You have the power to improve your cholesterol levels.
The not-so-good news: You have high cholesterol.
The great news: You have the power to lower your cholesterol—and in turn reduce your risk of heart disease and stroke.
High cholesterol occurs when there is too much “bad” fat in the blood. It can be treated with medication, but not everybody with elevated cholesterol needs drugs to lower cholesterol, especially at first, says Michelle Weisfelner Bloom, MD, a cardiologist at Stony Brook University Medical Center. “Depending on the level and depending on your risk factors, sometimes we can have a patient change their lifestyle.”
How to Pick the Right Cholesterol Treatment
“Medicine is recommended to treat high cholesterol based on an individual’s particular set of circumstances,” says Paul Knoepflmacher, MD, a clinical instructor in medicine at Mount Sinai Hospital in New York City. To determine whether or not you need medication, your healthcare provider will look at such risk factors as your family history, your blood pressure levels, whether you have diabetes or heart disease, or whether or not you smoke.
If your doctor does recommend that you take medication, he or she will likely prescribe statins, a class of drugs that block cholesterol formation in the liver. Statins are the most powerful and well-studied medication available to help lower “bad” LDL cholesterol levels, as well as your risk of heart disease, heart attack, and stroke. Other cholesterol medications that are less commonly prescribed include fibrates, niacin, and ezetimibe. There’s also a newer class of medicines called PCSK9 inhibitors, which work by a different way than statins; they're used by injection. Some doctors are starting now to use them, particularly in patients that can't tolerate statin therapy.
Other LDL-lowering medications include selective absorption control inhibitors, which prevent cholesterol from being absorbed by the intestine, and resins, which help get rid of cholesterol in the intestine. Lipid-lowering therapies, like fibrates, are another option. Unlike the others, however, these are more effective at lowering triglycerides and increasing your levels of “good” HDL cholesterol.
Whether or not you take cholesterol-lowering medication, leading a heart-healthy life is key for healthier cholesterol numbers. Here are five lifestyle tweaks to help you improve your cholesterol levels on your own.
1. Eat less saturated and trans fats. “Saturated fat does increase LDL cholesterol,” says Frances Largeman-Roth, RDN, a nutritionist and cookbook author in New York City. High-fat dairy, fatty cuts of meat, and coconut oil are all sources of saturated fat. Trans fats are usually found in fried food and pastries, like french fries, pizza dough, and cookies—don’t eat these foods often. Switch your dairy to fat-free or low-fat varieties, and stick to lean meats, like turkey or chicken.
2. Pump up the fiber. “Adding more fiber to the diet can actually decrease cholesterol by 10 percent,” says Largeman-Roth. According to a Harvard study, a fiber-rich diet may also lower your risk of coronary heart disease by 40 percent. Beta-glucan, which a soluble fiber found in oats and barley, is specifically beneficial for lowering cholesterol, says Largeman-Roth. Lentils, whole wheat grains and breads, carrots, and apples are also great sources of fiber.
3. Get moving. A sedentary lifestyle lowers levels of HDL cholesterol, which means there’s less “good” cholesterol to remove LDL (bad) cholesterol from arteries. To improve your HDL cholesterol levels, the American Heart Association recommends 40 minutes of moderate to vigorous aerobic exercise, three to four times a week, like brisk walking, swimming or dancing. If that’s quite a jump from your current activity level, start with just 10 minutes a day and work your way up.
4. Quit smoking. Smoking or exposure to secondhand smoke lowers “good” HDL cholesterol levels and increases the risk of coronary heart disease (more than someone who doesn’t smoke). Ask your doctor about ways to quit.
5. Lose (at least) 10 percent of your body weight. Being overweight increases “bad” LDL cholesterol and lowers “good” HDL. Losing just 10 percent of your weight—losing 20 pounds if you weigh 200, for example—can make significantly improve cholesterol, or even reverse it.
“Managing your cholesterol is a long-term investment in your health,” says Dr. Knoepflmacher. “You may not feel any different in the short term, but you’re giving yourself a better shot at a happy healthy heart, healthy blood vessels, and a longer life.”
Dr. Bloom is an associate professor of medicine at Stony Brook University Medical Center, a fellow of the American College of Cardiology, and a fellow of the Heart Failure Society of America.Paul Knoepflmacher
Dr. Knoepflmacher is a clinical instructor of medicine at The Mount Sinai Hospital in New York City, where he also maintains a private practice.Frances Largeman-Roth
Frances Largeman-Roth is a nutritionist and cookbook author in New York City.
