If you have said that you are like many other Americans who share concerns about the risk of coronary heart disease. But if you’ve never made up your mind to do something about it, keep reading. You’ll find answers to some of the most common questions people have about cholesterol and what you can do to control it. Happily, you’ll discover that controlling your cholesterol is much easier and better tasting than you thought!

Why is cholesterol suddenly so important?

If you’ve noticed that cholesterol has received increased attention in recent decades, you’re right. In 1985, the National Heart, Lung, and Blood Institute of the National Institutes of Health launched the National Cholesterol Education Program (NCEP). The goal of the program is to reduce illness and death from coronary heart disease (CHD) by reducing the number of Americans with high blood cholesterol. The impetus behind the NCEP was irrefutable evidence that lowering high blood cholesterol reduces the risk of coronary heart disease. In fact, a one percent drop in cholesterol produces a two percent drop in the chance of a heart attack!

The surveys also indicated that neither doctors nor the general public were adequately informed about the relationship between cholesterol and CHD. This led to an aggressive public and professional education strategy. So yeah, you’ve been hearing more about cholesterol, because there’s so much more to hear.

What is coronary heart disease?

Over time, cholesterol and other blood substances are deposited on the inside walls of the coronary arteries. When this buildup restricts blood flow through the arteries, too little oxygen reaches the heart. At best, CHD victims suffer from chest pain (angina); at worst, a deadly heart attack, the kind that accounts for 30 percent of nearly two million deaths in the United States each year.

While elevated blood cholesterol levels seriously increase a person’s risk of CHD, adding smoking and high blood pressure, the other major risk factors, multiplies that risk.

How many Americans have high cholesterol?

The American Medical Association released these figures based on NCEP estimates: Thirty-six percent of Americans have cholesterol levels high enough to warrant being under a doctor’s care. About 102 million Americans age 20 and older are candidates for medical advice and intervention for high blood cholesterol levels.

On top of that, there are millions more who should take immediate steps to bring their blood cholesterol levels into the “desirable” range.

In other words, if your cholesterol level can take a few tweaks, you have something in common with one in two Americans!

What role does age play?

If you are between the ages of 20 and 39, the chance that your cholesterol level is too high is one in five. That rate jumps to one in two between the ages of 40 and 59. Starting at age 60, there is a 60 percent chance that you will have a problem.

Should you get tested for high cholesterol?

If you are over 20 you should do it! The NCEP suggests getting tested at least once every five years.

Your initial evaluation will determine your total cholesterol level and assess risk factors such as smoking, blood pressure, and your personal and family health history. Cholesterol screening is often done during the course of a routine physical exam, but advances in finger-stick testing procedures (where the finger is pricked to draw a minute amount of blood) to make a widespread initial screening in non-clinical settings a practical and convenient alternative. Borderline or high blood cholesterol levels with the fingerstick method should be confirmed by your family doctor.

The important thing is that you know your cholesterol level. Blood cholesterol is measured in milligrams per deciliter (mg/dl). Levels below 200 mg/dL are classified as “desirable blood cholesterol,” those between 200 and 239 mg/dL are “borderline high blood cholesterol,” and levels above 240 mg/dL are “high blood cholesterol.” high”. After the age of 200, the risk of coronary heart disease increases steadily.

In general, the NCEP recommends that people with blood cholesterol levels between 200 and 239 mg/dL adopt heart-healthy dietary habits and get retested annually. If there are additional risk factors, further testing may be required.

People with blood cholesterol levels greater than 240 mg/dl should undergo further testing to determine a course of treatment to lower their blood cholesterol level.

Should children be tested?

The American Academy of Pediatrics Committee on Nutrition believes that children with a family history of early coronary disease or high cholesterol should be evaluated. “Precocious” means before the age of 50 in men and 60 in women.

For a variety of reasons, the Academy does not believe in universal testing for children, but not everyone shares its view. Cory Servaas, MD, director of the Children’s Better Health Institute, says that 20 to 30 percent of children younger than 12 that her organization tests “have cholesterol levels that are higher than we think they should be… 180mg/dL.” She adds: “Since screening is cheap and easy to do, why not do it? We often don’t know what the family history is to know if a child should be tested.”

