High cholesterol is common. In fact, more than one-third of American adults have been diagnosed with it. Many more may have it without even knowing.¹

That's because high cholesterol has no symptoms. But it can still put you at risk of heart disease, says Louis Gleckel, MD. He’s an internist and cardiologist (heart doctor) at ProHealth, part of Optum, in Lake Success, New York. Heart attacks and strokes, two types of heart disease, are among the most common causes of death around the world, reports the World Health Organization.²

Your first line of defense? Knowing your cholesterol numbers and keeping them in a healthy range. Dr. Gleckel helps answer your top questions about how to get there.

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What is high cholesterol?

When we talk about cholesterol, we’re usually talking about the amount of fat in your blood. Doctors measure four different things: total cholesterol, low-density lipoproteins (LDL), high-density lipoproteins (HDL) and triglycerides. You may hear this called a lipid panel, which consists of the four numbers grouped together.

• Total cholesterol is exactly what it sounds like: the total amount of cholesterol in your blood. Aim for 200mg/dL or less.³

• LDL cholesterol is “bad” cholesterol. It causes fatty buildups in the arteries, which increases the risk of a heart attack or stroke. Aim for 100mg/dL or less.³

• HDL is “good” cholesterol. It carries the bad LDL away from the arteries and back to the liver. Then it’s broken down and passed from the body. Men should aim for 40mg/dL or higher. Women should aim for 50mg/dL or higher.³

• Triglycerides are a different kind of blood fat. They’re the way the body stores extra calories, and they’re not part of your total cholesterol number. But like LDL, high triglycerides can cause buildups in the arteries, too. Aim for 150mg/dL or less.³

Looking at these four numbers together gives a clearer picture of your heart health, says Dr. Gleckel. The American Heart Association recommends that adults age 20 and older have their cholesterol checked every four to six years.⁴ If you’re older or have other risk factors, your doctor may want to check your numbers more often.

What causes high cholesterol levels in the first place?

Eating too much saturated fat, sugar and calories in general can raise bad cholesterol. Saturated fat is mostly found in meat and dairy products along with tropical oils like coconut and palm.⁵ Not being active can lower good cholesterol. Smoking is another cause. It can raise LDL and lower HDL cholesterol. And carrying extra weight in your belly can also boost your LDL levels, says Dr. Gleckel.

But high cholesterol isn’t just caused by what you eat or how little you move. Family history play a part, too. You can inherit medical problems that make it difficult for the body to handle cholesterol. One is called familial hypercholesterolemia. About 1 in 250 people have it.⁶ But you can have cholesterol problems without it.

“Sometimes you have bad genes, which aren’t your fault,” says Dr. Gleckel. “Your responsibility is to take care of it.”

What’s the best thing to improve your cholesterol?

“If their levels aren’t terribly high, I like to start with lifestyle changes,” says Dr. Gleckel. Making changes to your meals and moving more can make a big difference. “But it’s not easy,” he adds.

Exercise can increase HDL cholesterol and help with weight loss, if that’s a goal. You should aim to get at least 30 minutes of moderate physical activity on most days of the week. You know you’re working hard enough if you can talk but not sing. And being active doesn’t mean you have to hit the gym every day. Going on a few 10-minute walks each day could be a good place to start.

How can you change their eating habits?

Dr. Gleckel recommends cutting back on refined carbs. That includes pasta, white bread and sugary snacks and drinks. Those foods can raise LDL cholesterol and add to belly fat, he says. Swapping in whole grains and other high-fiber foods will improve your numbers. Good choices include vegetables, fruit, beans and legumes.

You may have grown up hearing that you need to eat low-fat foods and stay away from cholesterol. That has been largely debunked. Doctors now have a better understanding of the role of different kinds of fats.

• Trans fats are mostly artificially produced. They’re found in processed foods, although most food companies are phasing them out.⁷ Still, check labels on items like margarine and snack foods. You want to see zero grams of trans fat.

• Saturated fats are found mainly in animal foods, including red meat and dairy. They should be limited, but you don’t need to cut them out completely. “You can have some steak on a special occasion, maybe once a week, but not every night,” says Dr. Gleckel.

• Unsaturated fats are the “good” fats. They can help raise your good cholesterol and lower the bad. They’re found in plant foods such as nuts, seeds, avocados, olives and plant-based oils, as well as in fish. Tip: Use olive oil in place of butter when cooking.

Your doctor can help you adopt a heart-healthy eating plan. You can also ask to see a registered dietitian. They can look at what you eat and help you set goals.

What advice do you give to patients to help them make these changes?

“I tell people to pay attention to how they shop, because how you shop is how you eat,” says Dr. Gleckel. And be sure to involve the whole family. If you’re not the one doing the shopping and cooking, get that person on board. Plus, it’s easier to make lasting changes if the whole household is committed. What if you’re the only one with high cholesterol? Everyone can benefit from eating a little better and moving more.

Use exercise as a time to connect with your family, he says. Go for a bike ride or play a sport with your kids. Take a walk after dinner with your partner or a friend. It can be a chance to decompress and chat at the end of the day.

Your family can keep you motivated and hold you accountable. “If you have teenage [or adult] kids and they know you have a cholesterol problem, they’ll push you to do better. They don’t want to lose you,” he says.

Does everyone with high cholesterol need medication?

Medications can help lower cholesterol, but they’re not always necessary. “Not everyone can change how they live,” Dr. Gleckel says. At least not overnight. If it’s important to improve your numbers quickly, your doctor will likely prescribe a drug called a statin to help.

More than 40 million American adults take statins.⁸ They reduce the amount of cholesterol your body makes and help it get rid of the excess. “They save a lot of lives,” says Dr. Gleckel.

Statins are safe for most people, and they don’t have many side effects. They can cause joint and muscle pain, though. Dr. Gleckel often prescribes a Co-Q10 supplement to his patients to help with the pain. Ask your doctor if that may be right for you.

Q. Do you have to take statins for the rest of your life?

A. “If you start on statins, you are usually on them for the rest of your life,” Dr. Gleckel says. “But not always.” You should continue working on eating better and moving more, even if you’re taking medication. Eating well and exercising have a lot of other benefits. And eventually it may be enough to keep your cholesterol in check without medication.

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