HealthONE - January 10, 2023

You’ve probably heard cereal company General Mills advertise that its product, Cheerios, can help lower cholesterol. You may have also heard that oatmeal is great for that too. And you definitely know that high cholesterol is bad. But what is cholesterol and why is it so important? We turned to cardiologist Eric Hemminger, MD, of Denver Heart at Swedish Medical Center to help answer this question and give provide guidance on staying healthy by keeping cholesterol in check.

“Cholesterol is not inherently bad,” Dr. Hemminger explains. “This waxy substance is necessary to build healthy cells in your body. Cholesterol is made in the liver and usually your liver makes all you need. When you make too much ‘bad’ cholesterol, which we call LDL cholesterol, you are at a significantly increased risk of a heart attack or stroke.”

Diets high in animal products such as cheese, fatty meats and dairy desserts are generally also high in saturated fats. Saturated fats stimulate your liver to make more cholesterol- sometimes rising to unhealthy levels over time. Tropical oils such as palm and coconut oils also contain high saturated fat levels and can lead to high cholesterol. When there is too much LDL cholesterol (low-density lipoprotein), and not enough HDL cholesterol (high-density lipoprotein), fatty deposits can build up in the blood vessels. These deposits can narrow or clog the arteries, which can lead to a heart attack (reduced or blocked blood flow to the heart) or a stroke (reduced or blocked blood flow to the brain). The ratio of total cholesterol to HDL can be predictive of heart attacks and strokes- the lower the ratio, the better for patients.

“The total cholesterol to HDL ratio can be thought of as the ratio of bad cholesterol divided by the good. Lower ratios are associated with less heart disease. Life insurance companies know this and often use the ratio to rate patients because it predicts their heart attack risk.”

“Nearly two in every five adults has high cholesterol, which is measured as more than 200 mg/dL,” Dr. Hemminger notes. “This puts people at a significant health risk. And because there are no symptoms of high cholesterol, it is vitally important to keep an eye on your numbers.

Know your levels

The first step to controlling your cholesterol is to know your levels. This should be done on an ongoing basis throughout your life. Dr. Hemminger details that experts recommend the first cholesterol screening is taken between ages 9 and 11 and then every five years after that. Between ages 45-65 men should have their levels checked every one to two years and women ages 55-65 should do the same. After age 65, levels should be checked annually, or more often depending on your doctor’s recommendation. “Just knowing your numbers is a great first step in managing this health risk,” Dr. Hemminger encourages. “This way, you and your doctor can discuss a plan to keep it where it is or how to lower it.”

“Some patients have a genetic disorder which causes their cholesterol to be high. The earlier we know about this, the sooner we can intervene.”

Change your habits

While high cholesterol is a significant threat to your health, there are many lifestyle changes that you can take to keep your numbers in a healthy range. Dr. Hemminger recommends:

  1. Choose foods that are low in saturated fat, salt and sugar. Examples include lean meats, seafood, low-fat or fat-free dairy (milk, cheese, yogurt), whole grains, fruits and vegetables.
  2. Fill up on soluble fiber, which helps the body from absorbing bad cholesterol. Examples include oatmeal, apples, bananas, beans.
  3. Limit red and processed meats and sodium and sugar-sweetened foods and beverages.
  4. Maintain a healthy weight. The previous recommendations can help with that, but exercise is also excellent to help reach and maintain a healthy weight, and it strengthens your heart as well. Try to get in 20-30 minutes daily. This can be achieved by walking the dog, swimming, biking or playing racquet sports.
  5. Avoid trans fats. These artificial fats raise bad cholesterol (LDL) levels. Food labels are allowed to say “0 Trans fat,” if the portion size is very small. You can check for hidden trans fats by reading the ingredients. Trans fats will appear as “partially hydrogenated oils.”
  6. Avoid tobacco and limit alcohol consumption. If you need help to quit smoking, visit the Colorado QuitLine online. If you need help with alcohol use, check out the Behavioral Health Treatment Services Locator.

“Sometimes lifestyle modifications aren’t enough to make a difference in your cholesterol levels,” Dr. Hemminger cautions. “Your doctor can recommend medications that can help.”

Manage high blood pressure

There are several types of medications that can be prescribed to help lower your LDL cholesterol. Statins lower LDL by slowing down the liver’s production of cholesterol and increasing the liver’s ability to remove LDL already present in the blood. Bile acid sequestrants remove bile acid in the blood. Your body then breaks down LDL cholesterol to replenish the lost bile acid, lowering your ‘bad’ cholesterol levels. Lastly, injectable medications may be considered for those who have genetic conditions affecting cholesterol. “Each of these medications comes with risk factors, so it is important to discuss those with your doctor and be sure to find one that is right for your particular needs,” Dr. Hemminger cautions. “In partnership with their healthcare teams, many people use medications and lifestyle changes to make significant changes to their cholesterol levels and overall health.”

Learn more about heart care or find a doctor near you.