By Ernst Lamothe Jr
High cholesterol is often called a silent health problem because most people feel perfectly fine while it quietly damages the body. Yet it remains one of the leading contributors to heart disease and stroke in the United States.
Cholesterol itself is not inherently bad — it is a waxy substance the body needs to build cells and produce hormones.
Problems arise when levels become too high, especially low-density lipoprotein (LDL), often referred to as bad cholesterol. When LDL builds up in the bloodstream, it can form plaque inside artery walls, narrowing blood vessels and increasing the risk of serious cardiovascular events.
“High levels of LDL can cause buildup of fatty deposits in the blood vessels, which is the major cause of cardiovascular events such as heart attacks, strokes, and lower extremity or peripheral artery disease,” said physician Robert Block, a UR Medicine Cardiac Care cardiologist specializing in the care of individuals with lipid disorders.
The American Heart Association and National Lipid Association recommends checking cholesterol levels once between the ages of 9 and 11 years and again between the ages of 17 and 21 years for children and young adults without other risk factors or a family history of early heart disease.
Block discusses five aspects of high cholesterol.
1 — Active, fit individuals also have high cholesterol
A common myth is that only overweight people have high cholesterol. In reality, individuals who are thin, active or appear healthy can still have elevated cholesterol levels. Another misconception is that diet alone causes high cholesterol. While diet plays a role, genetics, age and other health conditions also contribute.
“People of any body type can have high cholesterol. Being overweight or obese increases your chances of having high cholesterol but being thin doesn’t protect you. Regardless of your weight, diet and level of physical activity, you should have your cholesterol checked on a regular basis,” said Block.
“You can take charge of your health. If you are 20 or older, ask your health care professional to conduct a cholesterol test, assess your risk factors and determine your risk for heart attack or stroke,” he added. “If you’re between 20 and 39, your health care professional should assess your lifetime risk.”
2 — High cholesterol means higher risks for heart attack, stroke
The greatest risks include heart attack, stroke and peripheral artery disease. Because plaque buildup develops gradually, many people are unaware of the danger until a serious event occurs.
“High LDL and non-HDL greatly increase risk of heart attack, stroke, peripheral vascular disease, coronary artery bypass surgery and coronary artery stenting and death outcomes,” said Block. “Reducing LDL is one of the most powerful strategies available to prevent heart attacks and strokes across diverse patient populations.”
3 — Effective lifestyle changes
Healthy lifestyle choices are a first line of defense. These include eating a heart-healthy diet rich in fruits, vegetables, whole grains and lean proteins; limiting saturated and trans fats; exercising regularly; maintaining a healthy weight; and avoiding tobacco use.
“Severe health conditions happen when the blood vessels get clogged with fatty deposits, restricting blood flow. To lower these risks, doctors often recommend that people with hyperlipidemia try to lower their cholesterol levels through a combination of dietary changes, exercise and medication,” said Block.
Experts also suggest consuming a heart-healthy diet such as replacing butter with vegetable oils, increasing soluble fiber and eating more nuts and fish, which is recommended by the American Heart Association and National Lipid Association.
4 — Genetics matters
Some believe genetics don’t play a significant role. That’s incorrect. Conditions such as familial hypercholesterolemia cause extremely high cholesterol levels that run in families. If a parent or close relative has had high cholesterol or early heart disease, others in the family may also be at higher risk.
“Familial hypercholesterolemia or FH is a genetic condition where people have very high levels of a type of cholesterol in their blood called low-density lipoprotein cholesterol People who have this condition are at higher risk of early heart disease,” said Block.
A normal total cholesterol level is approximately less than 200 mg/dL, but people with FH may have a cholesterol level in the 350 to 500 mg/dL range. Untreated individuals with FH have approximately 20 times higher risk of early onset heart disease compared with people with normal cholesterol levels, he said.
5 — When might statins be recommended?
Physicians may prescribe statins when lifestyle changes alone are not enough, particularly if LDL cholesterol remains high, if a patient already has heart disease, diabetes, multiple cardiovascular risk factors or if there is a strong family history.
“Adults with a greater LDL than 190 would be candidates for statins,” said Block. “Anyone with known cardiovascular disease like a past heart attack, stroke or peripheral artery disease are patients where physicians could recommend it as well.”