Know Your Cholesterol

Heart Healthy Challenges

Your first step to heart healthy living is to assess your risk. Complete the heart healthy challenges by checking yes, no, or unknown.

Cholesterol

Cholesterol is a fat-like substance that is carried by the blood to all parts of your body. Your body uses cholesterol to produce hormones, vitamin D, and bile salts that help digest fat. Though some of the cholesterol comes from food (dietary cholesterol), your body makes the majority of it. If there is too much cholesterol in your blood stream, it may eventually collect on the walls of the blood vessels. In time, cholesterol may clog the blood vessels. If that happens, you could have a heart attack or a stroke.

The first step to reduce your risks of a heart attack or stroke is to have a complete fasting lipoprotein profile (TC, LDL, HDL, and TG). To ensure accuracy, you will be asked to "fast" or go without food and drinks (only drink water) for the 12 hours before the test. A significant amount of blood (more than a finger prick) is taken. This initial blood test gives all your numbers, not just a screening for your TC number. Every adult 20 years and older should have a fasting lipoprotein profile every five years. Find your numbers to know your risks and to determine your next step.

Total Cholesterol (TC) Number Target < 200 mg/dL

Many people attend health fairs and get a quick finger stick cholesterol test. This is a start to finding out about your heart health. Your total cholesterol (TC) number is the number of milligrams of cholesterol in a deciliter of blood (mg/dL). A TC number of 200 or less is good. However, if you have two or more of the risk factors listed, talk to your doctor about having a complete fasting lipoprotein profile (TC, LDL, HDL, and TG).

A TC number between 200 and 239 may indicate a problem, especially if you have two or more of the risk factors. If your TC number is 240 or above, you should see your doctor for a complete fasting lipoprotein profile even if you do not have any of the other risk factors.

The doctor or lab report may give you a TC/HDL ratio number. The ratio number is calculated by dividing the TC number by the HDL-cholesterol number. In general, numbers less than five are associated with a decreased risk of heart disease. Make sure to ask your doctor to clarify the ratio number and how it was calculated.

Bad Cholesterol (LDL) Target < 100 mg/dL

The new cholesterol guidelines focus on lowering LDL-cholesterol as the primary focus for heart disease prevention and therapy. The cholesterol in LDL is carried to the tissues and may be deposited in the blood vessels. LDL-cholesterol is known as the "bad" cholesterol. Thus, a smaller LDL number or a LDL number less than 100 is more beneficial than a higher one.

An LDL number of 160 or higher is a high risk factor. A number between 130 to 159 is considered a borderline risk factor. You can lower high LDL-cholesterol and raise low HDL-cholesterol numbers by making dietary and lifestyle changes.

• Reduce intakes of saturated fat and cholesterol.
• Increase physical activity.
• Maintain optimal weight to lower cholesterol and reduce risk factors.

Your doctor will retest your blood with another fasting lipoprotein profile (TC, LDL, HDL, and TG) about one to eight weeks after the initial test. The doctor will decide on the best dietary, lifestyle, and medical treatment primarily based on your LDL number. Persons with a history of heart disease may be put on a very restricted diet with medications and therapeutic lifestyle changes.

Good Cholesterol (HDL) Target > 40 mg/dL

Cholesterol has to combine with protein to get through the blood vessels. HDL, a high density lipoprotein, is made up of lipids (another word for fat) and protein. HDL has more protein than fat and appears to carry the cholesterol it contains to the liver for excretion. HDL-cholesterol is known as the "good" cholesterol. The new guidelines are more strict by raising the low HDL number from <35 to <40 mg/dL. An average HDL number is in the mid-forties range for a man and in the fifties range for a woman. An HDL number of less than 40 is considered a major risk factor for CVD. A HDL number of 60 or more is very good. Therefore, you want a high or large HDL number because that indicates a high level of this good cholesterol in your blood and less risk of heart disease.

Triglycerides (TG) Number Target < 150 mg/dL

The new guidelines include a high triglyceride (TG) number, which is another risk factor for heart disease. Triglycerides in the blood are made from fats eaten in foods, or are made in the body from other energy sources, such as carbohydrates or sugars. Excess or high levels of triglycerides (hypertriglycerides) are a heart disease risk factor. The doctor may give persons with a triglyceride level -200 mg/dL additional medical treatment beyond cholesterol lowering treatments.

Multiple Coronary Heart Disease Risk Factors (CHD)

Persons with multiple (2 or more) risk factors have an increased risk for CHD and, therefore, need more intensive prevention measures. For example, diabetes increases risk for CHD complications. People with diabetes (insulin or non-insulin dependent) have a higher risk of new CHD within 10 years of a diabetes diagnosis.

Some CHD risk factors are inherited, but other factors can be changed or modified. Check the following risk factors you can change or modify.

