If you've said that you're like many other Americans who share a concern about the risk of coronary heart disease. But if you've never quite gotten around to doing something about it, keep reading. You'll find answer to some of the most common questions that people have about cholesterol, and what you can do to control it. Happily, you'll find that taking control of cholesterol is a lot easier and better tasting than you thought!
Why is cholesterol suddenly such a big deal?
If you've noticed that cholesterol has received increased attention over the past few decades, you're right. In 1985, the National Heart, Lung, and Blood Institute of the National Institutes of Health launched the national Cholesterol Education Program (NCEP). The program's goal is the reduction of illness and death from coronary heart disease (CHD) by reducing the number of Americans with high blood cholesterol. The impetus behind the NCEP was smoking-gun evidence that lowering high blood cholesterol reduces the risk of coronary heart disease. As a matter of fact, a one-percent decrease in cholesterol yields a two-percent decrease in the chance of a heart attack!
Surveys also indicated that neither physicians nor the general public were adequately informed about the relationship between cholesterol and CHD. This led to an aggressive strategy of public and professional education. So yes, you have been hearing more about cholesterol, because there's a lot more to hear.
What is coronary heart disease?
Over time, cholesterol as well as other blood born substances deposits themselves on the interior walls of the coronary arteries. When this build-up restricts the flow of blood through the arteries, too little oxygen reaches the heart. At best, CHD victims suffer chest pain (angina); at worst, a deadly heart attack - the kind that accounts for 30 percent of nearly two million deaths in the United States each year.
While elevated levels of blood cholesterol seriously increase a person's risk of CHD, tacking on smoking and high blood pressure, the other main risk factors, multiplies that risk.
How many Americans have high cholesterol?
The American Medical Association published these figures based on NCEP estimates: Thirty-six percent of Americans have cholesterol levels that are high enough to warrant being under the care of a physician. About 102 million Americans ages 20 years and older are candidates for medical advice and intervention for high levels of blood cholesterol.
On top of that, there are millions more who should take immediate steps to bring their blood cholesterol levels into the "desirable" range.
In other words, if your cholesterol level could stand some tinkering, you've got something in common with better than one-out-of-every-two Americans!
What role does age play?
If you are between the ages of 20 and 39, the likelihood is one-in-five that your cholesterol level is too high. That rate jumps to one-in-two between the ages of 40 and 59. Over the age of 60, there's a 60-percent chance that you have a problem.
Should you be screened for high cholesterol?
If you're over the age of 20 you should! The NCEP suggests that you have the test done at least once every five years.
Your initial evaluation will determine your total cholesterol level and assess risk factors such as cigarette smoking, blood pressure and your personal as well as family health history. Often, cholesterol screening is carried out during the course of a routine physical examination, but advances in finger-stick testing procedures (where the finger is pricked in order to draw a minute quantity of blood) make widespread initial screening in non-clinical settings a practical and convenient alternative. Borderline-high or high levels of blood cholesterol found using the finger-stick method should be confirmed by your family physician.
The important thing is that you know your cholesterol level. Blood cholesterol is measured in milligrams per decilitre (mg/dl). Levels below 200 mg/dl are classified as "desirable blood cholesterol," those between 200 and 239 mg/dl are "borderline-high blood cholesterol" and above 240 mg/dl are "high blood cholesterol." At 200 and above, the risk of CHD steadily increases.
In general, the NCEP recommends that persons with blood cholesterol levels between 200 and 239 mg/dl adopt heart-healthy dietary habits and be retested annually. If additional risk factors are present, further testing will likely be required.
Persons with blood cholesterol levels above 240 mg/dl should have additional testing to determine a course of treatment in order to lower their blood cholesterol level.
Should children be screened?
The American Academy of Pediatrics Committee on Nutrition believes that children with family histories of either early CHD or high cholesterol should be evaluated. "Early" means prior to the age of 50 in men and 60 in women.
For a variety of reasons, the Academy doesn't believe in universal testing for children, but its view isn't shared by all. Cory Servaas, MD, Director of the Children's Better Health Institute, says that between 20 and 30 percent of the children under the age of 12 that her organization tests "have cholesterol levels higher than we think they should be... 180 mg/dl." And she adds: "Since the screen test is inexpensive and easy to do, why not do it? Often we don't know what the family history is in order to know whether a child should be tested."
