High cholesterol speeds up the clogging of arteries, making it a major player in heart attacks, strokes and blood clots. Cutting down your cholesterol levels can play a big role in living longer and healthier.
“It’s probably one of the most under-recognized problems from a cardiovascular standpoint,” said Dr. Nathaniel Valin, a cardiologist at AdventHealth Daytona Beach, formerly Florida Hospital Memorial Medical Center.
The latest American Heart Association (AHA) guidelines reinforce these findings. We talked to two AdventHealth doctors who specialize in preventing and treating heart disease to come up with five takeaways you can apply to your life.
1. Lifestyle Remains First Priority
The new guidelines don’t change the primary recommendation to prevent the clogging of arteries.
“In all individuals, a healthy lifestyle is a mainstay of prevention,” said Dr. Amit Nanavati, an interventional cardiologist at AdventHealth Palm Coast, formerly Florida Hospital Flagler. As an interventional cardiologist, Dr. Nanavati diagnoses and performs procedures to open blood vessels.
The four biggest lifestyle modifications you can make, according to the latest AHA guidelines, are:
- Don’t smoke
- Stay at a healthy weight
- Be physically active
- Eat healthy food
To that last point, Dr. Valin recommendsthe DASH eating plan, which is short for Dietary Approaches to Stop Hypertension. The plan, which is available online, is promoted by the Centers for Disease Control and Prevention and has some of the strongest scientific evidence.
“If you start these changes early, your likelihood of heart disease later on in life is significantly reduced, both for people with and without established heart disease,” Dr. Valin said.
2. A Personalized Approach Works Best
General recommendations for cholesterol often focus on what works for large groups of people. But your personal risk for heart disease depends on the particulars of your health and family history. In other words, there’s no such thing as an average patient or an average heart.
“The best guidance I have is for patients to consult with their physician and find the best approach for them,” Dr. Nanavati said.
That’s because your risk for heart disease isn’t determined solely by only a few things; it’s a combination of your family history and many facets of your personal health. The new guidelines call them “risk-enhancing factors,” and they include the following:
- A family history of early clogged blood vessels (before age 55 in men or age 65 in women)
- Having a certain race or ethnicity (having South Asian ancestry, for example)
- Having metabolic syndrome (a group of conditions including having a bigger waist, high levels of fat in your blood, high blood pressure, high blood sugar and low good cholesterol)
The first step to determining your risk is to have your levels of LDL (or “bad”) cholesterol checked.
“With this very individualized approach, knowing your LDL level is helpful in determining what future therapies should be,” Dr. Nanavati said.
Men should get tested once they reach age 35, or 20 if they have risk factors. For women, testing is recommended at age 45 or 20 with risk factors.
3. Learn Your Target Level
Learning your risk factors is important in part because it determines how aggressive you and your doctor should be in controlling your cholesterol. This makes sense — if you have a high risk of cancer, for example, you’d want to be more vigilant about testing.
Cholesterol is measured in the blood in units of milligrams per deciliter (mg/dl), and people with levels of 100 mg/dl and below generally have low rates of artery blockage.
In general, the lower LDL cholesterol the better. Each person’s target cholesterol level will be different, but in general,people at high risk should lower their levels to 70 mg/dl. People who’ve already had a heart attack or other heart damage should lower their LDL to half of its previous number.
4. It’s a Lifelong Process, Not Just for Older Adults
Though older adults face higher rates of heart disease, cholesterol is not safe to ignore for everyone else. The steps that you take when you’re younger can protect you decades later.
“Cardiovascular disease is a lifelong process that starts early and progresses,” Dr. Valin said. “It needs to be recognized a lot earlier for prevention of coronary disease in later life.”
5. Learn About Your Medication Options — and Take Them
Repeated studies have left little doubt on the matter: Medicine to control cholesterol not only lowers your levels, but it also reduces your risk of heart disease. One 2016 summary of ten studies found reducing cholesterol by about 39 mb/dl reduced the risk of heart attack or a similar event by 24 percent.
Dr. Valin says there are three general tiers of anti-cholesterol medications. The first and most common are called statins, including brand names like Lipitor and Crestor.
If these don’t work, a medication called Zetia is sometimes used.
Finally, for patients whose cholesterol still hasn’t dropped, a new class of drugs called PCSK9 inhibitors is sometimes an option.
But these drugs are much more expensive than the alternatives. Even after a recent 60 percent price cut, one popular option costs about $6,000 a year.
“One thing we don’t recommend for people is to take over-the-counter supplements,” Dr. Valin says. Garlic and vitamins haven’t been shown to reduce heart disease risk.
Even when patients are prescribed medication, many don’t fill their prescription or stop taking it. Dr. Valin says patients sometimes stop taking cholesterol medication because they feel healthy or because it’s causing side effects like muscle aches. If side effects are impacting your daily life, ask your doctor if there could be a different medication right for you.
Dr. Nanavati agreed and said some people with very high cholesterol should generally start taking medication right away, even before they undertake needed lifestyle changes.
“If you’re in your 50s, you’ll reap the benefit of these medications 10, 20, 30 years down the line,” Dr. Valin said.
Even so, cholesterol control is no guarantee of heart health. Instead, it’s one piece of your whole health that you can monitor with your doctor’s help.
AdventHealth partners with patients to take control of their own heart health. It also recognizes the connections between our bodies and solid emotional and spiritual health.