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So high cholesterol has no symptoms.
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The only way you would know that your
cholesterol is high is if your doctor
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tested your blood.
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High blood cholesterol, or
hyperlipidemia is diagnosed based on
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a simple blood test called a cholesterol
profile, or lipid panel, or lipid profile.
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And this is done in your
doctor's office very routinely.
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There are several different
measurements that are important there.
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The first is the total cholesterol.
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For the average risk person, the total
cholesterol should be less than 200.
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The LDL cholesterol, or so-called bad
cholesterol, should be less than 130 for
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an average risk person.
00:00:41,820 --> 00:00:47,270
If a person has diabetes, then it should
be less than 100, and possibly much lower.
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The HDL cholesterol is the,
quote, good cholesterol.
00:00:50,140 --> 00:00:53,760
So we want that as high as possible,
and it should be 60 or greater.
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And when we talk about the final
measurement, these are triglycerides.
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And in a fasting specimen,
we like those to be less than 150.
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The risk factors for
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high cholesterol are diabetes,
high blood pressure, being overweight or
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obese, smoking or having a family
history of early cardiac disease.
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Not everybody that has elevated
cholesterol levels necessarily needs to be
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on a medication.
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Depending on the level and depending
on your risk factor, sometimes we can
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have a patient change their lifestyle.
We want to be eating less saturated fat
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overall, because saturated fat
does increase LDL cholesterol.
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And we want to be adding
more fiber to the diet.
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Adding more fiber to the diet can
actually decrease cholesterol by 10%.
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And specifically beta-glucan which
is the type of soluble fiber
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that’s in oats, as well as barley.
You wanna put more of a focus on those
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healthier fats which are unsaturated fats,
incorporating more avocado, nuts, and
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seeds, olive oil, and canola oil.
Medicine is recommended to treat high
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cholesterol based on an individual's
particular set of circumstances.
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So if a person just has high cholesterol,
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and they don't have any other risk
factors, they don't have a family history,
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they don't have high blood pressure,
they don't smoke,
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they don't have diabetes, then cholesterol
may not need to be treated with medicine.
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But if a person is a diabetic which is
a huge risk factor for heart disease or
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certainly if they've already had
a heart disease like a heart attack,
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then we're much more aggressive in
lowering their cholesterol with medicines.
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Probably the most important
class of medicines for
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treating cholesterol are a class
of drugs called statins.
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These drugs block an enzyme in the liver
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in the formation of cholesterol.
Trial after trial has shown us that
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when we use statins appropriately in
patients that we feel would benefit from
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them, they have a decreased risk of
developing heart attack, they have
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decreased risk of developing stroke,
and there's a decreased risk of death.
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In certain but generally rare situations,
there are other medications that we use
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for cholesterol-lowering such as fibrates,
niacin, or ezetimibe.
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Now there's a new class of
medicines called PCSK9 inhibitors,
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which work by a different way than
statins and they're used by injection.
00:03:09,750 --> 00:03:14,490
And some doctors are starting now to use
them particularly in patients that can't
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tolerate statin therapy.
Managing your cholesterol is
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a long-term investment in your health.
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You may not feel any different in the
short-term from lowering your cholesterol
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from 230 to 190, but you're giving
yourself a better shot at a happy,
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healthy heart, healthy blood vessels,
and a longer life.
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Lowering Your Cholesterol With TLC. Bethesda, MD: National Heart, Lung, and Blood Institute, 2005. (Accessed on May 2, 2021 at https://www.nhlbi.nih.gov/files/docs/public/heart/chol_tlc.pdf)
The Skinny on Fats. New York, NY: American Heart Association. (Accessed on May 2, 2021 at http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/The-Skinny-on-Fats_UCM_305628_Article.jsp#.WjAP8VQ-eL4)
Rimm EB, Ascherio A, Giovannucci E, Spiegelman D, Stampfer MJ, Willett WC. Vegetable, fruit, and cereal fiber intake and risk of coronary heart disease among men. JAMA. 1996 Feb 14;275(6):447-51.
Prevention and Treatment of High Cholesterol (Hyperlipidemia). New York, NY: American Heart Association. (Accessed on May 2, 2021 at http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Prevention-and-Treatment-of-High-Cholesterol-Hyperlipidemia_UCM_001215_Article.jsp#.WjALGVQ-eL4)Cholesterol Medications. New York, NY: American Heart Association. (Accessed on May 2, 2021 at http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Cholesterol-Medications_UCM_305632_Article.jsp#.WjE6JVQ-c5g)