As we age, it becomes increasingly important to keep track of what’s happening inside our bodies. You should especially watch for arterial plaque, caused when an excess of cholesterol creates fatty deposits that, over time, can block blood vessels, leading to heart disease.
Your healthcare provider can use a simple tool called a lipid panel to see what’s going on inside your arteries, the vessels that distribute oxygenated blood throughout your body. This routine blood test measures various fats in your blood, including cholesterol. If your levels are high, you are developing plaque, and while plaque can’t be fully reversed, it can be stabilized and even reduced to keep your blood flowing.
This test should be performed at least once a year, typically during your annual physical exam. Patients with high cholesterol may need to be tested more often.
What Is Cholesterol?
Cholesterol is a naturally occurring substance produced in the liver and delivered via the blood stream to every cell of the body. It is essential to building cell walls and producing certain hormones. Cholesterol is also found in some foods, especially certain oils and animal fats.
It’s carried through the blood on two types of proteins called lipoproteins. The predominant is low-density lipoprotein, or LDL. Its job is to transport cholesterol from your liver through your bloodstream to all your cells. After your cells take what they need, a second type cholesterol called high-density lipoprotein. or HDL, absorbs excess cholesterol in your blood before returning it to your liver, where it is broken down and then flushed from your body.
When the two types of cholesterol are in sync, your cells get what they need and the excess is eliminated. But when the body has more LDL than the HDL can handle, the excess drops out of the bloodstream, forming arterial plaque that can grow over time to narrow your arteries, a condition called atherosclerosis that can lead to heart attack or stroke.
Good and Bad Cholesterol
Because too much LDL causes plaque, it is often called “bad” cholesterol (although lethal may be an easier way to remember which is which). Ideally, you will have no more than 100 milligrams per deciliter of LDL cholesterol as measured by the lipid panel.
HDL is often called “good” cholesterol because it clears out LDL, and an ideal lipid panel will show a measurement at or above 40 mg/dL for men and 50 mg/dL for women.
If your LDL is high or your HDL is low, your healthcare provider will consider the most likely causes, including:
- Unhealthy diet
- Inactivity
- Obesity
- Genetics
- Smoking
- Alcohol consumption
Lifestyle Changes
Unless genetics or an underlying health condition is the cause of your problem cholesterol, your provider will likely begin treatment by encouraging certain lifestyle changes, which are often enough to manage your cholesterol.
On the dietary side, you will be urged to eliminate artificial trans fats and reduce consumption of saturated fats because both raise LDL cholesterol. Trans fats are created in an industrial process that adds hydrogen to liquid vegetable oils to change their texture. Look for “partially hydrogenated oils” on food labels to identify products with trans fats. Saturated fats occur naturally in meat and dairy products and in some plant-based foods made with coconut, cocoa and palm.
Instead of trans and saturated fats, use olive and avocado oils for cooking, and consider adding more of these heart-healthy foods to your diet:
- Oats and whole grains
- Foods rich in Omega-3 fatty acids (salmon, for example)
- Nuts
- Avocados
- Beans and legumes
- Leafy greens
- Other vegetables – the brighter the color, the better
You will also be encouraged to stop smoking, reduce alcohol consumption and increase your activity level, since regular physical activity has been shown to increase HDL cholesterol. Weight loss is another way to reduce cholesterol levels.
While these lifestyle changes are your first line of defense, they may have no effect if you are genetically predisposed to high cholesterol, or if you are already suffering from diabetes, kidney disease or certain other conditions.
When Medication Is Needed
When lifestyle changes alone don’t work, medicine can help. A class of drugs called statins, approved for use in 1987, reduce your chances of having a heart attack or stroke; needing surgery, angioplasty, or stenting to improve blood flow in an artery; and dying from a heart attack.
While statins have been around for decades and remain the go-to treatment in most cases, a newer class of drugs is emerging to lower LDL cholesterol in patients who can’t take statins. The breakthrough came in 2020, when the U.S. Food and Drug Administration approved two new medications for treating stubborn cases of high cholesterol in individuals with a genetic predisposition or a heart condition.
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