Simply put, high cholesterol kills. Elevated cholesterol levels are linked to a higher risk of heart disease (the leading cause of death in America), and according to the Centers for Disease Control and Prevention (CDC), over one third (37%) of Americans have elevated LDL cholesterol (that’s the “bad” kind). Yet according to the same study, only half of the people who should be on cholesterol-lowering meds actually take them.
Why the disconnect for such an obvious health risk? Everybody knows that high cholesterol is bad for you—even potentially fatal—yet many of us ignore high cholesterol as a minor nuisance. The problem is confusion. People don’t really know what cholesterol really is, how it works, and why high cholesterol is so bad for you.
It’s time to take a closer look at cholesterol and answer some basic question about this vital part of your health. Understanding how cholesterol works and how to read your lipid panel (that confusing chart full of numbers from your last checkup) is a first important step toward managing your health. So let’s dive in.
Table of Contents
- Cholesterol: Good and Bad
- What are Lipoproteins?
- How to Read Your Lipid Panel
- What’s High Cholesterol?
- How to Treat High Cholesterol
- Cholesterol Medication
- How Statins Work
- Alternative Depression Therapy
- More Depression Information and Resources
The most confusing thing about cholesterol is that it isn’t inherently bad. In fact, you need cholesterol to survive.
Cholesterol is what’s known as a sterol molecule—a specific chemical structure that’s essential for maintaining your cell membranes. It’s the building block for vitamin D and all your steroid hormones including: testosterone, estrogen, progesterone, and cortisol among others. It’s also an important part of bile acids, which your body uses to digest dietary fat. So, yeah…cholesterol is kind of important. Which all leads to the central question:
If cholesterol is so important to your health, why is too much cholesterol bad for you?
It’s complicated, but basically your cardiovascular health and cholesterol levels are inextricably linked. And it all starts with how your body makes and transports cholesterol in your bloodstream.
Cholesterol metabolism and transport are extremely complicated topics, and honestly the specifics of the process are more than you need to know. However, a quick overview of how you use and distribute cholesterol in your blood can help you understand your latest lipid panel.
Cholesterol is a lipid (fat soluble), which means it doesn’t move through your blood very well. But remember that practically every cell in your body needs cholesterol. That means you have to figure out some way to move it around in your body. And you do this with special proteins called apolipoproteins.
These proteins have both water and fat soluble parts—kind of like the opposite sides of a magnet. The fat soluble part bonds to cholesterol and the water soluble part interacts with your blood. Once these proteins grab cholesterol particles, we call them lipoproteins. Now we’re getting to the health risk part of things.
For simplicity’s sake, we’ll boil these lipoproteins down into two categories based on the way they work in your blood vessels:
- Apolipoprotein B (Apo B) deposits cholesterol into your blood vessel walls. This makes it the “bad” kind of cholesterol because these deposits contribute to blockages that can lead to heart disease, heart attack, and stroke.
- Apolipoprotein A-1 (Apo A-1) removes cholesterol from blood vessel walls. This makes it the “good” cholesterol because these lipoproteins protect you from the damage that leads to heart disease and stroke.
The main difference between “good” and “bad” cholesterol is simply about where cholesterol ends up in your body.
The more Apo B lipoprotein particles in your blood, the higher your risk of heart disease.
Since most of the cholesterol particles attached to “bad” Apo B are low-density lipoproteins (LDL), doctors use LDL levels as an estimate for all the particles that contribute to cardiovascular disease. This estimate isn’t perfect, but typically people with a higher LDL have a higher risk of heart attack and stroke.
- Apo B lipoproteins are “bad”
- The more LDL and/or Apo B you have in your system the higher your risk for heart disease
That’s all your really need to know about LDL and lipoproteins to understand your latest standard lipid panel. The lipid panel is one of the most common ways doctors evaluate your risk for cardiovascular disease. Here’s a sample lipid panel results page:
Exciting stuff, right?
Each lipid panel varies depending on your existing risk factors (age, family history, existing conditions like diabetes, etc.), but generally speaking the “normal” values are expressed in mg/dl (in the US) and mmol/l (most of the world) for each category are as follows:
- Total Cholesterol (TC): Normal = <200mg/dl
- LDL: Normal = <130mg/dl or <100mg/dl
- HDL (high density lipoprotein): Normal = >39mg/dl in men and >49mg/dl in women
- Triglycerides: Normal = <150mg/dl
- Non-HDL: No higher than 30mg/dl more than the LDL value
Download this infographic to learn How to read a lipid panel
The three most important takeaways from your lipid panel are LDL, Non-HDL, and triglyceride levels. Here’s what each one really means:
- High LDL, Non-HDL levels, and triglycerides all increase your risk for cardiovascular disease.
- High triglycerides and low HDL levels indicate insulin resistance.
