11 Expert Insights Into High Cholesterol
Despite all the negative things you hear about cholesterol, there's one thing to remember: You need a certain amount of it to function. The fatty substance is produced by the body or acquired from certain foods, and it's used to make important hormones, absorb vitamin D, and aid with digestion. Things get hairy only when levels get too high, which can lead to cardiovascular diseases, including heart attack and stroke. If you’re in that camp, let our experts guide you on how best to keep your cholesterol in check.
Know the Difference Between LDLs and HDLs
LDL—low-density lipoprotein—is the “bad” cholesterol you’ve heard so much about, says Jeffery Berger, M.D., director of NYU Langone’s Center for the Prevention of Cardiovascular Disease in New York. Too much of it inside your blood vessels leads to a fatty buildup called plaque—and too much plaque increases your risk for heart attack or stroke. “Good” cholesterol, or HDL (high-density lipoprotein) helps transport LDLs to the liver to be removed as waste. The more HDLs you have, the better able your body is at removing the LDLs you don’t need.
LDL and HDL Levels Reveal Only Part of Your Risk
Ideally, your good HDL cholesterol should be 60 or higher for a woman, 50 or higher for a man says Dr. Berger. Your LDL cholesterol should be 100 mg/L or lower to decrease the risk of a cardiovascular event, and 70 mg/L or lower if you already have heart disease. Both are measured with a blood test. Still, when it comes to HDL, he says that “people used to think high amounts of HDL cholesterol meant that the risks associated with too much LDL cholesterol were lessened, but this is false.” That’s because other factors like family history play an important role, too.
Your Family History and Other Conditions Count, Too
”It’s not [just] your ratio of good to bad cholesterol that poses a threat, but rather how your body processes LDL—and this has to do with your lifestyle and genetic background,” says Srinivas Kesanakurthy, M.D., director of The Brooklyn Heart Center in New York. If you’re in otherwise good health and still test high for LDL, he doesn’t sound the alarm "as long as you don’t have other cardiovascular risks” like high blood pressure or a history of smoking. If you’re obese with a family history of hypertension, he’d encourage weight loss, exercise, and a healthier diet.
Triglycerides Are Also Part of the Picture
In addition to LDL and HDL, your doctor will measure your triglycerides in what’s known as a lipid panel. Triglycerides are a type of fat found in your blood, and they usually come from excess calories you’ve consumed from high-carb foods your body doesn’t immediately need to burn for energy. Tris can add to plaque buildup when levels inch up. The normal range is around 150 mg/dL. Borderline is 150 to 199 mg/dL. High is 200 to 499 mg/dL. Very high is 500 mg/dl or above.
What’s on Your Plate Affects Your LDL and HDL
We’ve all heard, “You are what you eat!” Dr. Kesanakurthy agrees, saying that if you have low HDL levels, you can help raise them by eating a high-fiber diet—and even drinking a little wine (but no more than a single glass for women and two for men each day). “Eat salad!” he advises, plus healthy whole grains, veggies, and lean poultry. Then, limit your intake of saturated and trans fats, which are found in red meat, whole milk, and fried foods. Consumed in moderation, unsaturated fats like those found in sunflower oil and salmon can actually help lower LDL.
Weight Loss Can Also Help Improve LDL Levels
You don’t have to become a gym rat, but studies sponsored by the American Heart Association have shown that just 150 minutes of moderate physical activity each week can promote heart healthiness by decreasing LDL. And Harvard Medical School encourages those who are trying to manage their cholesterol to consider counting calories, and to be aware of how much fat you're consuming per meal. Need some accountability? Check out this physician-approved app, MyFitnessPal to break down ingredients and log activity levels.
Vitamin B3 Help Can Bring an HDL Boost
Niacin, or vitamin B3, has also been shown to up your HDL levels. You can get this essential nutrient as an over-the-counter supplement at the pharmacy or in your favorite meals serving chicken, turkey, tuna, and leafy greens. One caveat? Niacin supplements do sometimes cause side effects, including constipation, facial flushing, and insomnia, so be sure to talk to your doctor before you start taking them.
Statin Medications Help Keep LDL in Check
Medications are sometimes prescribed for people whose LDL remains high even after implementing healthy lifestyle habits, says Dr. Kesanakurthy. Statins, including Crestor (rosuvastatin) and Lipitor (atorvastatin), are the most effective and common class of LDL-lowering drugs. They work by disabling the enzyme in the liver that makes cholesterol. Statins can also help your body to reabsorb cholesterol that has built up into plaque. Side effects of statins are rare, but may include muscle aches (known as myalgias), so talk to your doctor to see if they're right for you.
Non-Statins Are Another LDL-Lowering Option
You could be among the 3% to 4% percent of people with high LDL cholesterol who can’t tolerate a statin, Dr. Kesanakurthy says. If this is you, your doctor might prescribe a non-statin medication like Zetia (ezetimibe). This drug is an absorption inhibitor, which means it blocks the absorption of bad cholesterol in your small intestine. One 2018 study suggests that pairing a statin—if you can tolerate it—with Zetia can further reduce LDL production by a whopping 25%.
Other Medications Are Used to Treat High Cholesterol, Too
According to Harvard Medical School, bile-acid sequestrants, or resins, have fewer serious side effects than other cholesterol-lowering drugs, although they’ve remained less popular due to unpleasant side effects like bloating and constipation. PCSK9 inhibitors are a new class of drugs that, according to Dr. Berger, “have a dramatic ability to lower LDLs. They’re very potent.” PCSK9 is an enzyme that binds to LDL receptors and prevents LDL from being removed from the liver. A PCSK9 inhibitor, then, prevents such binding, allowing LDLs to be removed as waste.
Find the Approach That Works for You
Cholesterol levels affect different people differently—and how they affect you has a lot to do with your lifestyle and genetic background. Dr. Kesanakurthy says that unhealthy habits can be as meaningful as your LDL and HDL numbers. If you’re a lifelong smoker, for instance, or your family has a history of cardiovascular disease, it’s extra-important to track your cholesterol levels. Most important? Stay mindful of the fact that it may take a few tries with medications and/or lifestyle changes to figure out what’s best—and what works!—for you. Then stick with it. Your heart will thank you!
HDL and LDL Cholesterol: Harvard Health Publishing. (2019.) “The truth about fats: the good, the bad, and the in-between.” health.harvard.edu/staying-healthy/the-truth-about-fats-bad-and-good
Lowering Cholesterol Without Drugs: Harvard Health Publishing. (2018.) “How to lower your cholesterol without drugs.” health.harvard.edu/heart-health/how-to-lower-your-cholesterol-without-drugs
PCSK9 inhibitors: Mini-Reviews in Medicinal Chemistry. (2019.) “PCSK9 Inhibitors: Novel Therapeutic Strategies for Lowering LDLCholesterol.” ncbi.nlm.nih.gov/pubmed/29692249
Statins: Mayo Clinic. (2018.) “Statins: Are these cholesterol-lowering drugs right for you?” mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/statins/art-20045772