Cholesterol

Cholesterol is not entirely the health villain it is often portrayed to be, even though it is commonly associated with heart attacks, strokes, and other cardiovascular diseases. It is a type of lipid, or fat, essential for the body. Cholesterol is necessary for building cell membranes, producing vital hormones like testosterone and estrogen, creating bile acids for digesting fats, and synthesizing vitamin D.

The issue with cholesterol lies not in the substance itself since we cannot live without it but in specific types of cholesterol and their levels in the bloodstream.

If you have high cholesterol, dietary changes can help lower it to a healthy range. Exercise can increase HDL (commonly called “good” cholesterol), while dietary adjustments and medications, particularly statins, can significantly reduce LDL (“bad” cholesterol).

What is Cholesterol?

Cholesterol is a fatty substance naturally produced by the body, essential for building cell walls and serving as the base material for certain hormones. While the body produces all the cholesterol it needs, a small amount of dietary fat is also necessary to maintain health.

Fat and cholesterol from food are absorbed in the intestines and transported to the liver, which converts fat into cholesterol and releases it into the bloodstream. There are two primary types of cholesterol:

• Low-density lipoprotein (LDL): Known as “bad” cholesterol, it can accumulate in the arteries, leading to blockages.
• High-density lipoprotein (HDL): Known as “good” cholesterol, it helps remove excess cholesterol from the bloodstream.

High levels of LDL cholesterol are associated with atherosclerosis, where fatty deposits accumulate in arteries, causing them to narrow or become blocked. This condition can slow or stop blood flow to essential organs like the heart and brain, leading to coronary artery disease, heart attacks, or strokes.

Conversely, higher HDL levels are linked to a reduced risk of cardiovascular disease. However, even individuals with high HDL and LDL levels may need treatment to lower LDL.

Cholesterol Levels and Risk Factors

Desirable LDL levels vary based on individual health risks. For those with cardiovascular disease, diabetes, or a history of atherosclerosis, LDL levels should ideally be below 70 mg/dL. For individuals without such conditions, an LDL range of 100–130 mg/dL may be acceptable.

An HDL level below 40 mg/dL increases the risk of atherosclerosis, heart disease, and stroke. Additionally, triglyceride levels below 150 mg/dL are considered healthy.

Risk factors for coronary artery disease include:

• Age (men over 45 and women over 55)
• Premature menopause in women
• Family history of early coronary artery disease
• Smoking
• High blood pressure
• Low HDL cholesterol levels

Managing Cholesterol Through Diet

While there is no universal diet for cholesterol management, vegetarian diets are most effective in reducing total and LDL cholesterol levels. However, many people find Mediterranean-style diets easier to follow. These typically involve:

• Eating mostly plant-based foods, including fruits, vegetables, grains, beans, nuts, and seeds.
• Using olive oil as the primary fat source.
• Consuming low-fat dairy products daily.
• Eating fish at least twice a week.
• Limiting processed foods.
• Drinking alcohol in moderation (up to two drinks per day for men, one for women).

To maintain a healthy weight, consume only as many calories as you burn daily. For weight loss, reduce calorie intake below the amount you burn. Regular exercise, such as 30 minutes of brisk walking daily, can also improve cholesterol levels.

Cholesterol-Lowering Medications

Whether you need medication to manage cholesterol depends on your response to dietary changes and your risk of heart attack or stroke. Statins, or HMG-CoA reductase inhibitors, are typically the first-line treatment for lowering LDL cholesterol. These include:

• Lovastatin (Mevacor)
• Simvastatin (Zocor)
• Pravastatin (Pravachol)
• Fluvastatin (Lescol)
• Atorvastatin (Lipitor)
• Rosuvastatin (Crestor)

Statins block an enzyme necessary for cholesterol production, reducing LDL levels and lowering the risk of atherosclerosis, heart attacks, and strokes.

For individuals who do not achieve their target cholesterol levels with statins alone, ezetimibe may be added. This medication reduces cholesterol absorption in the intestines.

PCSK9 inhibitors, more potent than statins, are useful for individuals with familial hypercholesterolemia or those who cannot tolerate statins. These drugs are administered via injection and are more expensive.

For managing high triglycerides, common medications include:

• Fibrates (e.g., gemfibrozil, fenofibrate)
• Omega-3 fatty acids (e.g., Lovaza, Vascepa)

By combining lifestyle changes with appropriate medications, individuals can effectively manage cholesterol levels and reduce their risk of cardiovascular disease.