Insulin resistance isn’t a common risk factor associated with high cholesterol, but it’s actually a really big side effect. Insulin resistance itself puts you at greater risk for type 2 diabetes—which is yet another risk factor for cardiovascular disease. Additionally, insulin resistance can even skew your LDL results by underestimating your Apo B (“bad” cholesterol) and LDL particle numbers, which can result in underestimating your risk factors.
Healthy ranges vary depending on your other risk factors. Just remember, Non-HDL, LDL, and triglycerides are the numbers to watch. Like I said, cholesterol is complicated. If you only track a few metrics, get to know your LDL and Non-HDL levels. Triglycerides are an important risk factor for cardiovascular disease (and insulin resistance), but not your chief concern.
Case in point: Sometimes Non-HDL levels are a better predictor than the LDL alone because they include other Apo B containing particles like VLDL, IDL, Lp(a). If you only consider LDL, you can actually underestimate the level of risk. It all depends on the patient. Don’t be afraid to talk to your doctor about your lipid panel results. No two people are the same.
Your lipid panel might have red flags if you exceed healthy normal ranges. That’s ok. When this happens, consult your doctor to discuss treatment and next steps. Your doctor can estimate your risk for cardiovascular disease based on your lipid panel, family history, smoking status, age, blood pressure, and other risk factors like diabetes. This one test isn’t the only factor. However, high LDL numbers may prompt more tests to see if you’re at risk of heart disease, heart attacks, and strokes.
The best follow up test for this is called a coronary calcium scoring. Calcium scoring uses a low-dose CAT scan to see how much calcium is actually in your coronary arteries. CT scans have even proven better at estimating risk than risk calculators alone. Your doctor may also recommend lifestyle changes, and medication to lower your risk of heart attack and stroke.
High Cholesterol: Recommended Lifestyle Changes
It may sound boring, but lifestyle changes are the best way to lower your cholesterol. The American Heart Association (AHA) and American College of Cardiology (ACC) both recommend the following lifestyle changes to naturally lower your cholesterol:
- Eat Better: A diet rich in fruits and vegetable, nuts, poultry, fish, legumes, and low-fat dairy products promotes heart health. Many physicians also recommend lowering your intake of red meat, saturated fat, trans fat, sweets, and sugar-sweetened beverages. The Dietary Approaches to Stop Hypertension (DASH) Diet and the Mediterranean Diet, are both great examples of these dietary changes.
- Use Less Salt: Lower your sodium intake to less than 2,400mg per day, especially if you’ve been diagnosed with hypertension.
- Exercise More: 40 minutes of moderate-to-vigorously intense physical activity, 3-4 times a week can reduce cholesterol.
For some, these lifestyle changes can be profound. For others, it just involves cutting out a few guilty pleasure foods and finding the time to stay active. Regardless of where you are with your diet and fitness, pay attention to what you eat and exercise regularly. They’ll both improve your LDL levels (and your life).
While lifestyle changes are usually very effective, they may only take you so far. Cholesterol medications, like statin therapy, are an important part of how many patients manage high cholesterol. The AHA/ACC recommends medication for:
- People with cardiovascular disease, peripheral vascular disease (atherosclerosis in the blood vessels of the legs), and cerebrovascular disease (atherosclerosis in the blood vessels to the brain)
- Ages 40-75 with diabetes and LDL levels above 70mg/dl
- Patients with LDL levels above 190mg/dl
- Anyone with a 10 year calculated risk of 7.5% or more. (This is where coronary calcium scoring can sometimes help reclassify people up or down).
Statins are a family of drugs that work by decreasing your liver’s ability to make cholesterol. That’s right, your body naturally makes cholesterol in addition to what you eat. Statins essentially reduce cholesterol levels by making your liver pull LDL out of the bloodstream. And while statins have been criticized by many, they’ve been shown to lower the risk of heart attacks and death when taken by the people who need them most.
High cholesterol is a serious problem if left untreated. Luckily, you can do a lot to lower your cholesterol. Learn how to read your lipid panel. Assess recommended lifestyle changes and how they fit into your day. Then talk to your doctor to develop a treatment plan or explore cholesterol medication that works for you.
Geek Out: More Cholesterol References
Not enough info for you? No problem. Geek out on this research from the most trusted sources on the interwebs. If you have any questions or you think we missed something important, leave a comment or book a consultation with me or one of these trained professionals and we’ll get you on the way to a healthier manhood.
- Defining Cholesterol
- High Cholesterol Facts (CDC)
- Lowering Your Cholesterol with TLC (NIH)
- Lipid Profile Values
- Major Lipids, Apolipoproteins, and Risk of Vascular Disease (JAMA)
- 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk (AHA/ACC)
- DASH Eating Plan (NIH)
- The Mediterranean Diet, its Components, and Cardiovascular Disease (Am J Med)
- 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults (AHA/ACC)
- The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors (BMJ)
This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.