids also raise cholesterol levels. Being overweight can also increase your LDL levels. High cholesterol levels can also run in families, and thus can be inherited. Individuals which have high cholesterol from birth may have a heart attack at an early age. As we age, our LDL cholesterol levels may also increase. Cholesterol levels in women may vary with their menstrual cycles, with as much variation as 19% in a month. As the level of estrogen rises during a woman’s cycle, her HDL level will also rise and peaks around the time of ovulation. In contrast, total cholesterol and LDL levels, as well as triglycerides, decline as estrogen levels rise. Estrogen containing compounds, such as oral contraceptives and hormone replacement therapies, can also influence cholesterol levels. Oral contraceptives have a modest positive effect on cholesterol levels, raising HDL-cholesterol and lowering LDL-cholesterol. This is a result of the estrogen component, as some progestins alone have a modest negative effective on cholesterol levels. Hormone replacement therapy has a broad scale impact on cholesterol metabolism. Estrogen therapy can increase HDL levels as well as decrease Lp(a), which is a cousin to LDL, and important mediator of cardiac disease.

Triglyceride levels are elevated by: being overweight, cigarette smoking, excessive alcohol use, very high carbohydrate diet, genetic disorders, certain drugs.

Why are elevated levels of cholesterol bad?

Elevated cholesterol levels can increase a woman’s risk to develop heart disease, and many women with elevated levels do not have symptoms. Elevated levels of cholesterol lead to buildup cholesterol containing plaques in the walls of the arteries. This eventually leads to narrowing of the arteries which can lead to decreased necessary blood flow to crucial organs of the body. Coronary arteries are the arteries which supply the heart with blood. When these are narrowed sufficiently, the heart does not receive the necessary oxygen and heart attacks can ensue. Some plaques can also rupture and lead to blood clots which block the flow of blood, leading also to a heart attack or stroke.

What do your cholesterol levels mean?

It is best to have your blood checked after not eating or drinking anything for 9 to 12 hours before the blood draw, so called “fasting” levels. Generally four levels are checked in a lipoprotein profile: total cholesterol, LDL, HDL and triglycerides. If it is not possible to fast before a blood draw, total cholesterol and HDL levels can be drawn in order to give you a general idea about your cholesterol levels. Additional testing should be done of your total cholesterol is greater than 200 mg/dL or your HDL is less than 40 mg/dL. Elevated levels of triglycerides can also increase a woman’s risk to develop heart disease.

Total Cholesterol                              

Less than 200 mg/dL  – Desirable

200-239 mg/dL – Borderline high

240 mg/dL and above – High

LDL Cholesterol Level                    

Less than 100 mg/dL – Optimal

100-129 mg/dL – Near optimal/above optimal

130-159 mg/dL – Borderline high

160-189 mg/dL – High

190 mg/dL and greater – Very high

HDL Cholesterol Level                    

Less than 40mg/dL – A major risk factor for cardiac disease

60mg/dL and greater – Considered protective against heart disease

Interventions to lower your cholesterol

For all, lifestyle changes will be advised in order to lower cholesterol levels. This includes eating a low cholesterol diet and increasing exercise. For some women, medications may be prescribed in addition to lifestyle changes, based on other cardiac disease risk factors and level of LDL. Because the risk of heart disease is linked to the level of LDL cholesterol and other risk factors, the main goal of cholesterol treatment is to lower the levels of LDL cholesterol. This can be accomplished through diet, exercise, medications and some alternative therapies. Risk factors for cardiac disease in addition to elevated LDL cholesterol levels include: cigarette smoking, high blood pressure, diabetes, HDL levels less than 40 mg/dL, family history of heart disease (heart disease in father or brother before age 55; heart disease in mother or sister before age 65), age (women greater than 55 years and older). Interventions that a physician will employ based on LDL levels and risk factors include: lifestyle changes and drug treatment. Your LDL goal will be determined by your risk of developing heart disease.

In order to decrease LDL cholesterol through lifestyle changes it is recommended to: limit the amount of saturated fat, trans fat, and cholesterol that your eat, achieve a healthy weight, increase soluble fiber in the diet, and add cholesterol lowering foods, and participate in regular physical activity (30 minutes each day of the week). A diet high in fruits and vegetables, nuts, and seeds is recommended. Goals of a cholesterol lowering diet include: increase fiber (through consumption of fruits, vegetables, legumes and unrefined grains), increasing soy protein in the diet (tofu, soy milk, edamame and other soy products – if you have a history of breast cancer or are at elevated risk for breast cancer, review with your health care professional), and increase phytosterols (whole grains and vegetables).

Cholesterol lowering medications, in additional to change in diet and physical activity, may be prescribed for women who have cardiac risk factors in addition to elevated LDL cholesterol. There are five types of cholesterol lowering medications: statins, bile acid sequestrants, nicotinic acid, fibrates, and ezetimibe.  Statins are the first line drug choice for many women; they block the production of cholesterol in the liver itself. They lower LDL, the “bad” cholesterol, and triglycerides, and have a mild effect in raising HDL. Side effects can include intestinal problems, liver damage, and in a few people, muscle tenderness. Examples of commonly prescribed statins include: atorvastatin (Lipitor), fluvastatin (Lescol), lovasatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor), and simvastatin (Zocor).  Nicotinic acid, a B-complex vitamin, is found in food, but is also available at high doses by prescription. It lowers LDL cholesterol and raises HDL cholesterol. Bile acid resins bind bile from the lever, made largely from cholesterol, and prevent it from being resorted into the circulatory system and thus deplete the body’s store of cholesterol. Examples of bile acid resins include: Questran and Welchol. Fibrates reduce the production of triglycerides and can increase HDL cholesterol. Examples include: Lopid and Tricor. Ezetimibe lowers bad LDL cholesterol by decreasing its absorption from the intestine. It can be used alone such as Zetia, or combined with statins, such as Vytorin when statins alone do not control cholesterol levels.

There are a number of alternative remedies for lowering LDL cholesterol, however these agents may interact with other medications and have serious and significant side effects. Therefore, you should always review with your health care professional whether these agents are safe and right for you. Supplements that may help to lower cholesterol levels include: garlic (may prolong bleeding and blood clotting time), guggulipid (gum resin of the mukul myrrh tree), red yeast rice, policosanol (from sugar cane). Most of these require additional, well controlled clinical trials to establish their effectiveness. As with any alternative therapy or supplement, the contents of these agents are not regulated by the major safety body for pharmaceutical agents in the United States, the FDA.

Prevention

  • Check your cholesterol levels

Healthy adults are recommended to have their levels checked every five years. Total cholesterol, HDL, LDL and triglyceride levels should be checked as part of a lipoprotein profile.

  • Exercise

30 minutes of aerobic exercise on a dally basis is recommended

  • Eat a healthy diet

Guidelines from the National Cholesterol Education Program include:

  • Saturated fat should account for less than 7% of calories consumed
  • Less than 200 mg of cholesterol should be consumed daily
  • Up to 30% of calories should be from total fat, but most should be unsaturated fat
  • Consume soluble fiber and phytosterols
  • Read food labels

Posted: October 10th, 2010 | Author: | Filed under: general health, great health at every age, nutrition & diet, weight loss | Tags: | No Comments »

Leave a Reply