Cholesterol Counts

H E A LT H A C T I O N G U I D E

H igh blood cholesterol is a major risk factor for heart disease. It affects about one in five Americans, many of whom dont know
it because high cholesterol levels alone do not cause symptoms. Knowing what your cholesterol numbers are and how to keep
them in check can lower your risk for developing heart disease and reduce the chance of having a heart attack or stroke.

The information in this guide explains how you can maintain a healthy heart through cholesterol control. Hint: Your lifestyle plays an
important roleand you may find its easier than you think to make some necessary changes.

What is Cholesterol? HDL cholesterol, on the other hand, is considered good

Cholesterol is a waxy fat-like substance found throughout
your body. It is present in the walls and membranes of every
cell, including cells in your brain, nerves, muscle, skin, liver
and heart. Its also a building block for hormones, vitamin D
and bile acids, which are necessary for fat digestion. Without
cholesterol, your body could not function properly.
Some of your cholesterol comes from the foods you eat.
But the bulk of it is actually made in your body, specifically
in the liver. In fact, your liver has the ability to make all the
cholesterol your body needs.
Getting to the Heart of Cholesterol
While some cholesterol is needed for good health, too much
can be a problem. Not all cholesterol behaves the same way.
Because cholesterol does not travel freely in the bloodstream,
it must be carried in packages called lipoproteins. Two main
types are low-density lipoproteins (LDL) and high-density
lipoproteins (HDL).
Excess LDL cholesterol in your blood is considered bad
because it tends to leave fatty deposits in the walls of your
arteries, particularly those that lead to the heart (coronary
arteries). Over time, these deposits (called plaque) can build
up, causing the arteries to narrow and hardena condition
known as atherosclerosis. When this happens, blood flow to
the heart may be reduced, possibly triggering symptoms such
as chest discomfort (angina). When blood flow is completely
stopped, usually due to a blood clot, a heart attack can occur.
Arteries leading to the brain can also become narrowed by too
much cholesterol. If there is a blockage, a stroke may occur.
because it has the opposite effect. It travels through the blood,
picking up excess LDL cholesterol and taking it back to the
liver where it can be can be eliminated by the body or recycled.
Reducing LDL cholesterol and increasing HDL cholesterol
is a powerful combination that can help lower your risk for
heart disease.
Know Your Numbers
The preferred way to learn your cholesterol numbers is by
having a lipid profile (or lipid panel) done. This is a simple
blood test that is often done at the same time as other routine
blood tests, such as during an annual physical. The lipid profile
provides information about:
Total cholesterol
LDL cholesterol
HDL cholesterol
Triglycerides (another form of fat in the blood)
Guidelines for how often to have your cholesterol checked
can vary. Talk with your health care provider about what
frequency is best for you.

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The following table shows how cholesterol test results are generally classified. If you know your numbers, write them in.

Less than 200 mg/dl Desirable

My Total:
Total Cholesterol 200-239 mg/dl Borderline high
_______
240 mg/dl and higher High

Less than 100 mg/dl Optimal

100-129 mg/dl Near optimal
My LDL:
LDL Cholesterol 130-159 mg/dl Borderline high
_______
160-189 mg/dl High
190 mg/dl and above Very high

60 mg/dl and higher Protective (low risk) My HDL:

HDL Cholesterol
Less than 40 mg/dl Low (high risk) _______

Less than 150 mg/dl Normal

150-199 mg/dl Borderline high My TG:
Triglycerides
200-499 mg/dl High _______
500 mg/dl and greater Very high

Source: National Heart, Lung, and Blood Institute

How cholesterol levels impact heart disease risk can vary among individuals and is usually determined by other risk factors. Discuss your
numbers, risk factors and treatment options with your doctor to come up with a plan that works best for you.

Other Risk Factors for Heart Disease
According to the American Heart Association, there are two
main categories of risk factors that can increase your risk for
heart disease.
1. Major risk factors are those that research shows
significantly increases the risk of heart and blood vessel
disease. They are considered uncontrollable (cant be
changed or modified) or controllable (can be modified,
treated or controlled with lifestyle changes and/or medication).
2. Contributing risk factors are those associated with
increased risk of heart disease, but their significance has
not yet been precisely determined.
Where do you stand? To determine your personal risk factors
for heart disease, check all that apply:
The major risk factors over which I have no control are:
o I am a male age 45 or older.
o I am a female age 55 or older.
o I have a family history of heart disease (father or brother
diagnosed before age 55 and/or mother or sister diagnosed
before age 65).
The major risk factors over which I have some control are:
o I have high blood pressure.
o I have unhealthy blood cholesterol levels.
o I smoke or am exposed to secondhand tobacco smoke.
o I get little physical activity.
o I am overweight or obese.
o I have diabetes.
The contributing risk factors over which I have some
control are:
o I experience a high level of stress on a constant basis.
o I drink more alcohol than is recommended.
o I do not eat a heart-healthy diet.
The more risk factors you have, the greater your chance of
developing heart disease. The good news is that once you know
your cholesterol numbers and the risk factors over which you
have some control, there are plenty of things you can do to
lower your risk and improve your overall health.

