Do You Have High Cholesterol?
You Need To Know Your Options

If you have high cholesterol there are certain things that your doctor can do. But believe it or not, there is even more that you can do. For many of us the key to lowering cholesterol is in our hands.

This page can be summed up under three very general headings. They are…

• a basic understanding of what cholesterol is
• how we calculate the risk of high cholesterol
• what can be done to lower cholesterol

We will proceed generally along the lines of these three points. As we look at details related to each area there will be links provided so you can see even more details on the points that interest you most.

Let’s begin by looking at the basics. It is helpful to know that…

There Are Really Three Types of Cholesterol

From best to worst these three types are…

• HDL
• VLDL
• LDL

The three types mentioned above are actually different types of lipoproteins that are responsible for transporting cholesterol through our bodies.

The reason LDL is considered bad is because it is responsible for transporting cholesterol through the blood. Unfortunately it tends to leave deposits along the way. High levels of LDL usually result in more deposits along the inside walls of our arteries. This is especially true when LDL undergoes oxidation. That is why it is important to keep LDL levels down. It is also important to have a sufficient supply of antioxidants in your system.

HDL, on the other hand, transports cholesterol out of our systems to the liver where it can be disposed of. That is one reason it is necessary to keep HDL levels sufficiently high. When your HDL levels are low cholesterol builds up in your system.

If you would like to read more detail on the three types of cholesterol please click here

Cholesterol Maintenance and Fat

One of the primary components of any diet is fat. That’s normal. In fact it is necessary. Fat is our main energy source. In addition to this, fat is also an important component used in the production of several hormone-like compounds called prostaglandins. Prostaglandins help regulate…

• blood pressure
• heart rate
• blood vessel constriction
• blood clotting
• the nervous system

Fat also carries certain fat-soluble vitamins such as…

• vitamin-A
• vitamin-D
• vitamin-E
• vitamin-K

… just to name a few.

Fat also helps maintain healthy hair and skin, protects vital organs and keeps your body insulated.

But, as you may have guessed, not all fats are the same. Some fats, such as saturated fats, can significantly raise blood cholesterol levels.

Other fats, such as trans-fatty acids, are actually worse than saturated fats and should be avoided at all costs. The sad thing about trans-fats is they are manufactured by us and pumped into a vast number of our foods.

You are probably aware that polyunsaturated fats and monounsaturated fats can have a positive influence on total cholesterol. Some polyunsaturated fats are called 'essential fatty acids' because they are necessary for health and cannot be made by our bodies. Some of these should be eaten in abundance.

We will not go into detail on cholesterol and diet just yet. You can however read more about the different types of fat by clicking here.

So much for generalities. The question you may have in mind is, "What is a normal cholesterol level?" Actually that is a good question. There are, of course, certain basic parameters. It is best if we keep our LDL levels below 100 mg/dL and our HDL above 40 mg/dL.

By the way if your HDL is low (below 40 mg/dL for men and below 50 mg/dL for women) you should make some lifestyle adjustments to raise your HDL.

However when it comes to risk assessment the parameters are not that simple. Let’s say your LDL cholesterol is 130 mg/dL. Should your doctor prescribe cholesterol lowering drugs? To answer that question lets look at…

Cholesterol Management and Risk Assessment

Current cholesterol management is much more involved than simply looking at a chart and prescribing drugs when your cholesterol rises above a certain level. To begin with, the main focus of cholesterol treatment focuses on LDL cholesterol. That is because LDL cholesterol levels are closely related to the development of coronary heart disease (CHD).





Generally speaking when our LDL cholesterol gets too high we have an increased risk of suffering from a CHD related heart event.

But our risk is determined by more than just our LDL levels. Let’s look at an example.

Let’s suppose you are 25 years of age with no risk factors related to coronary heart disease. The only exception is that your LDL is above 130 mg/dL. Would your doctor prescribe LDL lowering drugs? Probably not. You have a very low risk of developing coronary heart disease in the next decade.

On the other hand, let’s suppose I am over 50 and I have diabetes. Diabetes is a risk factor which is equivalent to the risk of having documented coronary heart disease. Age is also a risk factor. I also have LDL cholesterol slightly above 130 mg/dL. Would my doctor prescribe medication? Most likely he would.

The fact that I have diabetes and am not quite so young puts me at a higher level of risk for suffering from CHD in the next ten years. Elevated LDL raises that risk substantially. Lowering my LDL would lower the risk.

Click here if you would like more information on risk assessment.

This is a general example. Let’s get a little more detailed.

The Framingham Study

We owe most of our current knowledge about cholesterol management to the Framingham Heart Study. This landmark study began in 1948 under the guidance of The National Heart Institute - now the National Heart, Lung, and Blood Institute.

