Cholesterol, a waxy, fat-like substance, is important for you body, but too much in your blood can form plaques that sticks to artery walls and narrow or block your arteries increasing your risk of heart disease. Discuss topics including cholesterol’s link to heart disease, how to maintain a low cholesterol diet, and treatment methods for lowering your cholesterol.
Facts about cardiovascular disease
Cardiovascular disease includes a number of conditions affecting the structures or function of the heart, including coronary artery disease and vascular (blood vessel) disease. Cardiovascular disease is by far the leading cause of death in the United States.
Coronary artery disease (narrowing of the arteries supplying blood to the heart) causes about one million heart attacks each year. Even more worrisome, 220,000 people with heart attacks will die before even reaching the hospital.
Research about cardiovascular disease risk factors suggests that making even small lifestyle changes can reduce the risk of coronary artery disease, heart attack, stroke and other serious cardiovascular conditions.
Are you at risk?
Risk factors are certain conditions that increase a person’s risk for cardiovascular disease. It is important to know:
Nonmodifiable risk factors - note which ones apply to you
Since you can't change any of these risk factors, it is important to focus on the risk factors you CAN change.
Risk Factor Goals
You, along with support from your family and friends, can work to achieve the following goals to change or treat your modifiable risk factors and reduce your risk of cardiovascular disease. If you already have cardiovascular disease, you can follow these guidelines to help prevent its progression. (note which ones apply to you)
Goal: Eliminate the use of all tobacco products. Stay away from other's smoke.
More information: Smoking and Heart Disease
Lower your total cholesterol, LDL (bad) cholesterol and triglyceride levels.
Excessive lipids (fatty substances including cholesterol and triglycerides), especially in the form of LDL cholesterol, cause the build-up of fatty deposits within your arteries, reducing or blocking the flow of blood and oxygen to your heart.
Goals: Total cholesterol less than 200 mg/dl
LDL cholesterol should be less than 70 mg/dl for those with heart or blood vessel disease and other patients at very high risk of cardiovascular disease, such as those with metabolic syndrome. LDL cholesterol should be less than 100 mg/dl for those who have a high risk of cardiovascular disease, such as some patients with diabetes or those who have multiple heart disease risk factors. For all others, LDL cholesterol should be less than 130 mg/dl.
Triglycerides less than 150 mg/dl.
It is recommended to have your cholesterol level checked as early as age 20 or earlier if you have a family history of high cholesterol. The cholesterol profile includes an evaluation of total cholesterol, HDL, LDL and triglyceride levels. Your health care provider can tell you how often to have your cholesterol tested.
Raise your HDL (good cholesterol).
HDL cholesterol takes the LDL (bad) cholesterol away from the arteries and back to the liver where it can be passed out of the body. High levels of HDL seem to protect against cardiovascular disease.
Goal: HDL greater than 40 mg/dl; the higher the HDL level, the better.
More information: Cholesterol Guidelines
Lower high blood pressure
Blood pressure is a measurement of the pressure or force inside your arteries with each heartbeat.
Goal: 120/80 mmHg or lower (high blood pressure is 140/90 or higher)
Control blood pressure through diet, exercise, weight management, and if needed, medications. Also limit alcohol, as it can increase your blood pressure.
Diabetes occurs when the body is unable to produce insulin or use the insulin it has. This results in elevated blood sugar levels.
Goal: Hemoglobin A1c test less than 7.0% if you have diabetes, and less than 6.0% if you do not have diabetes. Follow-up with your doctor on a regular basis.
More information: Cleveland Clinic Health Information Center
Maintain a healthy body weight
The more you weigh, the harder your heart has to work to give your body nutrients.
To calculate your BMI, divide weight in kilograms (kg) by height in meters squared (m2).
Metric conversions are: pounds divided by 2.2 = kg; inches multiplied by 0.0254 = meters.
For example, a woman who weighs 140 pounds and is 5 feet, 6 inches tall has a BMI of 23.
140 lbs divided by 2.2 = 64 kg
5’6” = 65” x 0.0254 = 1.65
1.652 = 2.72
64 divided by 2.72 = 23
Your health care provider can help you calculate your BMI.
