This substance can be harmful—or helpful—to your arteries. The trick is to boost the good kind and slash the bad.

By Sunny Sea Gold
August 13, 2019

Cholesterol performs more than one vital job: The fatlike substance is a building block for the intestinal acids that digest your food, it helps keep cell walls healthy, and it allows your body to produce all-important vitamin D. Like most things in life, however, too much can be problematic.

“One myth that patients often bring up is: ‘I heard cholesterol doesn’t really matter anymore, that heart risk is more about inflammation,’ ” says Suzanne Steinbaum, DO, a cardiologist at the Mount Sinai Hospital and volunteer medical expert with the American Heart Association’s Go Red for Women campaign. While inflammation is important, cholesterol absolutely still matters, she says. One large study published in the journal Circulation in 2015, for example, found that for every decade that someone was living with high “bad” cholesterol, their chances of having a heart attack or stroke increased by 40 percent above their normal risk level.

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But here’s the most important message doctors want to get out: “We have so much more control over cholesterol than people think,” says Dr. Steinbaum—meaning simple, everyday choices can make a real impact on your cardiovascular health.

The Different Types

All it takes to check your cholesterol is a blood test. (You can even use a DIY test kit.) You’ll get results for two kinds of lipo-proteins, or cholesterol-protein combos, traveling through the bloodstream. Low-density lipoproteins (LDL) combine with other substances to form sticky plaque buildups on the walls of your blood vessels; that contributes to blockages and narrowing of the arteries that can ultimately damage your ticker. “I tell my patients LDL is lousy, so the lower the better,” says Dr. Steinbaum.

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High-density lipoproteins (HDL), on the other hand, act like a garbage collector in your blood, picking up LDL, and sending it to your liver to be broken down and excreted from the body. “Good cholesterol is really protective and guards the lining of your arteries,” says Dr. Steinbaum. “Think of HDL as happy, and the higher it is, the better.

There is one other result that will show up on a cholesterol panel—triglycerides. These lipids are made of extra calories your body doesn’t need right away. They are stored in fat cells to be used as energy later on. But when triglycerides get too high, they contribute to the buildup of artery plaque, says Tamara Horwich, MD, medical director of the UCLA Cardiac Rehabilitation Program. According to research, people with elevated triglycerides are at increased risk of heart disease even if their HDL and LDL levels are perfect. 

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Rising Levels

For many people, the main risk factors for high cholesterol and triglycerides are an unhealthy diet and a lack of exercise, says Dr. Steinbaum. But age counts, too. As you get older, your liver isn’t as efficient at removing LDL from the bloodstream, so levels tend to rise. At the same time, dropping estrogen levels during menopause push women’s HDL down and LDL up, Dr. Steinbaum adds. Medications such as birth control pills can also elevate triglycerides.

Some people are actually born with out-of-whack cholesterol levels, thanks to genetic mutations known as familial hyper-cholesterolemia. (Some DNA tests, like 23andMe and Helix, can tell you if you’re predisposed to the disorder.) “People think ‘Oh, it’s fine, that means my high cholesterol is genetic and I don’t have to worry about it,’ ” says Dr. Steinbaum. “What it really means is that you have to be more aggressive about treating it. Women with familial hyper-cholesterolemia who aren’t on cholesterol-lowering medications have a higher risk of heart attack before the age of 60.”

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Getting Control

If your cholesterol isn’t in the normal range, adopting a few healthy habits can go a long way: “Most of us can change our numbers through how we choose to live our lives,” says Dr. Steinbaum.

For starters, design a workout routine you can stick to: Exercise is the best way to boost helpful HDL, and it also slashes triglycerides. So aim for 150 minutes of moderate aerobic exercise (or 75 minutes of high-intensity activity) a week— some additional strength training, says Dr. Horwich.

In terms of your diet, try to limit refined carbohydrates and saturated fats (especially in processed and deep-fried foods). Gobbling up too much sugar and other refined carbs boosts triglyceride levels, while saturated fat hikes up LDL.

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Instead, focus on nutrient-rich plants and lean proteins: “Envision yourself on the beaches of Greece, and think about everything that you’d ever want to eat there—the vegetables, whole grains, and fresh seafood. That’s what you want to eat at home, too,” says Dr. Steinbaum.

It can also help to choose specific foods proven to lower LDL, including oats, barley, beans, nuts, and fatty fish like salmon or albacore tuna. And finally, there are medications called statins that can raise HDL and significantly reduce LDL. They’re usually required for people who need to cut their LDL levels by half or more.

“Cholesterol is one of the most tangible and controllable parts of the heart-health issue,” says Dr. Steinbaum. “It’s very empowering to watch your numbers change for the better.”

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