The study continues today including the children and the grandchildren of the original participants. Each participant in the study is given an extensive medical exam every two to four years. The data collected over more than half a century has literally pulled us out of the dark ages concerning our knowledge of heart care.

Among the achievements gained from the Framingham Heart Study is a score card that helps doctors predict the likelihood of a patient developing CHD or experiencing a CHD related heart event.

You can read more about the Framingham Heart Study by clicking here.

What does the Framingham score card help us resolve? It helps us determine…

Risk Factors and LDL Goals

Certain risk factors increase our likelihood of developing heart disease. Some of the more prominent risk factors are…

• cigarette smoking
• high blood pressure (at least 140/90 mmHg or taking an antihypertensive medication)
• low HDL cholesterol (less than 40 mg/dL)
• age (men: at least 45 yrs.; women: at least 55 yrs.)
• family history of early CHD development
• diabetes

By determining how many of these risk factors (among others) you have your doctor - using the Framingham heart scores - can categorize you into one of three main risk categories.

Each risk category carries with it a certain percentage of 10-year risk. For example, if you were in the highest risk category you would have more than a 20% chance of having a CHD related heart event within the next ten years.

What does this mean? It means your doctor would be very aggressive about lowering your LDL levels to reduce that 10-year risk.

Click here for more detail on risk factors and LDL goals

Metabolic Syndrome

In addition to cellular insulin resistance, the characteristics of Metabolic Syndrome might include…

• Abdominal Obesity – For men this is defined as a waist circumference of at least 40 inches. For women the minimum measurement is 35 inches.
  
• Low HDL (good cholesterol) – For men anything less than 40 mg/dL. For women the minimum healthy HDL level is 50 mg/dL.
  
• High Triglycerides – 150 mg/dL or greater.
  
• High Fasting Glucose (blood sugar) – at least 100 mg/dL or greater.
  
• Hypertension – Blood pressure equal to 130/85 mm Hg or higher.

The combination of risk factors attributed to Metabolic Syndrome puts one at greater risk for coronary heart disease. This greater risk will also be considered by your doctor when making therapy recommendations.

For more information on Metabolic Syndrome please click here.

LDL-Lowering Therapy in 3 Risk Categories

Overall cholesterol management may include several areas of concern such as…

• lowering LDL
• lowering triglycerides
• raising HDL
• lowering total cholesterol

However, as already mentioned, the primary focus of cholesterol management is usually reducing LDL. Again, that is because LDL levels and oxidation are so closely connected to the development of coronary heart disease.





But before treatment can be recommended our level of risk must be ascertained. As you now know the Framingham point scores are a useful tool in determining that risk. Risk is divided among three categories.

The highest risk category includes anyone with documented coronary heart disease or other equivalent factors. This category carries a greater than 20% risk of having a CHD related heart event within the next 10 years. If you are classified in this group your LDL goal is below 100 mg/dL. Your doctor will be very aggressive about reducing your LDL and will not hesitate to prescribe drug therapy to meet that goal.

The medium risk category includes people that do not have coronary heart disease but have at least two other CHD related risks. The 10-year risk in this group is less than 20%.

If you find yourself categorized here your LDL goal will be under 130 mg/dL. Is 100 mg/dL better? Sure it is. But for treatment purposes the LDL goal is set higher because long term risk is not as great as in the top group.

Will your doctor prescribe drugs? If your risk is under 10% then drug therapy is not considered essential. Lifestyle modification therapy will gain the focus. If your risk is between 10% and 20% then drug therapy is an option. However lifestyle modification therapy will be primary.

The lowest risk group is for folks who have no more than one risk factor for CHD according to the Framingham point scores. Their risk for developing coronary heart disease (or related diseases) in the next ten years is less than 10%.

Drug therapy is usually not an issue in this category since long term risk is so low. However lifestyle modification therapy will still be applied to keep the risk low.

If you would like to read more about LDL goals and the three risk categories you can click here.

As you noticed there are two approaches to cholesterol management. One is drug therapy and the other involves lifestyle modification.

If you watch commercials on television you will get the impression that drug therapy is number one. However, that is not the case.

Drug therapy has a very important place in cholesterol management. But it is much better to reduce cholesterol risk naturally.




Lowering cholesterol naturally is always a part of cholesterol management. Drug therapy should be considered its minor partner. We should always attempt to reduce cholesterol by lifestyle modification therapy. Sometimes we will need drug therapy to help.

