Check Your Cholesterol

Diet, exercise and medication keep it low

SUNDAY, Sept. 8, 2002 (HealthDayNews) -- If the risk of heart disease isn't enough to convince you to check your cholesterol levels, here's another incentive:

September is Cholesterol Awareness Month, so now's the time to learn your cholesterol count.

Approximately 100 million Americans, roughly one-third of the population, have a combined cholesterol count over 200, which is considered a borderline-high risk marker for heart disease, according to the American Heart Association. In that group, 41 million people are at high risk for heart disease because their cholesterol is over 240.

"High cholesterol is a major risk for atherosclerosis and stroke," says Dr. Roger Blumenthal, a cardiologist at Johns Hopkins School of Medicine. "But you can significantly reduce cholesterol by a combination of improving your lifestyle and appropriate use of medication."

Cholesterol is not always a bad thing. A waxy substance produced by the liver, it insulates the nerves, makes cell membranes and produces certain hormones. However, the body produces enough for its own needs. If, through a combination of poor diet or a genetic predisposition, you produce more cholesterol than needed, the excess stays in the blood, forming plaque that lines the arteries. Eventually, the arteries harden and put you at risk for heart disease.

So, you should first find out what your cholesterol levels are through a blood test at a doctor's office. There are two types: LDL cholesterol and HDL cholesterol.

LDL is often called the "bad" cholesterol because it stays in the blood, forming the plaque that lines the arteries. Eventually it hardens the artery walls, making them thicker and less flexible so that blood flow to the heart is restricted, which can cause heart attacks.

"Optimally, your LDL level should be less than 100 milligrams per deciliter of blood," Blumenthal says.

HDL is known as the "good" cholesterol because high levels are associated with less heart attack risk, and Blumenthal says a count above 40 milligrams per deciliter is considered healthy.

Together, the two counts should be under 200, Blumenthal says, which is considered "normal."

Also important is your level of triglycerides, which are fats present in the blood that are associated with the risk of heart disease. Blumenthal says they should not be higher than a count of 150 milligrams per deciliter of blood.

If your cholesterol counts are over 200 and/or your triglyceride count is over 150, the first thing to look at is changing your lifestyle.

"We look at food and physical activity," says Connie Diekman, a nutritionist and spokeswoman for the American Dietetic Association who works with people at risk for heart disease.

"We take a food history to get a snapshot of the whole diet, and then give a person feedback on basic nutrition and how to relate it to their goals of reducing their heart attack risk. Sometimes simple diet changes will naturally pull the cholesterol in line," Diekman says.

The most common problem with people's diets is that they are not eating enough servings of fruits and vegetables, which should be at least five a day.

Ironically, many people try to avoid fat in their foods, and wind up omitting healthier fats from their diets.

"Olive oil, canola oil, fatty fish and peanuts, for instance, are good fats that reduce cholesterol," Diekman says.

Diekman says improving your diet isn't easy: "We're very much creatures of habit and it takes some work." However, if you motivate people in the right way, it can be done, she adds.

"Fear, for instance, only works for about six months as a motivator," she says. "It's better to look at changing a diet as an opportunity to enjoy new things."

Diekman recommends working within your own dietary routines to find places to add good foods, rather than focusing on taking away foods. Adding fruit to your morning cereal, cooking vegetables along with the chicken you roast, sticking sliced tomatoes or red pepper strips into your sandwich are all ways to add nutrition without much strain.

"Also, you can shift the fat in your diet where you want it," she says. "If someone has a treat they really don't want to give up, I say, 'That's fine. We can work that in, but we have to shift something else to make room for it.' "

Exercise is equally important in reducing cholesterol, and Diekman recommends her clients try for 30 to 40 minutes of aerobic exercise most days of the week -- "walking, jogging, biking, dancing, whatever they like to do."

Diekman says it takes about six to eight weeks to see any decline in cholesterol after making changes. Even then, the most you can expect from improvements in your diet and increased exercise is a 5 percent to 10 percent drop in cholesterol.

If your cholesterol is still too high after lifestyle changes, then it's time to look at medications, Blumenthal says.

"Diet and exercise are the cornerstones of cholesterol management, but medication can be helpful," he says.

For people with high cholesterol who have never had a heart attack, doctors can decide whether drugs are appropriate using a score that assesses heart attack risk. Factoring in a person's age, total cholesterol count, HDL level, smoking history and blood pressure, doctors can predict the risk level for a heart attack within a decade. If the risk is more than 20 percent, they can prescribe a cholesterol-lowering medication.

A group of drugs called statins, which decrease the production of cholesterol in the liver, are the most common treatment for high cholesterol, Blumenthal says. They reduce the risk of subsequent heart attacks in people who have already had one, and are equally helpful for people who have never had a heart attack but who are at risk for one, he adds.

What To Do

An explanation of what cholesterol is and what it does can be found at the American Heart Association, which also offers a cholesterol test so you can see how much you know about cholesterol.

SOURCES: Connie Diekman, M.Ed., R.D., L.D., FADA, director, university nutrition, Washington University, St. Louis; Roger Blumenthal, M.D., associate director, medicine, Johns Hopkins School of Medicine, Baltimore
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