Is there really ‘good’ and ‘bad’ cholesterol?

Absolutely! But first, it’s important to understand that everyone, regardless of age, needs cholesterol. It is vital for the formation of cell membranes and for the manufacture of bile acids. It is also the chemical precursor to hormones such as progesterone, testosterone, and estrogen. All cells in the body can make cholesterol (80 percent is produced by the liver) and there is no known physiological reason to supplement the body’s own cholesterol with dietary cholesterol.

In order for cholesterol to get from where it’s made (in the liver, for example) to where it’s needed to support metabolism, it’s transported as a lipoprotein. (Lipoproteins are substances that allow insoluble fats, such as cholesterol, to move through the blood on a water basis.) Low-density lipoproteins (LDL) carry cholesterol from where it is made, while high-density lipoproteins (HDL) carry it to the liver. At this point, the cholesterol can be further metabolized or passed into the intestine for elimination. Because HDLs limit the amount of cholesterol in the blood, they provide protection against dangerously high cholesterol levels. High HDL levels have been associated with a lower incidence of CHD.

If your cholesterol tests are in the “high” range, or if you are “borderline high” with additional risk factors for CHD, your doctor will perform additional tests to establish the relationship between LDL and HDL.

What can you do to maintain a heart-healthy diet?

You don’t have to be a professional dietitian or follow a boring diet to lower or maintain a desirable cholesterol level. You also don’t have to carry a calculator to add up milligrams of this or that. What you do need to know are some basic principles.

• Eat less fat! There are three types of fat: saturated, polyunsaturated, and monounsaturated. A heart-healthy diet requires you to reduce your intake of saturated fat.

They are found in meat and dairy products, as well as commercially prepared baked goods made with coconut oil and cocoa fat. Read the labels!

Instead of eating foods high in saturated fat, shift your emphasis toward complex carbohydrates (whole grains, fruits and vegetables), shellfish, and skinless poultry. If you eat meat, select lean cuts and trim as much fat as possible before cooking. By cutting back on fat, you’ll also drastically cut calories, since fat contains twice the calories of protein or carbohydrates.

• Substitute polyunsaturated and monounsaturated fats for saturated ones. Polyunsaturated and monounsaturated fats can actually help you lower your cholesterol. And recent studies conducted at the Department of Medicine at the University of California, San Diego, indicate that monounsaturated fats lower LDL (bad cholesterol) levels while leaving HDL (good cholesterol) levels intact. Canola oil is a wonderful source of monounsaturated fat. It is one of the leading cooking oils in Japan, a country widely recognized for its low rate of heart disease.
• Reduce dietary cholesterol. Avoid organ meats altogether and eat fewer egg yolks.
• Increase dietary fiber. Never before has it been easier to introduce fiber into your diet. We’ve been hearing a lot about oat bran as a source of fiber lately, and for good reason. Studies indicate that oat bran, when consumed regularly, can lower cholesterol by up to 19%.
• Exercise! Exercise has been shown to reduce the risk of CHD by increasing the level of good HDL cholesterol in the blood.
• Stop smoking! Exercise raises HDL levels, but smoking lowers them. Smokers are at additional risk for CHD.

Do school lunch programs support heart-healthy dietary standards?

Jayne Newmark, national spokesperson for the American Dietetic Association, cautions that school lunch programs are self-sufficient and therefore sell foods that children are more likely to buy. “Our job is to get kids to like heart-healthy foods. You see a lot of burgers and fries today because that’s what kids like. We have a sales job to do. That’s why we’re trying to get nutrition into the curriculum. But education really starts at home and it can’t start too soon,” says Newmark.

What are the additional benefits of a heart-healthy diet?

A diet high in fat and low in fiber has been linked to colon and breast cancer, as well as diverticular disease, stroke, diabetes, high blood pressure, and even osteoporosis. And if that’s not enough, there’s always obesity to appeal to the vanity in all of us.