Cholesterol and Heart Disease



The connection between dietary cholesterol and heart disease has been under scrutiny for some time. While it remains controversial, there are a few things that we do know when it comes to cholesterol’s role in cardiovascular disease. First, we know that deposits along the artery walls called plaque contain cholesterol. Second, we know that once enough plaque accumulates inside the artery, it can cause a narrowing and eventually complete closure of the artery preventing blood flow. This restriction in blood flow is what causes the damage seen in heart attacks and stroke. Without oxygen and nutrients supplied by the blood reaching the heart and brain, the tissues begin to die. To help keep the arteries clean and open, the National Heart, Lung and Blood Institute in cooperation with the American College of Cardiology and the American Heart Association have established target blood cholesterol levels that have been shown to reduce the risk of  cardiovascular disease. These are the guidelines that are currently in practice.

Total Cholesterol




Less than 200 mg/dl <100 – 129 mg/dl  <150 mg/dl Optimal
200-239 mg/dl 130-159 mg/dl 150-199 mg/dl Borderline High
Above 240 mg/dl 160-189 mg/dl 200-499 mg/dl High
>190 mg/dl >500 mg/dl Very High

The latest guidelines were set in 2013 and changed how doctors treat people with elevated cholesterol levels. There were several updates based on clinical trial results that changed from the previous guidelines in 2004. The most drastic change was moving away from treating to target. This means that doctors are no longer advised to continue increasing the medication dose or adding more medications in order to get a patient’s number to a particular target. The goal is not whether your cholesterol levels get to a particular number but whether your risk of cardiovascular disease is decreased. This is based on the fact that studies have confirmed lowering your cholesterol levels with drug therapy is not equivalent to lowering your risk of heart disease. In real world experience, we have seen several patients in the Cardiac Rehabilitation program that had great cholesterol numbers but still had a heart attack. This makes it very important to identify other modifiable risk factors for heart disease, such as smoking, sedentary lifestyle, diet, weight and blood pressure. For an online calculator to help you determine your risk, click here. Cholesterol is still a key player but just getting that number to goal does not guarantee your risk is reduced, especially if it is achieved with drug therapy. Lifestyle intervention seems to be more beneficial for reducing risk of heart disease. If lifestyle changes alone are not enough, then drug therapy should be considered once the benefit versus risk are evaluated with your doctor. For those with a very high LDL, the benefit seems to outweigh the risk of drug therapy because the risk is much higher. We have to keep in mind that drug therapy always carries some risk and potential side effects. Another thing doctors must consider is a person’s HDL level. If HDL levels are optimal (>40 for men and >50 for women), then the risk of cardiovascular disease is reduced.

Regardless of cholesterol numbers, there are some healthy lifestyle habits that can help us reduce the risk of heart disease.

  1. If you smoke, quit.
  2. If you are overweight, try to lose weight. Even a 5-10% weight reduction can make a difference.
  3. Get 30 minutes of exercise at least 5 days a week. Even if it is in 5- or 10-minute increments.
  4. Keep your blood pressure under control.
  5. Avoid trans fats! Limit saturated fats in your diet. These include fatty meats, full fat dairy, cheese, egg yolks and butter. Some is okay but don’t overdo it. Healthy fats from fish, nuts, seeds and avocados are better for the heart.
  6. Increase your fiber. Fiber in the diet can decrease our absorption of fat and cholesterol in the gut and help lower cholesterol levels. Fruits, vegetables, nuts, seeds and whole grains are good sources.
  7. Fish or fish oil supplements provide healthy omega 3 fatty acids which primarily target high triglyceride levels but can potentially reduce heart disease risk. Salmon, trout, herring, mackerel, sardines and tuna are excellent sources.
  8. Limit refined carbohydrates and sugars in order to reduce inflammation.

For more information, please visit one of the websites linked above. Heart disease is still the #1 killer in the USA but a lot of these deaths are preventable. Here is to good heart health!

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