Is there really 'good' and 'bad' cholesterol?
Absolutely! But first, it's important to understand that everyone, regardless of age, needs cholesterol. It's vital for the formation of cell membranes and for the manufacture of bile acids. It's also the chemical precursor of hormones such as progesterone, testosterone and estrogen. All cells in the body can manufacture cholesterol - 80 percent is produced by the liver - and there is no known physiological reason to supplement the body's own cholesterol with dietary cholesterol.
In order for cholesterol to get from where it is manufactured - in the liver, for example - to where it is needed to support metabolism, it is transported as a lipoprotein. (Lipoprotein are substances that allow insoluble fats like cholesterol to travel around in water-based blood.) Low density lipoproteins (LDLs) carry cholesterol outbound from where it is manufactured, while high density lipoproteins (HDLs) transport it to the liver. At this point, the cholesterol can either be metabolized further, or passed into the intestine for elimination. Because HDLs limit the amount of cholesterol in the blood, they provide protection against dangerously high cholesterol levels. High levels of HDLs have been associated with a lower incidence of CHD.
If your cholesterol tests in the "high" range, or if you are "borderline-high" with additional CHD risk factors, your physician will do additional tests to establish the relationship of LDLs to HDLs.
What can you do to maintain a heart-healthy diet?
You don't have to be a professional dietitian, or eat a boring diet in order to reduce or maintain a desirable cholesterol level. You also don't have to carry a calculator around in order to add up milligrams of this or that. What you do need to know are some basic principles.
- Eat less fat! There are three types of fat: saturated, polyunsaturated and monounsaturated. A heart-healthy diet requires that you reduce your consumption of saturated fats.
They're found in meat and dairy products, as well as in commercially prepared baked goods made with coconut oil, and cocoa fat. Read the labels!
Instead of eating foods high in saturated fats, shift your emphasis toward complex carbohydrates (whole grains, fruits and vegetables), seafood and poultry sans skin. If you do eat meats select lean cuts and remove as much of the fat as possible before cooking. By cutting back on fat, you'll also dramatically reduce calories, since fat contains twice as many calories as protein or carbohydrates.
- Substitute polyunsaturated and monounsaturated fats for those that are saturated. Polyunsaturated and monounsaturated fats can actually help you to reduce your cholesterol. And recent studies conducted at the Department of Medicine, University of California, San Diego, indicate that monounsaturated fats lower LDL (bad cholesterol) levels while leaving HDL (good cholesterol) levels intact. Canola oil is a wonderful source of monounsaturated fat. It's one of the principal cooking oils in Japan, a country widely regarded for its low rate of heart disease.
- Reduce dietary cholesterol. Avoid organ meats altogether and eat fewer egg yolks.
- Increase dietary fibre. Never before has fibre been easier to introduce into your diet. Lately we've been hearing a great deal about oat bran as a source of fibre, and for good reason. Studies indicate that oat bran, when eaten regularly, can reduce cholesterol by up to 19%.
- Exercise! Exercise has shown to reduce the risk of CHD by increasing level of good cholesterol HDLs in the blood.
- Stop Smoking! Exercise raises HDL levels, but smoking reduces them. Smokers run an added risk of CHD.
Do school lunch programs support heart-healthy dietary standards?
Jayne Newmark, national spokesperson for the American Dietary Association, cautions that school lunch programs are self-supporting, and therefore, sell foods that kids are most apt to buy. "Our job is to get kids to like foods that are heart-healthy. Today, you see a lot of hamburgers and French fries because that's what kids like. We have a selling job to do. That's why we're trying to get nutrition into the curriculum. But education really starts at home and it can't begin too soon," says Newmark.
What are the additional benefits of a heart-healthy diet?
A high-fat and low-fibre diet has been linked to cancers of the colon and breast, as well as to diverticular disease, stroke, diabetes, high blood pressure and even osteoporosis. And if that isn't enough, there's always obesity to appeal to the vanity in us all.