What to do About Your Cholesterol

Let's start with a summary of how much cholesterol (or triglycerides) is too much. How do your own results compare with these numbers? What has your doctor told you about your cholesterol levels?

HDL cholesterol (high density lipoproteins) protects against heart disease. This is commonly known as "good" cholesterol. Higher numbers are better. A level less than 40 mg/dL is low and is a major risk factor for developing heart disease. HDL levels of 60 mg/dL or higher help lower your risk for heart disease. Triglycerides can also raise heart disease risk. Levels that are borderline high (150 to 199 mg/dL) or high (200 mg/dL or higher) may need treatment in some people. LDL cholesterol or low-density lipoproteins actually increase your risk for heart disease.

Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood.

Perhaps you've been told your cholesterol is too high. Or maybe you'd just like to keep it at a healthy level, to lower your risk of heart disease as much as possible. Of course, you should always follow your doctor's orders. Think about what kind of lifestyle habits will help you with these goals.

Change your eating habits

You can do it! Part of the solution toward lowering your cholesterol and reducing your risk of heart disease is to eat less high-fat, high-cholesterol foods. Your doctor may recommend a specific diet for you.

Otherwise, this is how you can follow a heart-healthy diet:

• Choose foods low in saturated fat. Saturated fat boosts your cholesterol level more than anything else in your diet. You should look for ways to cut these foods out of your diet (or cut down on them). Foods from animals are highest in saturated fat. They include fatty cuts of meat, chicken or other poultry with skin, whole milk and whole-milk dairy products, lard, and some vegetable oils like coconut oil, palm kernel oil and palm oils. We know these foods sound delicious. But it's possible to get them out of your life, or at least reduce their presence.
• Don't use lard or oils high in saturated fat when cooking.
• Plan other meals besides those based on "meat and potatoes" when the meat is a large fatty cut.
• When you do eat meat, eat smaller portions. Remove the skin from chicken and other poultry before preparing or eating it.
• Stay away from popcorn made with coconut oil, and eat air-popped popcorn instead.
• Switch to nonfat milk and milk products, not whole milk. Foods that are low in fat, and therefore much better choices if you'd like to decrease your cholesterol, include fruit, vegetables and whole-grain foods. But remember, vegetables doused in a cream- or oil-based sauce or if the fruit is part of a fatty dessert don't help. Look for other ways to enhance taste.

• Choose foods low in total fat. This will help you avoid foods high in saturated fat and also will help you lose weight, if needed. If you are overweight, losing weight can be an important part of lowering your cholesterol. You can't (and shouldn't) always avoid eating fat, but when you do, try to substitute unsaturated fats for saturated fats. Unsaturated fats are usually liquid at room temperature, and come in two types: monounsaturated and polyunsaturated. Examples of foods high in monounsaturated fats are olive and canola oils. Foods high in polyunsaturated fats include safflower, sunflower, corn and soybean oils. When you must use fat to cook with, try olive oil or another one of these oils, not lard. Better yet, use substitutes for fat wherever you can. Many recipes have helpful tips help you do this.

• Choose foods high in starch and fiber. It may take some adjustment, but eventually these foods will help you forget you ever ate so much saturated fat, especially if these foods are prepared well. Fruits, vegetables and grain products like oats, barley, peas (without sauce) and beans are the foods on which you should be casting a culinary eye.

• Choose foods low in cholesterol. Foods high in cholesterol can increase your blood levels of cholesterol, though saturated fats will raise these levels even more. Cholesterol is in foods from animals. Plants and foods from plant sources don't have cholesterol, though they sometimes have saturated fat. What does that mean to you? Try to cut down on the animal foods you eat, while replacing them with healthy plant-based foods. But don't assume that all plant-based foods are best, since those with saturated fats can raise your cholesterol level. Be choosy.

Be more physically active

Yes, we've heard it before. Exercise to lose weight, right? Well, yes, but did you know that physical activity can have direct effects on your cholesterol levels? It can increase HDL cholesterol (the good kind) and lower triglycerides and LDL cholesterol (the bad kind). This is good for reducing your risk of heart disease. Besides this direct benefit, physical activity can help lower your blood pressure (if it's too high), reduce your stress and improve your overall fitness, including that of your heart and blood vessels.

Lose weight if you're overweight

Being overweight means that you probably have higher blood levels of cholesterol and triglycerides than you otherwise would, placing you at higher risk for heart disease. And if you have an "apple" shape (you carry more weight in your belly than in your hips and thighs), you're at higher risk than overweight people with a "pear" shape (more weight in the hips and thighs).

If you are overweight, losing even a little weight can help reduce LDL cholesterol and triglycerides and increase HDL cholesterol. You don't have to lose all the weight you've always wanted to take off to see these change, or to benefit from a reduced heart risk. Don't give up.

Cholesterol-lowering drugs

A study in the New England Journal of Medicine says heart disease deaths have declined steadily over the last 30 years. In fact, the report states that between 1990 and 1994, heart disease deaths decreased by 10 percent. From this study and others, it appears that this downward trend can be attributed to improvements in medical care after heart attack, a reduction in the number of repeat heart attacks, better prevention of heart disease, and the discovery of a relatively new class of drugs known as statins. These powerful medications have provided doctors with an arsenal of therapies to lower elevated blood cholesterol levels, often dramatically, when diet and exercise have failed. Examples include MevacorŽ (lovastatin), LescolŽ (fluvastatin), PravacholŽ (pravastatin), ZocorŽ (simvastatin), LipitorŽ (atorvastatin) and CrestorŽ (rosuvastatin).

While statins are the most commonly used, your doctor may prescribe other medicines to lower your cholesterol, such as ZetiaŽ (ezetimibe) or QuestranŽ (cholestyramine). These drugs may be taken with a statin or in a combined form.

Another group of medicines called fibrates work by lowering tryglycerides and raising HDL. Examples are fenofibrate (Tricor) and gemfibrozil (Lopid).

Niacin is a B vitamin that is sometimes used to control cholesterol. Brand names include NiaspanŽ and NiacorŽ. AdvicorŽ (niacin/lovastatin) combines a statin and niacin to help raise HDL and lower LDL.

Related Articles Children and Cholesterol What Is Cholesterol and How Does It Affect Me? What Do My Cholesterol Results Mean?

External Sources National Heart, Lung, and Blood Institute American Heart Association The Food and Drug Administration

This article was reviewed and updated June 2007.

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