Goals: A normal BMI ranges from 18.5 to 24.9 kg/m2. Overweight is defined as having a BMI higher than 25 kg/m2. A BMI higher than 30 kg/m2 is considered obese.
Waist measurements for women should be less than 35 inches. Men should aim for a waist less than 40 inches.
Achieve and maintain a desirable weight. A diet and exercise program will help you reach your goal.
More information: Overweight and Heart Disease (includes BMI calculator)
The heart is like any other muscle -- it needs a workout to stay strong and healthy. Exercising helps improve how well the heart pumps blood through your body.
Goals: Moderate exercise 30 minutes a day, on most days. More vigorous activities are associated with more benefits.
Exercise should be aerobic, involving the large muscle groups. Aerobic activities include brisk walking, cycling, swimming, jumping rope and jogging. If walking is your exercise of choice, use the pedometer goal of 10,000 steps a day.
Consult your doctor before starting any exercise program.
More information: Exercise for your health
Follow a heart-healthy diet
The old saying, “You are what you eat,” may be truer than ever - especially when it comes to cardiovascular disease. Four risk factors are related to diet: high blood pressure, high blood cholesterol, diabetes and obesity.
Goals: Eat foods low in sodium, saturated fat, cholesterol, trans fat (partially hydrogenated fats) and refined sugar.
Omega-3 fatty acids are good fats and come from tuna, salmon, flaxseed, almonds, and walnuts. Mono- unsaturated fats also are preferred and are found in olive and peanut oils.
Also eat plant-based foods such as fruit and vegetables, nuts and whole grains.
More information: Nutrition Strategies
Contributing Risk Factors (note which ones apply to you)
Some risk factors are not considered traditional risk factors, but are still thought to contribute to overall risk for heart disease. These include:
Individual response to stress: Although stress is not considered a traditional risk factor, some researchers have noted a relationship between cardiovascular disease risk and stress in a person’s life, their health behaviors and socioeconomic status. Stress may affect established risk factors.
Learn to manage stress by practicing relaxation techniques, learning how to manage your time, setting realistic goals, and trying some new techniques such as guided imagery, massage, Tai Chi or yoga.
Drinking too much alcohol Intake of too much alcohol can lead to increased blood pressure, heart failure and stroke. It is also linked to high triglycerides, irregular heart beats, obesity, and cancer. Research has shown that those who drink one drink per day (4 oz. of wine, 12 oz. of beer, or 1-1/2 oz. of 80-proof spirits) may have less risk. However, the American Heart Association does not recommend that non-drinkers start using alcohol or that drinkers increase the amount they drink.
Know your risk factors
If you have a family history of cardiovascular disease or high cholesterol, it is even more important to decrease your other risk factors. Get your cholesterol levels tested every year. Make sure you follow-up with your health care provider every year for a checkup.
Ask your doctor about the ultra-sensitive C-reactive protein (us-CRP) blood test. High us-CRP levels are related to an increased risk of heart attack, stroke, peripheral vascular disease and restenosis (reclosing) of the arteries after angioplasty procedures.
Homocysteine is a protein in the blood. High levels of homocysteine -- above 10 -- are associated with an increased risk of cardiovascular disease. There have been conflicting studies about the benefits and risks related to treatment of elevated homocysteine levels with folic acid and B vitamins. Therefore, ask your doctor before taking these supplements.
Click here to learn more about these laboratory tests
Here’s to your heart-health!
The Preventive Cardiology and Rehabilitation Program at The Cleveland Clinic comprises a multi-disciplinary team of physicians, nurses, dietitians, exercise physiologists, and behaviorists. This team cares for people who either have heart disease or who are at risk. The program includes assessment, education, treatment and follow-up. A referral is required for an evaluation. Preventive Cardiology provides reports to your referring doctor on your treatment and progress.If you would like to be evaluated at the Cleveland Clinic for risk factors and current prevention strategies for cardiovascular disease, please use the Contact Us Form or contact the Preventive Cardiology and Rehabilitation Program at 216.444-9353 (or toll-free at 800/223-2273, extension 49353).
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