Non-modifiable Risk Factors

• Age: Male 45 years or older; Female 55 years or older
• Family history of premature CHD in parent or sibling before 55

Modifiable Risk Factors

• High Total Cholesterol
• High LDL-Cholesterol
• Low HDL-Cholesterol
• Diabetes
• Obesity/overweight
• Physical inactivity
• Cigarette smoking
• High blood pressure

Dietary and Lifestyle Changes

How can you keep your blood cholesterol at a low level? Consider making these lifestyle changes. Check with your doctor to see what kind of exercise is best for you. Walking, gardening, bicycling, swimming, and aerobic exercise classes are all possibilities.

• Get plenty of exercise
• Stop smoking
• Keep your weight down
• Lose those excess pounds, if you are overweight
• Learn to deal with stress

Also, make some dietary changes. Are you eating a variety of foods according to the Food Guide Pyramid? It is important for persons with borderline or high LDL levels to lower the amount and type of fat as well as the amount of cholesterol in their diets. Fewer than 30 percent of your total calories should come from fat. More of the fat should be monounsaturated (15 percent) than polyunsaturated (about 7-9 percent) or saturated (less than 7 percent).

Healthy Eating Check-Up

How are your eating habits? Complete the check-up to find out. Check yes or no to each question.

Choose foods low in saturated (animal) fats

• Choose lean meats, poultry, and fish – 5 to 6 ounces per day.
• Remove as much of the visible fat in meats as possible.
• Bake, grill, broil, or stew meats.
• Drink skim or low-fat milk.
• Cook with less fat.
• Select soft or liquid margarine or spreads that list liquid oil as the first ingredient.
• Limit deep fat fried foods.
• Choose foods low in total fat.
• Limit butter, margarine, salad dressing, sauces, and gravy.
• Use yogurt to replace sour cream as yogurt has less fat and fewer calories. Frozen yogurt may have less fat than ice cream but not fewer calories.
• Use oil, or soft or liquid margarine instead of solid shortening.

Choose foods low in cholesterol

• Decrease egg yolks, liver, heart, brains, and other organ meats that contain a lot of cholesterol. Limit eggs to four or fewer per week or use egg whites.

Choose foods high in starch and fiber

• Eat lots of fruits, vegetables, and whole-grain breads, grains, and cereals.
• Add meat substitutes (dried beans, peas, and legumes) several times a week.
• Eat the "5 A Day" way. Choose a variety of colorful fruits and/or vegetables that add up to five a day.
• Limit cakes, cookies, pies, candy, and soft drinks, which are high in fat and/or sugar and low in fiber.

Daily Energy Needs

If your daily energy needs exceed 2,000 calories, labels on larger food packages have footnotes, like the one shown here, to help you. The amount of fat, saturated fat, and cholesterol needed for a 2,500-calorie diet is listed in grams. These amounts can be compared with those listed (in grams) in the nutrient list for a serving of the food. This will help you to determine what a food contributes to your diet.

A gram of fat has more than twice the calories of a gram of either carbohydrate or protein, so a diet low in fat can help you maintain a healthy weight.

Ingredient List

All foods made from more than one ingredient have an ingredient list. For example, bread, peanut butter, margarine, mayonnaise, and salad dressing are foods that have ingredient lists. Ingredients are listed in descending order by weight. Those present in the greatest amount are listed first, and those present in the least amount are listed last.

The list tells you the amount and type of fat in the food. If ingredients such as coconut oil, butter, cream, or palm oil are at the beginning of the list, the food contains a large amount of fat, especially saturated fat. If ingredients such as soybean oil, corn oil, or canola oil are at the beginning of the list, the product is high in fat, but the fat is unsaturated.

Food Preparation

In most cases, the amount of total fat, saturated fat, and cholesterol listed on the label refers to the amount present in a serving of food as it is packaged, or before you prepare it. If fats such as margarine, bacon, gravy, or cream sauce are used as seasonings, the amount of fat and cholesterol in a serving of the food increases. Therefore, it is important to limit fats used as seasonings. Alternatives are lemon juice, herbs, spices, and yogurt.

RETESTING: If your LDL-cholesterol was 130 or above, the doctor will probably want to check it again in about two months to see if it is coming down as a result of the changes that you have made in what you eat and do.

MEDICINES: Medicines are usually not prescribed until the doctor is sure that diet modification won't work.

What Are Your Cholesterol Numbers?

It is time to keep a record of your cholesterol and triglycerides numbers. Start monitoring your heart healthy improvements!

From your last cholesterol check, write down your numbers in the space below and keep it for your records.

print this table
	Date	Number	Date	Number
Total Cholesterol
LDL-Cholesterol
HDL-Cholesterol
Triglycerides