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Unscrambling high cholesterol: HDL, LDL and proven strategies to manage your risk

By Maureen Shelly

When he was in his early 20s, Brian Sullwold underwent a physical for a life insurance policy and discovered his LDL cholesterol was very high. “I ignored it entirely,” admits Brian, now 40. “Over the next ten years, I rarely if ever went to the doctor. I had full knowledge that heart disease ran rampant through my family. I even witnessed a close relative have a heart attack when I was a teenager. I should have known better than to eat terribly, smoke, not exercise. But I was young and invincible.”

Brian’s experience is a common one: One in three Americans has high cholesterol. And because the condition has no noticeable symptoms, less than half of those people are getting treatment. But overlooking cholesterol is risky: It’s a leading predictor of heart disease, heart attack and stroke. Read on to learn more about the role cholesterol plays in overall health, how to lower your bad cholesterol, and how things turned out for Brian.

What is cholesterol? 

If you’re like most people, your impression of cholesterol is something foreign and unsavory, even toxic. In fact, cholesterol molecules are important building blocks that are present in all cell membranes and in hormones like testosterone and estrogen. Here’s another surprise: All cholesterol is the same. References to “good” HDL and “bad” LDL refer to the proteins that carry cholesterol through the blood where it’s needed. Each serves a different role in the body.

HDL stands for high-density lipoprotein. These waxy molecules serve as the sanitation crew for blood vessels, scrubbing arteries and carrying waste back to the liver for removal. An HDL level above 60mg is thought to protect against heart disease. LDL, or low-density lipoprotein, moves cholesterol from your liver to the body’s organs for use building cells and hormones. The problem with LDL is that it tends to stick to artery walls, reducing blood flow and leading to heart disease. That’s where its bad reputation comes from. Your LDL level should be under 100mg ― lower if you or anyone in your family has a history of heart problems.

"I had full knowledge that heart disease ran rampant through my family. I should have known better.”

What causes high bad cholesterol? 

Cholesterol can reach dangerous levels due to genetics and unhealthy habits. About 75% of our cholesterol is produced in the liver and controlled by genes. To get a sense of your genetic risk, it can be helpful to talk to older relatives about cholesterol. Ask if any family members have been told they have high cholesterol or have been put on medication to lower their bad cholesterol.

Some bad habits contribute to high cholesterol in a different way:

  • Poor diet
  • Lack of exercise
  • Smoking
  • Heavy drinking

In 2013, Brian was indulging in three out of four bad habits when he suffered a heart attack at 35. “The cardiologist who saved my life told me the morning after, ‘It’s your body and your life, so do what you please. But if you continue to smoke, you’ll be dead before you turn 40.’ That’s all I needed to hear.” He quit cigarettes immediately. 

Learn how John Agin quit his two-pack-a-day cigarette habit.

Some heart health experts believe the most dangerous habit of all isn’t on the list. It’s a habit of mind that makes you feel helpless about your health. For instance, if you have a family history of high cholesterol, you may think that nothing you do will make a difference ― so what’s the point of trying? On the other hand, if you have no family history, you may blame yourself and feel you deserve to suffer the consequences.

“There is no reason for anyone to feel helpless,” Dr. Artel reassures. “Because family history or not, when it comes to being healthier, we are more capable than we think. And the changes we should make are usually not as severe as we fear.”

Read more about the psychology of heart-health behavior

How to lower your bad cholesterol

If you’re looking for a starting point, get your cholesterol checked at your next doctor’s visit. Unlike blood pressure, you can’t track your cholesterol levels at home. Only a blood test can measure your HDL and LDL numbers. Ask your doctor if your levels have changed over time or remained steady ― it may indicate whether genetics or lifestyle is driving your numbers. Then discuss these three strategies for managing cholesterol to determine what’s right for you:

  1. Start exercising. Some experts believe that physical activity influences cholesterol to a greater extent than dietary changes. Studies have shown that moderate activity can raise good HDL. Aim for 30 minutes of exercise a day. If you’ve been sedentary for a while, start with 10 minutes of walking a day.
  2. Learn all you need to know about sticking to a fitness routine.

  3. Take your statin. Statin drugs are the main medical treatment for high cholesterol. They block an enzyme in the liver needed to make cholesterol. Many studies have shown statins to be safe and effective over the long term, with very few side effects.

  4. Eat real food. Yes, you should cut back on processed treats that deliver a double whammy of refined sugar and saturated fat ― like ice cream and donuts. But adding more healthy ingredients to your plate also pays off. One influential study showed that just four food groups lowered bad LDL better than a vegetarian diet low in saturated fat:

    • Nuts, especially walnuts, almonds and ground flaxseeds
    • Plant-based protein, found in soy products, beans, peas, chickpeas and lentils.
    • Soluble fiber, like that in oats, barley, eggplant, okra, apples, oranges and berries.
    • Margarine enhanced with plant sterols that block the absorbtion of cholesterol. Look for cholesterol-lowering spreads like Benecol and Take Control as a replacement for regular butter or margarine.

What about eggs? 

“There was a time when if you saw an egg, you were supposed to cross to the other side of the street,” Dr. Artel jokes. “Anything in excess is bad. But eggs are not bad. A daily omelet is not the most terrible thing in the world.” In fact, eggs are full of micronutrients that are great for the health of your eyes, blood vessels and heart. A recent study by the University of Sydney showed that eating up to 12 eggs per week did not increase cardiovascular risk in people with pre-diabetes and Type 2 diabetes, who are especially vulnerable to heart disease.

The bottom line on cholesterol

So what happened to Brian? After a second heart attack in 2016, he’s improved his diet. “I’ve really made an effort to reduce my carb intake and portion size,” he says. “But I know that additional adjustments are required given my family history. For now I’m monitoring the pedometer on my phone to make sure I keep my daily steps above 10,000.”

When it comes to lifestyle changes, Dr. Artel recommends finding a comfortable balance between healthy habits and enjoying life. “People talk about waking up at 5 a.m. every day to run and strictly following the Mediterranean diet,” he says. “That’s probably not going to last. Just make small, meaningful changes that you know you can live with.” Even one of the three cholesterol-lowering tips above could make a big impact on your overall health.


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About the author

Maureen Shelly is a health and science geek living in New York City.

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