High cholesterol is an extremely common problem, affecting as many as 93 million people over age 20 in the United States (about 40 percent of adults), according to the Centers for Disease Control and Prevention (CDC). But because high cholesterol has no symptoms and can only be detected with a blood test, many people may not realize they have it.
High cholesterol and its close cousin high triglycerides — another type of fat, or lipid, in your blood — can increase your risk for heart disease and stroke, which is a problem because they’re leading causes of death in the U.S., according to the American Heart Association (AHA).
“Everyone really needs to pay attention, because if they don’t have high cholesterol, they probably know someone who does,” says Partha Nandi, MD, host of the Dr. Nandi Show and chief health editor of WXYZ-TV ABC Detroit. “What’s key is that you have to get your cholesterol checked.”
During an exclusive Facebook Live event on April 19, Everyday Health teamed up with Dr. Nandi; Cate Collings, MD, president of the American College of Lifestyle Medicine and director of lifestyle medicine at Silicon Valley Medical Development, in Mountain View, California; John G. Canto, MD, director of the Center for Cardiovascular Prevention, Research & Education at the Watson Clinic in Lakeland, Florida, and a consultant on the speakers’ bureaus for Amarin and other pharmaceutical companies; and guest patient David Ader, a heart attack survivor, for an informative conversation packed with helpful, actionable advice about how to take charge of your health if you have high cholesterol and high triglycerides.
What Are Your Numbers? HDL, LDL, Triglycerides, and Why They Matter
Your risk for cardiovascular disease is determined by a lipid panel, which is a blood test that measures your high-density lipoprotein (HDL, or “good”) cholesterol, low-density lipoprotein (LDL, or “bad”) cholesterol, and triglycerides. High cholesterol is defined as 200 milligrams per deciliter (mg/dL), according to the CDC.
When coupled with high LDL cholesterol or low HDL cholesterol, high triglycerides can lead to a buildup of fat in the artery walls and increase your risk of heart attack and stroke, according to the AHA. Knowing these numbers is an important part of managing your cardiovascular disease risk.
Ader was diagnosed with high cholesterol and prescribed statins when he was in his early 30s, despite a fairly healthy lifestyle — he ran, ate healthy, and didn’t smoke — prior to diagnosis. When he was in his early 40s, Ader, who has a family history of heart disease, had angina, or chest pains that occur when your heart muscles don’t get enough oxygen-rich blood, and had to have a stent put into his heart.
He continued to stay physically active and tried to make his diet even healthier by cutting out red meat, limiting cheese, and switching to soy milk. Despite his efforts, Ader, who had a “relatively stressful job working for an investment bank,” had a heart attack when he was 49, on an international flight in the midst of an intensely busy business trip.
“When I was on statins starting in my early 30s, I knew what my overall cholesterol was, but I didn’t pay much attention to the LDL, HDL, and the triglycerides,” says Ader. “But after the first stent and the heart attack, I was paying a lot more attention to those specific levels and became very aware, much more of a self-advocate, looking at my levels and constantly monitoring to see if they changed a couple of points in one direction or the other.”
This attention to numbers is crucial to understanding your risk for cardiovascular disease, and according to Dr. Canto, the optimal levels have evolved over the years. For instance, a few decades ago, experts recommended people have LDL levels below 130 mg/dL; now, they encourage people to shoot for under 70 mg/dL — under 55 mg/dL if you have a high risk of heart disease.
“LDL cholesterol is very, very important,” says Canto. “As you bring the LDL cholesterol down, through lifestyle modification and possibly pharmacological therapy, you begin to halt the progression of atherosclerosis, [a buildup of fatty deposits called plaque in your arteries], and potentially regress the progression of plaque.”
Dr. Collings points out that LDL doesn’t necessarily have to be sky-high to pose a risk. “It is the number of years you have even mildly elevated LDL cholesterol, particularly [along with] mildly elevated or high blood pressure, that really adds up to disease risk.”
The Role of Diet in Managing Your Cholesterol
The doctors on the panel agree that a healthy eating plan, rather than a particular fad diet, can help reduce cardiovascular disease risk. “Whether it’s the Mediterranean diet; a whole-food, plant-based diet; or the DASH diet — [all of which emphasize fruits, vegetables, and whole grains while limiting saturated fats] — we know that diet makes an enormous difference,” says Collings. And, she notes, decreasing processed food is also key. She points to a study published in March 2021 in the Journal of the American College of Cardiology, which found that study participants — the offspring of the people in the Framingham Heart Study — who consumed as many as 7.5 servings a day of ultra-processed foods had an increased risk of cardiovascular disease.
