Most Americans know that cholesterol in the body is one of the biggest contributors to heart disease and stroke. But according to new research from the American Heart Association, many still aren’t sure what they should be doing about their high cholesterol levels.
In the nationwide survey of more than 800 people, all of whom had a history of cardiovascular disease or at least one major risk factor for it, 47% said they had not had their cholesterol checked in the last year. And while close to 90% of people said they understood the importance of managing their cholesterol, almost half did not feel confident about their ability to do so.
“There was a major disconnect between perceptions about cholesterol and the significance of its health impact,” says Dr. Mary Ann Bauman, a member of the American Heart Association’s cholesterol advisory group. Bauman says that knowing just the basics about cholesterol can save lives and prevent health complications. Here’s what she and other experts want Americans to do to protect themselves.
The American Heart Association recommends that all adults have their cholesterol tested every four to six years starting at age 20. If you have abnormal levels, or if you have other risk factors for heart disease and stroke, your doctor will likely recommend more frequent monitoring.
Bauman says it’s no longer enough to only know your total cholesterol; it’s also important to know your breakdown of the two types of cholesterol, LDL (the “bad” type responsible for plaque buildup in the arteries) and HDL (the “good” type that helps clean out that plaque). “You can remember that by thinking you want your LDL to be as low as possible and your HDL as high as possible: L for low and H for high,” she says.
High cholesterol doesn’t cause symptoms early on, making it easy to ignore or go unchecked. “It’s not actually bothering people, so they don’t feel a sense of urgency about it,” says Bauman. “But they should, because over time it increases their plaque and makes them more prone to heart attack and stroke.”
Home testing kits are available for cholesterol levels, but none are recommended by the American Heart Association. It’s best to be tested in your doctor’s office, says Bauman, to ensure an accurate reading and get personalized advice for what to do with your results.
Know what your numbers mean—for you
High cholesterol can mean something different for every person. While the accepted threshold for “desirable” total cholesterol is 200 mg/dL, doctors are moving away from a one-size-fits-all approach to diagnosis and treatment.
“For somebody who has already had a heart attack or stroke, or has high blood pressure or is diabetic, we as physicians may want their cholesterol much lower than somebody who has no other risk factors,” says Dr. Susan Smyth, medical director of the Gill Heart Institute at the University of Kentucky.
Sometimes even a reading in the “normal” range can be problematic, she says. A recent study in the Journal of the American Heart Association found that most major heart attacks occur in people with normal LDL cholesterol.
Bauman encourages people to plug their total and HDL cholesterol numbers—along with their blood pressure and a few other pieces of information—into the American Heart Association’s and American College of Cardiology’s 10-year cardiovascular risk calculator. According to 2013 guidelines, doctors should use this calculation (and not cholesterol numbers alone) to determine whether patients should be prescribed cholesterol-lowering medication or lifestyle modifications.
Eat more heart-healthy foods
Whether you want to lower your cholesterol or just keep it in a healthy range, eating well can help. Research has shown that eating less red meat and processed foods—and more fruits, vegetables, whole grains and legumes—can have a positive impact on cholesterol levels, as well as other risk factors for heart disease and stroke.
Avoid trans fats as much as possible, since they raise LDL levels while lowering HDL, and eat plenty of unsaturated fats, like olive oil. A recent review highlighted the power of avocados to positively affect cholesterol profiles, and Bauman also recommends eating fatty fish, like salmon or tuna, at least twice a week.
“Paying attention to a healthy diet doesn’t mean you have to deprive yourself of the things you love that aren’t healthy,” says Bauman. “It just means you have to do the right thing most of the time, and occasionally have those things as treats instead of on a regular basis.”
Being physically active can help control weight gain and keep the heart and blood vessels healthy, all of which can help cholesterol levels stay where they should. For overall cardiovascular health, experts recommend at least 30 minutes of moderate-intensity aerobic activity at least five days a week.
That may not be enough to lower cholesterol levels that are already elevated, though. To do that, says Bauman, aim for 40 minutes of moderate- to vigorous-intensity aerobic exercise—like brisk walking, dancing, swimming or cycling—three to four times a week. (This level of activity can bring down high blood pressure, too.)
Avoid smoking, stress and too little sleep
Tobacco smoke, both first- and second-hand, lowers HDL cholesterol and raises the risk for atherosclerosis—the buildup of fatty plaque in the arteries that can lead to heart attack, heart failure and stroke. But the damage doesn’t have to be permanent. One year after quitting, a person’s risk of coronary heart disease is reduced by 50%, and five years after quitting, their risk of stroke is similar to a nonsmoker’s.
Don’t balk at prescription meds
Depending on your cholesterol levels and risk assessment score, your doctor may recommend a medication. Moderate-intensity statins are designed to lower LDL by 30% to 50%, for example, while high-intensity statins should lower it by 50% or more.
Smyth says a lot of her patients worry about side effects or argue that because their cholesterol is normal, they shouldn’t have to take a drug. “But other risk factors—some that you inherit and some due to lifestyle—are going to affect what is a safe number for you,” she says.
While statin side effects like muscle weakness and aches can occur, they can often be prevented or treated. Smyth adds that new cholesterol-lowering medications are also available for people who can’t tolerate statins. Doctors are still learning which people are best suited for these new drugs, she says, “but it’s exciting to have options now that were not available a year ago.”
Don’t wait until your doctor tells you that you have elevated cholesterol, or until you suffer a stroke or heart attack, to take these steps, says Bauman. “We need young people to start paying attention now,” she says. “We are seeing risk factors popping up in younger and younger children.”
That’s why everyone should know their cholesterol numbers starting at age 20, she adds, and why behaviors like diet, exercise and smoking matter long before middle age. “People think they don’t need to worry if they’re young and have no family history,” says Bauman. “But you can overcome your good genes if you make the wrong decisions, and the consequences can happen sooner than you think.”
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