Manage Your Cholesterol to Improve Your Heart Health
The heart muscle thrives on a continuous supply of oxygen-rich blood from arteries on its surface, called coronary arteries. When cholesterol builds up in the arteries, blood flow slows down, and the result can be chest pain, or angina.
The accumulated cholesterol in the arterial walls are called plaques. These plaques are unstable; when they rupture, a clot forms at the site and cuts off blood supply. The result is a heart attack, or even a stroke. The higher your cholesterol is, the greater your risk for such events.
This is why it is so important to keep your cholesterol under control. As most people know, there are two types of cholesterol to be concerned with, one bad, one good.
Low density lipoprotein (LDL) is the bad kind. “Everyone should shoot for LDL cholesterol levels of less than 100 mg/dL,” says Arun Karlamangla, MD, assistant professor of medicine at the David Geffen School of Medicine at UCLA. “This recommendation is even stronger for people who have suffered a heart attack or have diabetes.”
High density lipoprotein (HDL) is good cholesterol. “Men with HDL under 40 mg/dL and women with HDL below 50 mg/dL are at higher risk for heart disease,” says Dr. Karlamangla.
Exercise, not smoking, and losing weight can help you boost your good cholesterol. For most adults, a total cholesterol level of 240 mg/dL or above is considered high; levels between 200-239 mg/dL are risky. And again, people with diabetes or a history of heart problems need to strive for even lower levels. Those who can-not bring their cholesterol down to a healthy level with diet and exercise may need prescription medications.
Statins—The best defense
There are several different types of drugs used to treat cholesterol problems.
Statins are the most popular cholesterol-lowering drugs, and are often the first line of treatment. These medicines lower bad LDL cholesterol more than any other type of anti-cholesterol drug. “Anyone in the 40- to 70-year range with high cholesterol should be taking a statin,” Dr. Karlamangla says.
Statins are usually taken or with a meal. Side effects may include stomach pain and constipation. In rare cases, muscle problems may occur. “The goal of cholesterol-lowering treatment isn’t to reduce LDL cholesterol levels; it’s to prevent heart attacks and strokes,” says Dr. Karlamangla. Most anti-cholesterol drugs generally help prevent new cholesterol plaques from forming in the arteries.
“In addition to preventing new plaque formation and reducing existing plaques, statins also stabilize existing plaques and prevent their rupture, a benefit not seen with other classes of cholesterol-lowering drugs. Anyone, of any age, who has had a previous heart attack, stroke, coronary bypass, or angioplasty, or has diabetes, should be taking a statin,” Dr. Karlamangla adds.
Other medications
Bile acid sequestrants help the intestines get rid of bad LDL cholesterol. The drug comes in powder or tablet form. The powder must be mixed with water or juice. Tablets should also be taken with plenty of water to prevent constipation, bloating, nausea, and gas.
Nicotinic acid (niacin) is a type of vitamin B that prevents the liver from making blood fats. Warning: Over-the-counter niacin should never be used as a substitute for prescription niacin. Many people cannot toler-ate the side effects, which include flushing of the face and neck, stomach upset, diarrhea, and increased blood sugar (glucose).
Fibrates decrease the amount of fats (lipids) in the blood. Fibrates are usually taken twice a day with meals. Such drugs increase the risk of gallstones.
Cholesterol-absorption inhibitors are among the newest types of anti-cholesterol drugs. Unlike other drugs that work mainly in the liver, these medicines work on the digestive track. The most common side effects are stomach pain and fatigue.
Managing your medications
Just because you take drugs to control your cholesterol doesn’t mean you can forego diet and exercise. While a big, juicy steak may be okay on special occasions, it’s best to choose foods that are low in saturated and trans fats and cholesterol.
If you take a statin, you should not eat grapefruit or drink grapefruit juice. Grapefruit causes the body to slow the breakdown of these drugs. This increases the risk for side effects.
Exercise is an important component of a heart-healthy regimen. Everyone should get at least 30 minutes of moderate to vigorous exercise on most days. Regular exercise can boost HDL cholesterol and reduce LDL. “Exercise not only improves bad cholesterol levels, it also directly lowers your risk for heart attacks and strokes,” says Dr. Karlamangla. “If you get your exercise from walking, buy a pedometer and make sure you walk at least 5,000 steps a day.”
Always take your medicine as directed, and never stop taking it unless your doctor tells you to. High cholesterol has no symptoms—just because you feel better doesn’t mean your cholesterol is under control.
You should also tell your doctor about any other medicines you take, including vitamins and supplements. Some cholesterol-lowering drugs can interfere with other prescription medicines, so be sure to let your physician know everything that you are taking to avoid interactions.
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