This year’s theme is “Know your cholesterol numbers—Know your risk—Give yourself some TLC” (therapeutic lifestyle changes).
Jennifer Robinson, MD, MPH, epidemiologist at University of Iowa Hospitals and Clinics, talks about cholesterol:
Why is it important for all adults to have their cholesterol measured?
Over a lifetime, cholesterol can clog up the blood vessels and cause heart attacks and strokes, and possibly even dementia or Alzheimer’s disease. So if we find somebody whose cholesterol is high, we can treat it and really significantly reduce the risk of these terrible problems.
Do exercise and weight gain/loss affect cholesterol levels?
Weight loss and regular exercise improves all of the cholesterol numbers. The bad cholesterol, or LDL, goes down and the good cholesterol, or the HDL, goes up and the triglycerides or blood fats also go down, so those are all beneficial changes. When people gain weight or stop exercising, all their numbers get worse.
I also want to put in a plug for exercise beyond just the cholesterol effects because we know that people who get exercise – meaning walking 30 minutes most days of the week – cuts in half the risk of diabetes and a number of other serious diseases, including cancer.
How important is it to read food labels when trying to reduce LDL cholesterol?
The main focus on the food label should be the percent of calories from fat. We want people to aim for 25 to 30 percent of daily calories from fat and that helps to reduce cholesterol levels. Also, saturated fat – from butter and dairy products, meat, and things like that, as well as baked goods – have a lot of saturated palm and coconut oils that make them last longer on the shelf. The saturated fat should be less than 7 percent and people should really focus on getting plenty of monounsaturated and polyunsaturated oils, because those help raise HDL and also appear to help prevent heart disease.
This is less of a focus on cholesterol, per se, because all animal food has a little bit of cholesterol. The focus should be on fat. Fiber is important too because we know that fiber helps to lower cholesterol levels, and people need to aim for about 25 grams of fiber a day. People can eat a couple of eggs a week, that’s OK.
People know the risk of smoking and cancer, but does smoking also affect cholesterol levels?
Smoking can lower good cholesterol or HDL a little bit, but what it really does is it multiply the effect of the high cholesterol level. Smokers have more heart attacks, more strokes, and actually are more likely to die about 10 years before non-smokers.
How much is our cholesterol level hereditary or linked to genetics?
Just about all of us, about 75 percent at least, have genetics where if we eat a high fat diet, don’t get enough exercise, and gain weight, our cholesterol levels get bad and harmful. About 20 percent of people have very high cholesterol levels that are familial hypercholesterolemia.
Just because someone is genetically at risk to develop high cholesterol, are there steps they can take to keep their cholesterol levels down?
Lifestyle is always extremely important, so we talk about diet and regular exercise, controlling weight, not just focus on the cholesterol but also preventing diabetes and other things. But there are a number of very effective drugs on the market – they’re called statin drugs – and what they do is they block cholesterol synthesis in the liver. And if you use statins, they can lower the LDL or the bad cholesterol by about 50 percent and that translates into about a 50 percent reduction in heart attack and stroke risk.
How safe are statins, the groups of medications used to lower cholesterol?
They’re very safe. They get a lot of bad press, and I’m not sure why, basically people who take statins have about a 20 percent reduction in the risk of dying over five years. The main concern that people have are achy sore muscles and I’d say about one in 200 people has achy sore muscles that are truly due to a statin – we all have achy sore muscles, I think, as we get older – but most of the time we can find a statin that people can take, that they can tolerate some dose of.
Are there any new drugs for treating cholesterol?
We’re doing a number of studies with a number of new agents that block cholesterol synthesis and kind of downstream from the statin drugs. There are some drugs that block cholesterol from the diet being taken up by the intestines. And then there are some just brand new agents that block other pathways in the liver and things like that, so our hope is we can really get everybody’s cholesterol levels to very low levels and basically, in people who have heart disease, start dissolving their blockages and then in people who don’t have heart disease – prevent them from ever getting it, so that’s quite exciting.
Once a person is prescribed a cholesterol lowering medication, will they take it the rest of their lives?
Yes, as long as you keep eating, you’ll keep taking cholesterol drugs. They only work if they’re present in the blood. |
