Cholesterol: Do You Know Your Numbers?

"Do you know your cholesterol level?” That’s the question most of us have been accustomed to being asked over the years. But knowing your total cholesterol level is no longer enough. Now we know that the components of your cholesterol are even more important than your total cholesterol level. This includes your high-density lipoproteins (HDL), low-density lipoproteins (LDL), and your triglyceride levels, which are all part of the lipoprotein blood profile.
“Over the years, we’ve found that high LDL levels—the bad cholesterol, as well as elevated triglyceride levels—can have a greater impact on your risk than the total cholesterol level alone,” says Ann Narmi, M.D., interventional cardiologist with Alegent Health Clinic Heart and Vascular Specialists. “In fact, a high LDL was found to be the most common lipid abnormality in patients who experience premature heart disease.”
The optimal level for preventing heart disease in women with a normal heart disease risk is a total cholesterol level lower than 200 mg/dL, LDL level below 100 mg/dL and triglyceride levels below 150 mg/dL. Unlike triglycerides and LDL, higher levels of HDL—the good cholesterol—protect against heart disease by helping to prevent clogging in the arteries. Women should strive for levels of 50 mg/dL and above. Levels of 60 mg/dL and higher can actually lower the risk for heart disease. If you have other risk factors for heart disease, your doctor may set target HDL levels that are higher and LDL levels that are lower than the levels recommended for healthy individuals.
Women with other risk factors for cardiovascular disease should be the most concerned with their cholesterol levels, says Rebecca Jacobi, M.D., OB/GYN at Methodist Women’s Hospital. This includes risk factors such as family history, obesity, smoking, high blood pressure, and diabetes. “If you can decrease your cholesterol level, then you may be able to decrease your risk of experiencing a cardiovascular event,” she says.
Up until menopause, women are naturally protected from negative cholesterol levels due to estrogen. But this begins to change about 10 years after menopause. That’s when women may begin to see their LDL levels and triglycerides creep up and their HDL levels decline.
Exercise and diet have the greatest impact on cholesterol levels. Increasing your exercise level to 45 minutes to an hour five days a week, and decreasing fast food and saturated fats from your diet, can affect your cholesterol by as much as 25 percent with changes seen in both HDL and LDL levels, says Dr. Narmi.
Your diet should consist of foods low in fat and high in fiber and complex carbohydrates, like whole grains. “It needs to be foods that you like so that>>
<<this can become a long-term lifestyle modification instead of a short-term change,” says Dr. Jacobi. She also advocates the Mediterranean diet, which includes lots of fruits and vegetables, nuts, olive oil, small portions of fish and chicken, and small amounts of red meat and dairy products.
“Women need to keep up with their annual exam so their doctors can stay on top of their numbers, especially as they get older,” says Jacobi.
Some general guidelines for healthy eating habits include the following: keep total fat to less than 25 to 30 percent of total calories; saturated fat to less than 7 percent of total calories; and protein to about 15 percent of total calories.
Triglycerides are another component of your lipoprotedin profile that need to be taken seriously, especially in women, says Claire Hunter, M.D., cardiologist at Creighton University Medical Center (CUMC). Triglycerides are fatty acids in your blood and are more prevalent in women who tend to gain weight around the middle. Weight around the middle has been associated with the development of heart disease and diabetes.
“Triglycerides tend to be more potent in women than men,” says Hunter, “and unlike cholesterol, they are affected by carbohydrate intake rather than saturated fat. Women should strive for triglyceride levels of 150 and below.”
The good news is that triglycerides respond fairly rapidly to diet and exercise changes.
Adding regular exercise to your routine can result in a drop in triglyceride levels within several weeks, says Hunter. Exercise re-sensitizes your body to respond to insulin, which affects your blood sugar levels, your carbohydrates and triglycerides. Exercise and possibly fish oil are the only two things that can help raise your HDL level.
Genetics can also play a role in your cholesterol levels, causing some women with a family history of high cholesterol to produce too much LDL cholesterol. If high blood cholesterol runs in your family, diet and exercise may not be enough to lower your LDL cholesterol.
In cases in which cholesterol cannot be controlled by diet and exercise, Statins, which can help stabilize plaque in your arteries, may be recommended. “Statins can have a dramatic impact on your cardiovascular risk,” says Hunter. “Statins can cut your cholesterol level in half, lower LDL by 40 to 50 percent, and provide small increases in your HDL. These types of changes to your cholesterol will lower your risk of stroke and heart attack.
“Many people have an aversion to taking pills. But Statins are so effective, we joke among the cardiology world that Statins should be in the water. Very few people have any side effects when taking Statins.”