Reviewed By: Dr. Kurt Kloss, MD
Last Reviewed Date: Nov 20, 2019
Last Modified Date: Nov 20, 2019
Published Date: Nov 21, 2018
- What is Cholesterol?
- What are Lipids?
- Understanding the Effects of Cholesterol on Your Health
- When and Why You Should Consider a Lipid Panel
- Knowing What Causes High Cholesterol
- How To Maintain Normal Cholesterol Levels
- Cardiac Disease
- Blood Vessel Disease
- Arterial Fibrillation And Middle-Aged Men
- COMMON QUESTIONS ABOUT HEART DISEASE
What is Cholesterol?
Fats and cholesterol are intended to keep the body healthy and to prevent disease. However, if there are high levels of unhealthy dietary-based fats in the bloodstream, which leads to high cholesterol levels, it can subsequently have the opposite effect and promote serious diseases. Cholesterol is a waxy, somewhat fat-like substance, which is found throughout the entire body and is an essential part of the body’s cells. Cholesterol digests fats and produces hormones, cell membranes and Vitamin D.
There are two types of cholesterol – blood or serum cholesterol, which naturally circulates in the bloodstream and comes from the liver and dietary cholesterol, which comes from food. Although the chemical substance of cholesterol is the same, it’s transported in the blood using different carriers, referred to as LDL (Low-Density Lipoproteins), which is the “bad” cholesterol and HDL (High-Density Lipoproteins), which is the “good” cholesterol. High LDL cholesterol levels are harmful, while high levels of HDL are protective. Additionally, high LDL and total cholesterol blood levels are major risk factors for heart disease.
Although eating some fat is necessary, eating too much of the wrong kinds of fats is not only unhealthy, it can lead to high cholesterol and increase the risk of heart disease and some forms of cancer. Even for those who eat a relatively healthy diet, maintain an exercise regimen or aren’t obese, having a regular blood cholesterol test is essential to preventing the disease or taking the steps needed to bring unhealthy cholesterol levels down. Recognizing the risk factors for high cholesterol, as well understanding blood cholesterol levels allows patients and physicians to treat the condition before more serious health problems or diseases develop.
What are Lipids?
Lipids are any of several fat-like substances in the blood, including oils, steroids, waxes, triglycerides, and fats. The term lipid is a generic name for a variety of molecules that are relatively insoluble. This means they do not dissolve well in water. They are naturally occurring molecules found in humans, plants, animals and microorganisms. Lipids are found in every cell structure and perform a long list of biological functions within the human body. Cholesterol is the best-known lipid, but there are several others. Though some lipids get a poor reputation as being bad for the heart, not all are undesirable. In fact, it's essential that you have some lipids in your bloodstream, as they perform several critical functions.
Lipids can provide the building blocks for many hormones. These hormones are essentially chemical messengers that carry information throughout the body, letting it know when you need to eat, sleep, and perform other critical functions. Lipids are also an essential component of bile acids, which help your body digest food. Lipids help form the membranes surrounding your cells, insulate and protect the body, and serve as a critical part of your nervous system.
Lipids serve as a source of energy as well. While protein and carbohydrates provide just four calories per gram, fat offers nine. This means that fat provides more than twice as much energy for your body. Though you don't want to consume too many calories, lipids play an important role in helping you ration out the calories that you need. Lipids store unused energy for you in adipose cells, then release this as energy when the time is right.
It's important to have the right balance of lipids in your body. Too much or too few of certain lipids can spell trouble for your health. Understanding more about the lipid levels in your body is the first step toward maintaining the right balance for long-term health.
Common examples of lipids and some of their most essential functions in the human body include:
Triglycerides (fats and oils) – Providing energy for muscles and body processes is one of the primary roles of these types of lipids in the body, since fats and oils are energy dense, containing 9 calories per gram as opposed to the 4 calories per gram provided by carbohydrates and proteins. These lipids provide about half of the energy your body uses every day. On days that your calorie intake is higher than your body's demand for energy, the excess energy is stored away in adipose cells, commonly known as fat cells. That stored energy is used by the body at times when calorie intake is low – between meals for instance – or demand for energy is high – such as during physical activity. Other important functions include aiding the absorption and transportation of fat-soluble nutrients, such as vitamins A, D, E and K, helping regulate body temperature by providing a layer of insulation (body fat), and forming a protective cushion around vital organs to help insulate them against injury.
