True or False?

The lower my cholesterol, the lower my risk for heart disease.

True and false. The statement above is true. According to the statistics, your risk for heart disease is lower when you have low total cholesterol and low LDL (low density lipoprotein) cholesterol. LDL cholesterol is the fatty substance that is most related to arterial blockage.

The statement above is also false. Your risk for heart disease is actually higher if you have a low HDL (high-density lipoprotein) cholesterol level. HDL is the "good" cholesterol; it carries fat out of the coronary arteries.

If a product's package reads "low cholesterol," it is low in fat and safe to eat.

False. A lot of foods marked "low cholesterol" contain oils that may be high in saturated fats and transfats, substances that research suggests may be as bad if not worse for you as cholesterol. Unsaturated fats, such as vegetable oils, are also high in calories.

Remember, all fats are high in calories — 1 gram of fat has 9 calories. Protein and carbohydrate each have 4 calories per gram. It's true that we all need some fat in our diets.

Unsaturated fats are considered the healthiest fats because they improve cholesterol levels, help reduce inflammation (a risk factor for heart disease) and help decrease the overall risk of developing heart disease. The main source of unsaturated fats is plant-based foods. Of the unsaturated fats, monounsaturated fats are one of the healthiest, and include fats such as olive oil, canola oil, peanut oil, most nuts, nut butters, seeds, olives and avocados. Monounsaturated fats do not increase blood cholesterol when included in a low-fat meal plan.

Other unsaturated fats include polyunsaturated fats with sources that include: corn oil, soybean oil, safflower oil, flax, sunflower, walnuts, and fish.

The total amount of fat in your diet should be about 25-35% of your daily intake (or 1 tbsp. of the fats listed above, per meal).

The best age to have my cholesterol level checked is age 50 because that's the peak age for heart attacks in men.

False. It is important to have your cholesterol level checked when you are young, since the process of arterial clogging (called atherosclerosis) is a gradual one and takes many years. Heart attacks that occur in people age 50 and above may be the result of plaque that began to form on the inside of their coronary arteries when these people were teenagers.

Total cholesterol should be measured at least every 5 years starting at age 20. If your cholesterol levels are within the normal range and you do not have other risk factors for heart disease, you can continue getting tested every 5 years. If your cholesterol levels are too high, you should talk with your doctor about making lifestyle changes or taking medication. You and your doctor should also discuss a re-testing schedule.

Note: If you have high cholesterol and your doctor has told you there may be an underlying genetic cause, you may want to have your children, under age 20, get their cholesterol levels tested. Talk with your children's healthcare providers about cholesterol testing.

Cholesterol is the only risk factor for cardiovascular disease that I should worry about.

False. There are several other important risk factors that predispose you to cardiovascular disease. The good news is that most of these risk factors can be changed by making small modifications in your lifestyle. Cigarette smoking is by far one of the strongest risk factors for cardiovascular disease. However, your risk is drastically reduced after 1 year of not smoking. After 4 years of being smoke-free, your risk for cardiovascular disease is equivalent to that of a non-smoker.

Other risk factors for cardiovascular disease include physical inactivity, diabetes, uncontrolled high blood pressure, and obesity. The following guidelines may help you prevent the development and/or progression of cardiovascular disease:

  • Add 30 minutes of moderate exercise most days of the week
  • Lower the amount of fat in your diet to under 35% of your intake
  • Manage your high blood pressure, diabetes, and other medical conditions

Since both of my parents died from coronary disease when they were young, there's little I can do to prevent this disease from developing in me.

False. While your family history is an important risk factor (and not changeable), you can control your risk of developing cardiovascular disease by controlling high cholesterol (through diet and sometimes medication), quitting smoking, managing high blood pressure and diabetes and exercising regularly. In fact, recent research shows that you can stop or reverse the progress of atherosclerosis by following a very strict risk factor modification program.

Because atherosclerosis is a slow, gradual process that probably starts in childhood, it is important to have your cholesterol levels tested at age 20. Those who have a strong family history of heart disease should be even more vigilant in testing their cholesterol levels. A strong family history is:

  • Having a first-degree male relative who had a heart attack, angioplasty, or bypass under age 55.
  • Having a first-degree female relative who had an angioplasty, heart attack, or bypass under age 65.

Fact summary

  • Twelve million Americans have coronary artery disease, making it the leading cause of death in this country.
  • More than 90 million adults have cholesterol levels that are higher than desirable.
  • High blood cholesterol is a major risk factor of coronary artery disease, but one that is also quite modifiable.
  • Lowering your cholesterol level by 1% lowers your risk for heart disease by 2%.
  • For some people, losing excess weight will lower total blood cholesterol levels.
  • Egg yolks and organ meats, such as liver, are the foods highest in cholesterol. (One egg yolk has 213 milligrams of cholesterol.)

Cholesterol information

Total Cholesterol (TC):

Directly linked to risk of heart and blood vessel disease

Goal values:

  • 75-169 mg/dL for those age 20 and younger
  • 100-199 mg/dL for those over age 21

High Density Lipoprotein (HDL) "Good cholesterol":

High levels linked to a reduced risk of heart and blood vessel disease

Goal value:

  • Greater than 45 mg/dL for men and greater than 55 mg/dL for women

Low Density Lipoprotein (LDL) "Bad cholesterol":

High levels linked to an increased risk of heart and blood vessel disease and is a major treatment target for cholesterol lowering medications

Goal values:

  • Less than or equal to 70 mg/dL for those with heart or blood vessel disease and for other patients at very high risk of heart disease
  • Less than or equal to 100 mg/dL for high risk patients (for example: some patients who have diabetes or multiple heart disease risk factors)
  • Less than 130 mg/dL for individuals who are at low risk for coronary artery disease

Triglycerides (TG):

Elevated in obese or diabetic patients. Level increases from eating simple sugars or drinking alcohol. Associated with heart and blood vessel disease.

Goal value:

  • Less than 150 mg/dl

Talk with your doctor about a regular schedule for cholesterol testing.

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