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Lifestyle CountsA Lot!
We gave you a hint earlier, but its no secret that lifestyle is
your first line of attack against unhealthy cholesterol levels
(and triglycerides) and heart disease. Put a check next to any
of these heart-healthy lifestyle tips that youre willing to make
a part of your personal action plan.
o Be physically active
o Eat a heart-healthy diet
Choose
o a colorful variety of fruits and vegetables daily.
o foods rich in soluble fiber, such as oats, barley, dried
beans and peas, legumes, ground flax seeds, apples,
pears, citrus fruits, dried plums, carrots, brussels sprouts
and psyllium seed husk.
o salt used to season foods and processed/prepared foods
already high in sodium.
o sugary beverages and foods with added sugars.
o PORTION SIZES! Eating too many calories, even from
nutritious foods, can lead to weight gain.
Getting regular cardio (aerobic) exercise is important for
healthy cholesterol levels. And, of course, physical activity
supports achieving and maintaining a healthy weight, which
has a positive impact on overall cholesterol and triglyceride
levels. There are other benefits, including stress reduction,
better sleep, decreased risk of type 2 diabetes, lower blood
pressure and many more.

o to eat more dietary fiber in general, including whole-
grain breads, cereals and pasta, brown rice, fruits and
vegetables, legumes, nuts and seeds.
o monounsaturated and polyunsaturated fats such as olive,
canola, soybean and peanut oils; avocado; olives; nuts
and seeds.
o at least 2 servings of fish a week, especially oily fish
rich in omega-3 oil like salmon, tuna, trout, mackerel,
herring and sardines.*
o lean meats, skinless poultry breast and vegetable meat
alternatives (soy).
o nonfat, 1% or low-fat dairy products.
o to follow the DASH (Dietary Approaches to Stop
Hypertension) or USDA (choosemyplate.gov) Eating
Plan. These plans incorporate the elements of heart-
healthy eating.
o Lose weight, or maintain a healthy weight and waist size
o to read food labels for information on serving size,
calories, fats, sodium and fiber.
Cut back on
o foods containing trans fat (partially hydrogenated
vegetable oils) including some prepared baked goods,
packaged snack foods, commercial fried foods and stick
margarine; its best to avoid trans fat altogether.
o solid fats and foods high in saturated fat, such as whole
and 2% milk, butter, lard, cream, cheese, and fatty meats.
To benefit, aim to do at least 150 minutes a week of
moderate-intensity physical activity, such as brisk
walking. Spread your activity throughout the week. For
example, go for 30-minute walk, five days a week. Before
you get started, let your doctor know you want to be more
active, especially if you havent been active in a while or
have a health condition such as high blood pressure,
diabetes or asthma.
Any activity you enjoy and that gets you moving will help.
It may be walking, hiking, dancing, cycling, swimming,
using gym equipment or taking a group exercise class.
Discover a variety of activities to enjoy. Whatever you
choose to do, take it easy at first and gradually pick up
the pace as you feel your heart rate, breathing and body
temperature rise. Moderate intensity is the level when your
body systems are revved up but youre still able to talk
comfortably during your activity.
If you are overweight, even a small weight loss, just 5-10
percent of your current weight, can improve your cholesterol
and triglyceride levels. For someone who weighs 200 pounds,
thats just 10-20 pounds. Regular exercise, a healthy diet,
and effective stress management can help you achieve and
maintain a healthy weight.

*Pregnant and nursing women, women who may become pregnant, and young children should avoid shark, king mackerel, tilefish (Gulf of Mexico), marlin, swordfish, orange roughy, and
bigeye tuna due to high levels of mercury. Check local advisories before eating fish caught locally. For more information on the best fish choices for children and women of childbearing age,
visit www.FDA.gov/fishadvice.

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Having excess abdominal (belly) fat can also increase your
risk for heart diseaseand type 2 diabetes. This is true
even if youre not much overweight. Measuring your waist
circumference is one way to determine if you have too
much belly fat. A healthy waist measurement is:
less than 40 inches (men)
less than 35 inches (women)
o Avoid all tobacco products
Smoking and exposure to secondhand smoke are linked
to many harmful health effects, including lowering HDL
(good) cholesterol. It can also reduce your tolerance for
physical activityan important component for cholesterol
and weight control. Quitting smoking can increase your
HDL cholesterol as well as offer these other benefits:
Within 2 weeks to 3 months, the chance of having a
heart attack decreases.
At one year, excess risk of heart disease is cut to half
that of a smoker.
At 15 years, the risk for heart disease is similar to
someone who has never smoked.
Quitting isnt easy; the key is being committed and finding
helpful resources. Talk to your doctor about ways to help
you quit.
o Practice moderation with alcohol
If you dont currently drink, then dont start. If you do
drink alcohol, do so in moderation. Moderation means no
more than one serving a day for women and two servings
a day for men.
A serving of alcohol is:
5 ounces of wine
12 ounces of beer
1 ounces of 80-proof liquor
Sources: National Heart, Lung, and Blood Institute; American Heart Association
This information is intended for educational purposes only and should not be interpreted as medical advice. Please consult your doctor for advice about changes that may affect your health.
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If your triglycerides are very high, you may want to avoid
alcoholor at least discuss with your doctor firstsince it
may raise your triglycerides even more.
o Relax
Although there is no evidence of a direct link between
stress and high cholesterol, improving how you handle
stress and negative emotions may benefit your heart health
and overall quality of life. Here are some suggestions:
o Learn and practice relaxation techniques such as deep
breathing, meditation or visualization.
o Learn how to manage your time better.
o Go for a relaxing walk, practice yoga or take a
Tai Chi class.
o Set realistic expectations about what you can
accomplish or achieve.
As you work on lifestyle changes, be easy on yourself and set
realistic expectations. Dont try to change too much at one
time. And dont expect to see improvements overnight. It can
take several weeks or months to see positive changes in your
lipid profile test. Dont be discouraged by minor setbacks along
the way; it happens, just keep your goals in sight and stay with
it. Lifestyle changes take practice. But theyre always worth
the effort.
What About Medication?
For some people with certain risk factors, a cholesterol-
lowering medication may be recommended. Your doctor
can help decide what is best for you. Whether you take a
medication or not, its still important to focus on eating right,
maintaining a healthy weight, and being physically active.
A healthy lifestyle is important for everyone.