Lipoproteins and cholesterol – Lipoproteins, a combination of lipids and proteins, help fats move around the body. Cholesterol is a lipid that is transported by lipoproteins. When carried by low-density lipoproteins, it is known as LDL cholesterol and travels through the blood stream to reach the cells, organs and other tissues that require cholesterol to function. Cholesterol is an important structural component of every cell in the body, aids in the proper function of cell membranes, and is necessary for the production of steroid hormones, such as estrogen, testosterone, cortisol and the active form of vitamin D. High-density lipoproteins collect excess cholesterol from the bloodstream and carry it to the liver, and cholesterol making that trip is known as HDL cholesterol. In the liver, cholesterol aids in the production of bile acids, which are necessary for digestion.
Phospholipids and Glycolipids – These lipids are found in cell membranes and are essential to their function, including the proper absorption of nutrients into the cells. Glycolipids also support the health and function of the immune system.
Waxes – In humans, these lipids are found in the ears (ear wax) and their primary function is in protecting and lubricating the ear canals.
Understanding the Effects of Cholesterol on Your Health
So is a lipid a danger or a helper? Given the many warnings about the potential health dangers of some familiar examples of lipids – dietary fats and cholesterol – this is a common question. The short answer is that they can be either or both, depending upon the circumstances. Here we'll discuss the functions, benefits and dangers of lipids, as well as how to keep track of common lipids in the body that have the potential to cause harm.
Lipids can become a danger to the body when they are present in excessive amounts or in unhealthy ratios. For instance, excessive levels of lipids in the diet contribute to obesity and the many health dangers associated with it. Higher than normal levels of triglycerides in the blood can contribute to hardening of the arteries or thickening of the artery walls (atherosclerosis) – a major risk factor for hypertension, heart attack, various forms of heart disease, stroke and peripheral artery disease, among other serious diseases and health conditions. It can also be indicative of other health problems that increase cardiovascular risk, such as diabetes, metabolic syndrome, obesity, thyroid disease, kidney disease and some genetic conditions. High levels of LDL cholesterol and/or low levels of HDL cholesterol can also promote atherosclerosis, increasing risk of cardiovascular diseases, and contributes to other health problems, such as the development of gallstones.
When and Why You Should Consider a Lipid Panel
A lipid panel is something you may hear about frequently at your doctor's office. This is a routine test that provides a wealth of information for your health care provider. Ordering a lipid panel is routine at certain points in a person's life. If you're getting a regular physical and want a well-rounded look at your current state of health, a lipid panel can help provide this information.
What Is a Lipid Panel?
A lipid panel is a blood test that examines several key lipids in your bloodstream. This test examines the cholesterol and triglycerides that are found on lipoprotein particles in your bloodstream. These particles contain phospholipid molecules, cholesterol, protein, and triglycerides. A lipid profile will measure the particles and classify them based on their composition. The particles fall into one of three categories: high-density lipoproteins (HDL), low-density lipoproteins (LDL), and very-low-density lipoproteins (VLDL).
You can have a brief lipid panel performed with a finger stick which punctures the skin on the tip of the finger and deposits a drop of blood on a test strip. You might find this type of test at a health fair. Though it can provide you with a limited amount of information, it's not as comprehensive as what you'll get with a full lipid panel.
A complete lipid panel is done by taking a larger blood sample, collected in one or more vials, from a needle inserted into a vein in the arm. There are many key components of a full lipid panel. When you get your test results, it should include some or all of the following lipids. Understanding what each lipid is and what numbers you want to see there will make your lipid panel much easier to understand. Below is a breakdown of the most common features of a lipid panel.
Your total cholesterol is the full amount of cholesterol in all of your lipoprotein particles. This includes your HDL, LDL, and VLDL cholesterol levels. Cholesterol typically comes from your diet. However, if you don't consume enough cholesterol, your body can produce it in the liver. Lower cholesterol levels are nearly always better. However, if you have extremely low cholesterol, this is unhealthy as well and something that you'll need to discuss with your doctor.