Having said that, let’s hold off on discussing lifestyle modification therapy for a moment. Let’s look instead at…

Cholesterol Management through Drug Therapy

• lower your LDL cholesterol by 18-55%
• raise HDL cholesterol 5-15%
• lower triglycerides 7-30%

• reduce major coronary events
• reduce deaths due to CHD
• reduce total mortality
• limit the number of procedures related to heart disease and stroke

But there are some negative concerns you should be aware of. You can read about these by using the link that follows this section.

There are other treatments that have been shown effective in lowering cholesterol. A few of these are…

• bile acid sequestrants
• nicotinic acid
• fibric acids

The second in the above list, nicotinic acid is actually not a drug. It is a derivative of vitamin-B. However it should be taken with caution and under supervision.

You can get more detail on drug therapy and the potential side-effects by clicking here.

Whether or not your doctor prescribes drug therapy for your cholesterol management it will always be important to apply therapeutic lifestyle changes.

Lowering Cholesterol Naturally With Therapeutic Lifestyle Changes

Let’s look at some general comments here and you can link into a detail page for more information.

The obvious ones are…

• stop smoking
  
• conrol your diabetes
  
• watch your weight
  
• maintain a healthy diet
  

The first three are beyond the scope of this website. But you know what they mean. The latter two are normally related. Therefore we will look at a little detail on diet here.

Your diet should be high in fiber from fruits and vegetables. Forget the imitation fruit drinks. Both fruits and vegetables are deplorably neglected in the average diet.

I do not advise low carbohydrate diets. It is true they can help you lose weight in the short run. But carbohydrates are necessary for energy.

Select your carbohydrates from the complex varieties like…

• whole grain breads
  
• potatoes
  
• whole grain rice
  

You get the picture. Stay away from simple carbohydrates like sugar and white varieties of bread, rice and cereal. Simple carbohydrates are not only high in empty calories they can contribute to a rise in triglycerides as well.

Heart Health Note: Don't take high Triglycerides lightly. Omega-3 really can help lower your triglycerides. Taking Omega-3 is an easy way to safeguard your heart. That is one reason the American Heart Association recommends 2 to 4 grams of Omega-3 for anyone with high triglycerides. Learn more about Omega-3 and Triglycerides. Here is a great Omega-3 supplement at a very good price.

Also, you’ve got to have fat. That’s good news isn’t it?

However, limit your consumption of saturated fats. Not only do they negatively affect cholesterol levels but they contribute to atherosclerosis (hardening of the arteries).

And of course limiting foods high in cholesterol is also helpul.

By all means avoid trans-fats. If you want to know if your food has trans-fats in it look on the label for the word 'hydrogenated'. The hydrogenation process converts natural polyunsaturated fats into trans-fats so the product can be more solid at room temperature and have a longer shelf-life.

However, many have suggested that trans-fats have contributed to the heart disease epidemic of the 1990s.

Unfortunately trans-fats are everywhere. A safe way to avoid them is by purchasing many of your food items from health food stores.

Polyunsaturated fats and monounsaturated fats are, for the most part, the guys in the white hats.

There is a certain group of polyunsaturated fats that deserve special attention. These are called essential fatty acids. They are necessary to health and must be consumed in the diet.

Perhaps chief among these is the omega-3 group. Omega-3 is found in three forms…

• ALA
• EPA
• DHA

ALA is derived from plant sources such as flax seeds and broccoli. EPA and DHA are, however, more potent in relation to heart health and cholesterol maintenance. The latter two can be found in cold-water oily fish such as salmon and mackerel.

Click here for a great Flaxseed (ALA) supplement.

Here is a great EPA-DHA Omega-3 supplement at a very good price.

Read more about a Low Cholesterol Diet.

To read more about cholesterol reducing foods please click here.

To learn about good cholesterol foods and raising HDL please click here.

Dietary Supplements are a Must for Optimal Heart Health

• Balance cholesterol levels
• Lower triglycerides
• Reduce stickiness of blood platelets
• Reduce buildup of atherosclerosis
• Regulate heartbeat thereby reducing risk of sudden cardiac death

.. and much more. However, to get enough omega-3 we must eat the right kinds of fish several times per week. Some people eat salmon everyday. The big concern there is not everyone loves fish enough to eat it everyday. The other concern is metal poisoning from high fish consumption.

That is why so many people take fish oil supplements.

There are several supplements that can help with cholesterol maintenance and therefore reduce the risk of coronary heart disease. We won’t discuss the particulars here. But you can follow the links below to get more information.

Omega-3 and Cholesterol Maintenance

How CoQ10 Helps Reduce Cholesterol Risk

Natural cholesterol care supplement.


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For more information on cholesterol maintenance through therapeutic lifestyle changes please click here.

For more information on ways to lower your cholesterol, click here.