All About Cholesterol

Don't know your HDL from your LDL? Our experts explain why understanding what your numbers mean could save your life.
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The Cholesterol Lowdown

As the health director of Ladies' Home Journal, I know a thing or two about cholesterol. But I was a little surprised by the response when our editor-in-chief, Sally Lee, took an informal poll during a recent staff meeting. "How many of you know your cholesterol numbers?" she asked the roomful of mostly women. About a third of the hands went up. Then I jumped in and asked, "How many of you really understand what those numbers mean or how to change them?" Every hand went down.

So, if a bunch of research-oriented journalists don't know what to do with all their data, we thought, how can we expect our readers to know? We asked our LHJ Facebook fans the same questions and they posted answers such as this one: "I never really understood the numbers and how they work. I just eat my Cheerios." In fact, only about 21 percent of women 18 to 44 know their total cholesterol level, according to a 2007 survey by the Society for Women's Health Research. And just under 14 percent know their LDL ("bad") cholesterol level, while only 12 percent know their HDL ("good") cholesterol number. That backs up a previous Harris Interactive survey, which found that 81 percent of women 50 and older don't know their LDL or HDL numbers -- and nearly a quarter of those respondents had actually suffered a heart attack or stroke or had diabetes.

Most doctors don't have time to sit down with you and explain your lab results in detail, so many women never learn the true extent of their risk for heart disease, or how to prevent it. Heart disease is still the number one killer of men and women, and women are less likely than men to have their cholesterol levels under control, according to a large analysis of managed-care and Medicare plans.

We realized it was time to get back to basics. So we consulted two top experts from our LHJ Medical Advisory Board: Michael F. Roizen, MD, chief wellness officer at the Cleveland Clinic, and cardiologist Holly S. Andersen, MD, director of education and outreach at the Ronald O. Perelman Heart Institute at New York City's New York-Presbyterian Hospital, to fill in the blanks.

Total Cholesterol

What's ideal: Under 200

First, cholesterol isn't technically the same thing as fat. Cholesterol is a soft, waxy, fatlike substance mainly produced by the liver. And it's not inherently bad; in fact, it's vital to all kinds of bodily processes, from keeping cells healthy to making hormones. But sometimes the body cranks out more cholesterol than you need, and the things you eat, what you weigh, and the way you live can add even more, putting you at risk for heart disease. But improving your diet, losing weight, and increasing your exercise can reduce those risks, so keep reading.

We've learned a lot about cholesterol in the past 20 years, says Dr. Andersen, and what we know is constantly evolving, too. "When I was in medical school, for example, we were taught that having a total cholesterol number of less than 250 was normal, and we didn't even know what HDL and LDL were. Today I still look at total cholesterol, and we know we want it to be under 200, but HDL and LDL are much more important."

The Bad Guy: LDL

What's ideal: Under 100

It stands for low-density lipoprotein, but you can just remember the "L" stands for "lousy," says Dr. Roizen. LDL circulates through your bloodstream and deposits cholesterol in the walls of your blood vessels. This actually starts when you're young; you get little deposits of the fatty stuff here and there. Over the years it can build up, and other stuff traveling through your bloodstream, such as waste products or calcium, gets stuck on there, too. All this gunk combines to form plaque, which can cause blockages, chest pain, shortness of breath, or a heart attack (see "How Plaque Can Become a Heart Attack" on the next page). To prevent plaque, you generally want to get your LDL as low as it can go.

What Moves the Needle

If you're overweight, the most important thing you can do to reduce your LDL is lose weight, says Dr. Roizen. You should especially focus on your waistline. "The fat around your belly releases proteins and hormones that can make your LDL higher and raise your blood pressure and your risk of diabetes," says Dr. Andersen. That means cutting the simple-carb calories that go right to your belly -- sugary stuff like sodas, candy, cakes, white breads, rice, and pasta.

Processed foods containing trans fats are harmful, too. Fish oils and plant fats tend to be okay. If you're not overweight and don't have a big waist but your LDL is still high, then you need to try lowering your intake of meat and dairy products, too, says Dr. Andersen. It can be tough to eat an almost vegan diet, she says, but those who do it really see a dramatic reduction in their LDL. Working out more is also effective. When lifestyle efforts don't reduce your LDL enough, your doctor will probably suggest that you go on statin drugs (see "Who Should Take Statins?" on the next page).

The Good Guy: HDL

What's ideal: Over 50

HDL, or high-density lipoprotein, can actually take some of the LDL from your plaque and return it to your liver, where it's processed and disposed of, says Dr. Roizen. Not only does HDL help prevent new gunk from accumulating in your arteries, it can reduce what's there. Women tend to have higher HDL than men do. But the benefits of a high HDL level don't cancel out the bad effects of a high LDL level, says Dr. Andersen. You have to work on improving both numbers to really make a difference in your heart health.

What Moves the Needle

HDL is much more difficult to manipulate than LDL, but experts agree that aerobic exercise is key. "It can take a lot of physical activity, like running a few miles a day, to really bring up your HDL level," Dr. Andersen says. "But any amount of physical activity can improve the quality of your HDL, so that it works better."

"We don't have really good data on this yet," says Dr. Roizen. "But it appears that a little more intense aerobic exercise is much better than a lot of milder exercise. You need to raise your heart rate, but whether you get there from doing cardio or from intense weight training that gets your heart rate up doesn't seem to matter."

Taking niacin (vitamin B3) supplements has also been shown to increase HDL and decrease the risk of stroke and heart attack. Dr. Andersen suggests that you talk to your doctor first to determine the right dose. One side effect to watch for: Niacin can make you flush. Taking it at night may help; so can taking a baby aspirin or 325-mg adult dose aspirin 30 minutes before taking the niacin. Aspirin also has anti-inflammatory effects that can help your heart, but it can cause bleeding problems, so ask your doctor before you take it.

As for food, omega-3s, which are in walnuts, fish oil and algal DHA supplements, can raise HDL, says Dr. Roizen. A moderate amount of alcohol may raise your HDL, too. "I don't tell women who don't drink to start drinking, but one drink a day or maybe two has been shown to improve cardiovascular health in women and improve their HDL," says Dr. Andersen. But alcohol can also increase your risk of breast cancer, so you have to factor in your family history and other risks.

Continued on page 2:  More Crucial Info


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