Many people seem to be getting the message about heart-healthy eating. A recent Everyday Health Twitter quick poll asked people what they do to keep their heart healthy and lower their cholesterol. They found that:
- 35.5 percent said that their top tactic was to decrease processed foods
- 29 percent said their number-one move was to increase their intake of whole, plant-based food
Collings also reminds us to be wary of foods that claim to be plant-based but are really processed foods in disguise. Instead, she emphasizes the importance of eating whole foods that are full of antioxidant and anti-inflammatory compounds, such as polyphenols. She notes that a study published in November 2020 in the Journal of the American College of Cardiology found that eating pro-inflammatory foods, such as processed foods, was associated with higher cardiovascular disease risk.
How powerful are dietary changes? At Silicon Valley Medical Development, Collings found that diet changes alone can reduce total cholesterol by as much as 20 percent and LDL cholesterol and harmful triglycerides by nearly 35 to 40 percent in as little as 30 days in the highest risk group (those who have the highest cholesterol).
The Holistic Way to Manage High Cholesterol
As important as what you eat may be, other lifestyle measures, such as exercising, reducing stress, getting plenty of sleep, and taking medication, if necessary, all play a role in your heart health.
Collings notes that even though Ader wasn’t able to prevent his heart attack by exercising, it likely helped him survive it. “The data says there’s up to a 60 percent reduction in cardiovascular mortality in folks that are regularly active,” says Collings. “Being sedentary is a risk factor.”
The AHA recommends at least 150 minutes of moderately intense exercise, such as brisk walking, jogging, or cycling, or 75 minutes of vigorous activity — or a combination of both — spread throughout the week. They also suggest at least two days per week of moderate- to high-intensity muscle-strength training with weights or resistance bands.
That said, Collings emphasizes that exercise itself has a very modest effect on reducing total cholesterol and LDL. “We can’t exercise away from high cholesterol,” she notes. “So it’s all the more reason that we really need a multi-pillar approach to lifestyle and cardiovascular disease — stress, eating, exercise, sleep, healthy relationships, and avoiding substance misuse.”
In addition to lifestyle modifications, Canto notes that there may be some individuals, such as Ader, who need medication to manage their cholesterol and triglyceride levels. “You start out with the statins, which can halt the progression of atherosclerosis,” says Canto. And today, there are therapies commonly used with statins to control LDL cholesterol and triglycerides: The first are PCSK9 inhibitors, which help reduce the amount of LDL cholesterol circulating in the bloodstream, according to Mayo Clinic. The second is a fish oil-derived prescription containing icosapent ethyl — a purified form of an omega-3 fatty acid called eicosapentaenoic acid (EPA) — that has been shown to be effective in reducing risk of heart attack, stroke, and cardiovascular death.
“If you’re on a statin and your LDL or triglyceride levels are still not at goal, sometimes we do have to turn to pharmacological treatment if the lifestyle changes don’t come to fruition,” says Canto.*
So what are some big-picture tips for incorporating and sustaining these lifestyle changes and healthy habits? Collings, who is a health and wellness coaching advocate, notes that telling people what to do is ineffective. Instead, she says, it’s essential to identify — say, through a coaching session — what’s driving the individual’s behavior and what steps they may need to take to make a change. “It’s very important to meet people where they’re at,” says Collings. “For instance, if somebody is not sleeping well, then there may be stress in their life, and that may affect their ability to make appropriate changes in their exercise habits or how they eat.”
She notes that it may also help to break down changes into doable steps. “For instance, when we look at lifestyle change, sometimes people are very empowered to work on one initial thing, and that will segue to another behavior change in another area,” says Collings.
How to Keep Heart-Healthy Habits Going
Healthy lifestyle changes are clearly helpful in managing heart disease risk, but the doctors in our Facebook Live event all noted that it’s a lifelong process. “A lot of this seems a bit daunting,” notes Ader, but once you get into it, you realize you’re exercising and eating right for a reason. It becomes a part of your life, and you feel better for doing it.
Canto emphasizes that with the right treatment and management, people with heart disease can live happy, healthy, and fulfilling lives. “You can have a heart attack in your 30s and have multiple heart attacks in the course of your lifetime, have bypass surgery, have multiple stents, have your heart shocked, have a defibrillator, and then maybe later on a heart transplant, and lead a normal life with heart disease,” says Canto.
And, adds Nandi, you have the power to be your own health hero. “The most important point is that your health is in your hands,” says Nandi. “You’re not helpless.”
*Canto is a consultant on the speakers’ bureaus for Amarin and other pharmaceutical companies.