In the past two weeks, I have had several doctors' appointments. Just routine visits really, checking in with my primary care doctor, neurologist, and rheumatologist, getting new prescriptions, etc. Part of this process includes routine bloodwork. My neurology nurse practitioner was the first one to call me with the results of that bloodwork. Everything looked pretty good except that my vitamin D level remains low (argh) and my cholesterol levels are high.
So today, I thought we'd talk about cholesterol. What is it? How is it measured? Is all cholesterol bad? Why is too much cholesterol bad? What can you do to lower your cholesterol?
What is Cholesterol?
Cholesterol is a soft, waxy substance among the lipids (fats) found in the bloodstream and in all body cells. It is used to form cell membranes, produce hormones, and for other bodily functions. Fats, including cholesterol, cannot dissolve in blood and are transported by lipoproteins. Too much cholesterol in the blood (hypercholesterolemia ) is a major risk factor for coronary heart disease.
The correct way to have your cholesterol tested is by having a "fasting" blood draw. For 12 hours before you go to the doctor or lab, you must not eat. You should drink water to stay hydrated, but food can make the test inaccurate. In the United States, cholesterol levels are measured in milligrams per deciliter (mg/dL) of blood. In Canada and the UK, they are measured in millimoles per litre (mmol/L).
My blood results were:
- Total Cholesterol: 205 mg/dL
- HDL (good) Cholesterol: 44 mg/dL
- LDL (bad) Cholesterol: 143 mg/dL
- Triglycerides: 89 mg/dL
In 2006, the respective numbers were 214, 45, 147, and 112. So everything is just a bit lower, but my neurologist would like to see those numbers lower still.
High-Density Lipoprotein (HDL) or "Good" Cholesterol
Where "good" cholesterol is concerned, higher is better. HDL levels in the average man range 40-50 mg/dL (1.04-1.30 mmol/L) . In the average woman, they range 50-60 mg/dL (1.30-1.55 mmol/L) . A low HDL level, which is less than 40 mg/dL (1.04 mmol/L) for men or less than 50 mg/dL (1.30 mmol/L) for women, increases the risk of cardiovascular disease. Conversely, an HDL cholesterol of 60 mg/dL (1.55 mmol/L) or higher gives some protection against heart disease.
My HDL result at 44 mg/dL (1.14 mmol/L) is too low. Increasing physical activity and losing weight can both raise HDL cholesterol in the blood. Smoking, being overweight and a sedentary lifestyle can result in lower HDL cholesterol. Interestingly, progesterone, anabolic steroids and male sex hormones (testosterone) lower HDL cholesterol levels while female sex hormones raise HDL cholesterol levels.
Low-Density Lipoprotein (LDL) "Bad" Cholesterol
We want to get our "bad" cholesterol levels as low as possible. The lower the level, the lower the risk of heart attack and stroke. The American Heart Association states that LDL cholesterol is a better gauge of risk than total blood cholesterol. In general, less than 100 mg/dL is optimal (< 2.59 mmol/L) ; 100-129 mg/dL is "near optimal" (2.59-3.34 mmol/L) ; 130-159 mg/dL is borderline high (3.37-4.12 mmol/L) ; 160-189 mg/dL is high (4.15-4.90 mmol/L) ; and above 190 mg/dL is very high (> 4.92 mmol/L) .
My LDL result is 143 mg/dL (3.70 mmol/L) which is borderline high. Since I have a family history of heart disease, my LDL is truly too high. Just the fact that I have rheumatoid arthritis increases my risk for heart disease by 2-3 times . It is the other risk factors for heart disease and stroke that help determine what your LDL level should be, as well as the appropriate treatment option for you.
Triglycerides are a form of fat. People with high triglycerides often have high total serum cholesterol, including high "bad" cholesterol and low "good" cholesterol levels. In general, less than 150 mg/dL is "normal" (< 3.89 mmol/L) ; 150-199 mg/dL is borderline high (3.89-5.16 mmol/L) ; 200-499 mg/dL is high (5.18-12.93 mmol/L) ; and above 500 mg/dL is very high (> 12.95 mmol/L) .
My triglyceride result is 89 mg/dL (2.31 mmol/L) which is good. Several possible causes of high triglyceride levels include being overweight/obese, physical inactivity, cigarette smoking, excess alcohol consumption and/or a diet very high in carbohydrates (60 percent or more of calories). Although underlying diseases or genetic disorders can be the cause of high triglycerides, more often they are related to lifestyle.
Total Blood Cholesterol Level
When it comes to total cholesterol level, we want a level which is less than 200 mg/dL (< 5.18 mmol/L) . The American Heart Association says, "If your LDL, HDL and triglyceride levels are also at desirable levels and you have no other risk factors for heart disease, total blood cholesterol below 200 mg/dL puts you at relatively low risk of coronary heart disease."
A level of 200-239 mg/dL (5.18-6.19 mmol/L) presents a borderline-high risk for developing coronary heart disease. My total cholesterol result is 205 mg/dL which falls in this category. As described above, my LDL "bad" and HDL "good" cholesterol levels need improving. But it is possible to have borderline-high total cholesterol numbers with normal levels of LDL balanced by high HDL cholesterol.
A high risk level would be results of 240 mg/dL and over (> 6.22 mmol/L) . The American Heart Association says that "people who have a total cholesterol level of 240 mg/dL or more typically have twice the risk of coronary heart disease as people whose cholesterol level is desirable (less than 200 mg/dL)."
Work with your doctor to create a prevention and treatment plan that's right for you. Whether or not you need cholesterol-regulating medication to lower LDL "bad" cholesterol levels, it is smart to make lifestyle changes which include eating a heart-healthy diet, getting regular physical activity and avoiding tobacco smoke.
My nurse practitioner has recommended that I watch what I eat, less saturated fats and sweets. We had not discussed my recent weight loss during this appointment because I was there to do my "silly human tricks" as a neurology patient. I will continue to make lifestyle changes, not just for weight loss, but for heart health too now.
SOURCES: American Heart Association
Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (pdf) National Cholesterol Education Program (NCEP)
March 14, 2010
Weight: 258.2 lbs
Blood pressure: 124/76