Serum Cholesterol & Cardiovascular Disease
Chester J. Zelasko, Ph.D. | February 18, 2003

Cholesterol has been talked about for over 20 years as being related to cardiovascular disease (CVD). While Total Serum Cholesterol (T-CHOL) is one indication of CVD risk, there is a lot more to it than that. Recently, the National Cholesterol Education Program announced its Adult Treatment Panel III recommendations for Goals and Treatment of cholesterol levels (1). This Newsletter summarizes those recommendations by answering a series of questions we often get at Better Life Unlimited. Be sure to discuss any changes in your lifestyle with your healthcare professionals--they should be your partners in health.

At what age should I start to get my cholesterol levels tested?
All adults should have a baseline fasting lipoprotein panel at 20 years of age. Lipoprotein literally means "fat protein" and reflects the different types of protein containers that carry cholesterol around in the blood. It should then be repeated every 5 years if the numbers are acceptable but repeated more often if they're higher than desirable.

A fasting lipoprotein panel includes:

  • Total cholesterol (T-CHOL)
  • Low-density lipoprotein cholesterol (LDL)
  • High-density lipoprotein cholesterol (HDL)
  • Triglycerides (TG)
What should my cholesterol level be?
The following Table gives the NCEP Adult Treatment Panel III Classifications for the different serum cholesterol levels. The top line below each type of cholesterol signifies the Desirable or Optimal Levels, and numbers are expressed in mg/dl or milligrams per deciliter.

Total cholesterol LDL cholesterol HDL cholesterol
< 200 (5. 0 mmol/L) Desirable < 100 (2.6 mmol/L) Optimal > 60 (.6 mmol/L) High
200-239 (5.2-6.2 mmol/L) Borderline High 100-129 (2.6-3.4 mmol/L) Near Optimal < 40 (1.0 mmol/L) Low
>240 (6.2 mmol/L) High 130-159 (3-4-4.1 mmol/L) Borderline High
160-189 (4.1-4.9 mmol/L) High
>190 (4.9 mmol/L) Very High

In the case of HDL cholesterol, the higher the number, the better; in the other Total and LDL cholesterol, the lower the better.

What are some of the risk factors for CVD that I should pay attention to besides T-CHOL?
The Adult Treatment Panel III identifies the following as risk factors for an increased risk of CVD in addition to your cholesterol levels:

  • Cigarette smoking
  • Hypertension (blood pressure higher than 140/90 mm Hg or you take antihypertensive medication)
  • Low HDL cholesterol (< 40 mg/dl)
  • Family history of premature CVD (your father or brother had CVD before 55, or your mother or sister had CVD before 65)
  • Age (men: you're over 45; women: you're over 55)
Diabetes is missing from the list. That's because diabetics are considered to have the equivalent of CVD according to the new recommendations.

You can't change your family history and you can't get younger. The rest of the items on the list can be positively modified with lifestyle changes. Your goal is to get the lipid profile into the optimal or normal ranges, especially the LDL cholesterol.

If the important thing is to change my LDL cholesterol level, how do I do that?

The Adult Treatment Panel III recommends several lifestyle changes that are effective in lowering LDL levels. Why lifestyle changes first? Because they're the most cost-effective means to reduce risk for CVD. Try to implement all of these changes:

  • Reduce saturated fat intake to less than 7% of daily calories.
  • Increase physical activity to 30-60 minutes every day.
  • Lose weight if you need to--cholesterol levels can be tied to higher body weight.
  • Increase soluble fiber intake to 20-30 grams per day.
  • Increase intake of stanols and sterols from plants. They have a similar structure to animal cholesterol and compete for binding sites in the digestive system. They're found in whole grains such as wheat, corn, rye, and oats, in olive oil, and in the margarine BenecolĀ®.
I just returned from my doctor and he recommended that I take a drug to lower my cholesterol. I don't want to take medications. What should I do instead?
Do what your physicians recommend--they're in charge of your healthcare. If they recommend a medication to lower cholesterol, you should take it. How long you have to take it is up to you. Why? Because chances are he or she would not have recommended a medication unless you already have CVD, have not made lifestyle changes the two of you previously discussed, or because the LDL cholesterol levels were dangerously high.

If you really don't want to take the medication forever, change your lifestyle. Get your weight to normal. Eat less, and especially eat less saturated fat and refined carbohydrates. Eat more fruits and vegetables and drink more tea--both green and black. Exercise regularly, and pump up the volume once you achieve a higher fitness level. Don't smoke. Take a quality fish-oil product every day. Manage stress better.

It won't happen overnight, but if you make your cholesterol a priority, you may be able to reduce or eliminate the medication. But if you do all you can and your LDL cholesterol is still too high, then continue on the medication. It's really that important.

Reference:

  1. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) JAMA; 2001. 285 (19) 2486-97.
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