What is Cholesterol and How do You Manage It?
By Maj. Beverly A. Crosby

Cholesterol can be good AND bad, so it is important to learn what cholesterol is, how it affects your health, and how to manage your blood cholesterol levels. High cholesterol is one of the major risk factors for heart disease. The higher your cholesterol level, the greater your risk for developing heart disease or having a heart attack. Heart disease is the number one killer of men and women in the United States.

Cholesterol is a soft, waxy fat found in all human beings. It is normal to have cholesterol. Your body manufactures about 80 percent of it. The rest is consumed through animal products such as meat, eggs, and dairy products. Food from plants like fruits, vegetables, and cereals do NOT have cholesterol. Cholesterol is used to form cell membranes, some hormones, and serve other needed bodily functions.

Hypercholesterolemia is the term for high levels of blood cholesterol. High cholesterol is a major risk factor for Coronary Heart Disease, which can lead to heart attack and stroke. Everyone 20 and older should have his or her cholesterol checked at least once every 5 years. This blood test is done after a 9- to 12-hour fast and will give information about your total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoproteins (HDL) cholesterol, and triglycerides.

Total Cholesterol Level
Less than 200 mg/dl	Desirable
200-239 mg/dl	Borderline
240 mg/dl and higher	High Risk

Cholesterol and fats do not dissolve in blood. They must be transported to and from cells by special carriers known as lipoproteins. There are two kinds of lipoproteins that you need to be concerned with: LDL and HDL. The LDL, known as "bad" cholesterol, is the main cause of harmful fatty buildup in arteries. The higher the LDL level the greater the risk of heart disease, which will increase your risk of heart attack and stroke. This HDL, which is the "good" cholesterol, is made by your body for your protection and travels away from your arteries. The HDL helps prevent cholesterol buildup in the arteries by carrying blood cholesterol to the liver where it can be eliminated. The lower the HDL, the greater the risk of heart disease. Refer to tables below:

HDL Levels
Less than 40 mg/dl	Low (increased risk)
60 mg/dl and higher	High (heart protective)
LDL Levels
Less than 100 mg	Optimal
100 to 129 mg/dl	Near Optimal
130 to 159 mg/dl	Borderline High
160 to 189 mg/dl	High
190 mg/dl & higher	Very High

Atherosclerosis is a process that clogs your coronary arteries, arteries that supply your heart with oxygen-rich blood. Cholesterol and other fatty substances collect on the damaged artery walls. The substances build up layer upon layer and form a hard substance called plaque. Plaque build-up will narrow the arteries causing a decrease in blood flow to the heart. The decrease in blood flow increases your risks of heart attack or stroke.

A variety of things can affect cholesterol levels. Some things you can change and some you cannot. Below are some of the therapeutic lifestyle changes you can make to improve your cholesterol levels:

1. Change your eating habits:
   • Eat a low-saturated fat, low-cholesterol diet.
   • Broil, roast, bake or steam foods.
   • Remove skin/extra fat before cooking.
   • Use nonstick pans or cooking sprays.
   • Read food labels.
2. Quit Smoking:
   • Make an agreement with yourself to quit.
   • Fight the urge by going where smoking isn't allowed
   • Associate with people who don't smoke
   • Ask your healthcare provider for information and programs that may help
3. Limit Alcohol Intake (Moderate Amounts):
   • One drink a day for women.
   • Two drinks a day for men.
   • One drink is equal to: 12 fl oz beer, 4 fl oz wine, 1 fl oz 100-proof spirits, or 1½ fl oz 80-proof spirits (Bourbon, Scotch, Vodka or Gin).
4. Avoid or Reduce Obesity. Diets are NOT recommended - they may take the weight off fast, but only work in the short term. When you stop the diet the weight returns. Instead of dieting, make lifestyle changes:
   • Get a cholesterol screening.
   • Maintain a healthy weight.
   • Exercise regularly.
   • Change what you eat, obesity can cause increased cholesterol and high blood pressure.
5. Reduce stress:
   • Deep breathing exercises.
   • Engage in regular physical activity.
   • Eliminate or reduce caffeine (coffee, tea and cola drinks) and alcohol.
   • Relax and sit quietly for 15-20 minutes a day.
   • Use waiting time to read a book or write letters.
6. Perform aerobic exercises regularly:
   • 3 times a week for 20-60 minutes each time, gradually increasing.
   • Prior to exercising, warm up for 5 minutes.
   • Rhythmic and steady exercise will increase your heart rate.
   • After exercising, cool down for 5 minutes.

Things you cannot change include age, gender, and heredity. As men and women get older, cholesterol levels rise. Before menopause, women tend to have lower total cholesterol levels than men of the same age. After menopause, LDL levels tend to increase. Heredity is also a factor. High blood cholesterol levels can run in Families. Your genes partly determine how much cholesterol your body makes.

Sometimes diet and exercise are not enough to reduce cholesterol to goal levels. Cholesterol-lowering drug therapy may be necessary. The decision of which drug to prescribe will be based on factors such as the degree of cholesterol lowering desired, side effects, and cost. Even though you begin drug treatment, you will need to continue with lifestyle changes. High blood cholesterol does not cause symptoms so many people are unaware that their level is too high.

Understanding the facts about cholesterol will help you develop a healthier lifestyle, take better care of your heart, and reduce your risk for heart attack and stroke. Get a cholesterol screening; eat a low-saturated fat, low-cholesterol diet; maintain a healthy weight; exercise regularly; drink only moderate amounts of alcohol; and follow all your healthcare provider's recommendations.

For more information see:
Cholesterol Guidelines Update
Winning the Weight Loss Race - Cholesterol "101"
Blood Pressure - Your Body's Warning Lights