Know Your Numbers: Cholesterol

Have you ever gotten test results back from your doctor and all he tells you is that it’s normal? Of course you’re going to be happy to hear the good news, but what exactly does ‘normal’ mean for you? The desirable range for total cholesterol is anything less than 200 mg/dl. So normal could be 50, 150 or 199. Yes, 199 is normal, but has your cholesterol continued to rise over the years? Even if your cholesterol level is 199 the first time it’s ever tested, walking away armed only knowing that it’s normal could put you at a disadvantage.

What Is Cholesterol?

Cholesterol is a waxy substance found in many foods, as well as in our bodies^[1]. Although cholesterol usually gets a bad wrap, our bodies actually need cholesterol for cell membrane and key hormone production. Cholesterol is also plays a role in digesting and absorbing fat, as well as absorbing vitamin D^[2].

Because the body relies on cholesterol, the liver produces about 75% of the cholesterol in our bodies. ^[3]The other 25% of the cholesterol comes from the foods we eat.

If Cholesterol is Good, How Can It Lead to Heart Disease?

Too much cholesterol can cause a build-up in the walls of the arteries, which can restrict or completely block blood flow. This can definitely cause a domino effect. Restricted blood flow also means less oxygen being carried throughout the body, including to your heart. Inadequate blood and oxygen to your heart could cause chest pains. No blood or oxygen to your heart leads to a heart attack.

The Good, the Bad and the Ugly

Cholesterol is broken down into two main parts – HDL and LDL.

HDL

HDL (high-density lipoprotein) is the good cholesterol. It helps remove bad cholesterol from the body, which helps keep plaque from building up in the arteries. Up to 33% of the cholesterol is carried via HDL.^[3]

The desirable range for HDL is above 40 mg/dL (1 mmol/L) in men; and

The desirable range for HDL is above 50 mg/dL (1.3 mmol/L) in women.^[5]

LDL

On the other hand, we have LDL (low-density lipoprotein). This protein can combine with other substances to clog the arteries, thus the name bad cholesterol. This can cause the arteries to narrow and become more rigid, a condition known as atherosclerosis. The majority of the body’s cholesterol travels this route.

The desirable range for LDL is below 130 mg/dL (3.4 mmol/L).^[5]

Triglycerides

Here’s the ugly truth about triglycerides. They’re a combination of extra calories, glucose (sugar) and alcohol that the body has converted and stores in fat cells. In fact, triglycerides are the most common type of fat in the body^[4]. According to James Beckerman, MD, a triglyceride level of 150 or more “puts you at risk for metabolic syndrome, which is linked to heart disease and diabetes.”^[1]

The desirable range for triglycerides is below 150 mg/dL (1.7 mmol/L).^[3]

Total cholesterol

When you bring HDL, LDL and triglyceride levels together, you get the overall number you may hear when you get your results – your total cholesterol.

Let’s take a quick look at how you can calculate your total cholesterol if you know your component levels. We’ll use the numbers from my lipid panel taken in December 2019.

HDL                                      70

LDL                                        94

Triglycerides                     40

Total Cholesterol         172

Formula: HDL + LDL + (triglycerides ÷ 5) = total cholesterol

70 + 94 + (40 ÷ 5) = 172

70 + 94 + (8) = 172

The desirable range is below 200 mg/dL (5.2 mmol/L).

The borderline high range is 200-239 mg/dL (5.2-6.2 mmol/L).

The high range is 240 ml/dL (6.2 mmol/L)

Factors That Can Affect Your Cholesterol

There are several factors that can increase your risk for high cholesterol. Although they’re divided into two categories, you still must be aware of all factors.

Factors You Can’t Control

• Heredity – Unfortunately, a propensity for high cholesterol can be passed down from generation to generation. That’s why it’s important to check with parents, grandparents, etc. to find out if they have had any cholesterol or heart-related issues.
• Age – Cholesterol levels tend to rise as we age
• Gender – Men tend to have higher cholesterol than women. HDL (good cholesterol) tends to be higher in women during childbearing years, and declines during menopause. According to James Beckermann, MD, “after age 55, a woman’s risk of developing high cholesterol begins to climb.”^[3]

Factors You Can Control

• Eating habits – Eating high amounts of trans and saturated fats can lead to elevated LDL levels (bad cholesterol)
• Activity levels – Activity increases HDL (good cholesterol), while inactivity increases LDL (bad cholesterol)
• Smoking – Tobacco products decrease HDL (good cholesterol), and increase LDL (bad cholesterol)
• Weight – Overweight and obese individuals are at greater risk
• Medications – Side effects of some medications actually increase cholesterol levels

High Cholesterol and Cardiovascular Disease

While higher cholesterol levels can lead to an increased risk of cardiovascular disease, cholesterol alone isn’t the only factor. Your health care professional will considered other factors in order to get a complete picture of your risk. Some additional factors include:

• Family history – family members who suffered a heart attack or stroke before 55 years old
• Sex – Men run a higher risk than women
• Ethnicity – Certain races are inherently at higher risk than others
• Diabetes – Type 2 diabetes increases the risk
• High blood pressure – Places extra strain on the blood vessels and heart
• Smoking – Cigarette smoking increases the risk

Speaking with your health care professional is always best. If you’d like to get an idea of your cardiovascular risk now, check out the American Heart Association’s Check. Change. Control. Calculator.

I’ve Made Several Lifestyle Changes, But My Cholesterol is Still High

This is a very unfortunate situation many people face. If you haven’t already, you should strongly consider checking with a medical professional. Your doctor will have information on steps to take to get your cholesterol under control, which may include prescribing a medication called a statin.

Summing it up:

While having normal cholesterol levels are good, there’s no substitute for knowing your numbers. Make sure you get the following individual numbers from your health care professional:

• HDL (good cholesterol)
• LDL (bad cholesterol)
• Triglycerides
• Total cholesterol

Several factors can affect your cholesterol level. High cholesterol levels, along with other factors, can increase your risk of cardiovascular disease. Understand these factors and make lifestyle changes to reduce the likelihood of a cardiac event.

References:

[1] Gordon, B. (n.d.). What is Cholesterol? Retrieved February 12, 2020, from https://www.eatright.org/health/wellness/heart-and-cardiovascular-health/what-is-cholesterol

[2] Harvard Health Publishing. (n.d.). Cholesterol. Retrieved February 12, 2020, from https://www.health.harvard.edu/topics/cholesterol

[3] Cholesterol Overview: LDL, HDL, Triglycerides, What Cholesterol Levels Mean. (2018, March 6). Retrieved February 3, 2020, from https://www.webmd.com/cholesterol-management/ss/slideshow-cholesterol-overview

[4] HDL (Good), LDL (Bad) Cholesterol and Triglycerides. (2017, April 30). Retrieved from https://www.heart.org/en/health-topics/cholesterol/hdl-good-ldl-bad-cholesterol-and-triglycerides

[5] High cholesterol: Overview. (2017, September 7). Retrieved February 20, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK279318/