- Extremely low: less than 50 mg/dL
- Normal: 200 mg/dL or less
- Borderline high: 201 to 240 mg/dL
- High: Over 240 mg/dL
Your triglycerides are the fats absorbed in the blood. These can either come from the liver or from the food you consume, and they serve as a source of energy. Ideally, triglycerides are stored for only a short period of time, waiting for you to use this excess energy. If you consume more calories than you can use, you will maintain high triglyceride levels, which are bad for your health.
High triglycerides can indicate many underlying conditions such as hypothyroidism, liver or kidney disease, or diabetes. It may also indicate that you've been consuming a diet that's overly high in refined carbohydrates, sugar, and fat.
- Normal: less than 150 mg/dL
- Borderline high: 150 to 199 mg/dL
- High: 200 to 499 mg/dL
- Very high: over 500 mg/dL
HDL cholesterol is also known as “good” cholesterol. It helps to remove other types of cholesterol from the bloodstream, depositing it in the liver for removal. A higher level of HDL cholesterol is preferable because this can lower your incidence of coronary heart disease. Consuming a diet high in refined sugars, refined carbohydrates, and saturated fats leads to low HDL levels, which is not what you want. Obesity, a sedentary lifestyle, and smoking cigarettes will also lower your HDL cholesterol levels.
While you want lower numbers for most things on your lipid panel, this is one area in which a higher number is better for your health. In addition to measuring the level of HDL cholesterol, you should also compare this number to your LDL in the ratios described later.
- Healthy: 60 mg/dL or higher
- Low: less than 40 mg/dL
LDL cholesterol is the type of cholesterol that's typically cast in the terrible villainous role. LDL cholesterol is what forms deposits in your blood vessels, leading to potentially dangerous conditions such as heart disease. Inactivity, obesity, type II diabetes, and a poor diet all contribute to high LDL cholesterol. You want to keep this number low.
If you have a high risk for heart disease, your doctor may recommend keeping your LDL cholesterol under 70 mg/dL. If you have only a moderate risk of heart disease, you may be good with an LDL up to 130. Those with a very low risk of heart disease are often fine to maintain LDL cholesterol up to 160 mg/dL. Discuss your individual situation with your doctor to determine where this number really needs to be.
- Optimal: less than 100 mg/dL
- Near optimal: 100 to 129 mg/dL
- Borderline high: 130 to 159 mg/dL
- High: 160 to 189 mg/dL
- Very high: 190 mg/dL or higher
The ratio of cholesterol to HDL is important because it will alert you to situations in which you may have a good cholesterol level yet still find yourself at high risk for heart disease. If you have exceptionally high HDL cholesterol, this essentially cancels out some of the benefits of having a healthy overall cholesterol level. If your lipid panel doesn't include this number, you can calculate the cholesterol to HDL ratio on your own by dividing your total cholesterol by your HDL cholesterol. This number should be lower than 4.5. Something around two or three is ideal.
The ratio of LDL to HDL will give you valuable information about how you can put some key details of your lipid panel together to get a more comprehensive picture of your health. Understanding the ratio between the two numbers will help you better assess your health and cardiovascular risk factors. If your lipid panel hasn't included an LDL/HDL ratio for you, you can figure this out yourself easily. Divide the LDL cholesterol on your report by the HDL cholesterol number. The recommended LDL/HDL ratio is under 3.5. Ideally, you'll achieve a ratio of 2.5 or less.
VLDL (very-low-density lipoprotein cholesterol) is produced in the liver from dietary triglycerides. This cholesterol contains low levels of proteins and is primarily responsible for transporting triglycerides. Unfortunately, there's no way to measure this lipid directly. Your VLDL measurement is calculated by dividing the triglycerides detected in your blood by five. This will give you the typical composition of VLDL. An ideal VLDL is between 2 and 38 mg/dL. Normal is considered anything under 40 mg/dL
Measuring Cholesterol Particle Size
According to Johns Hopkins Medicine, when assessing cholesterol as a risk factor for cardiovascular disease, research has shown that the size and density of LDL (bad) cholesterol particles is as important in predicting risk as overall levels of LDL cholesterol. Small, dense particles of LDL cholesterol have been shown to be more strongly associated with cardiovascular risk than large, fluffy cholesterol particles. For that reason, doctors often use Apolipoprotein B (Apo-B) tests in cholesterol screenings. By testing the amount of Apo-B, a protein on the surface of LDL cholesterol particles, the size and density of those particles can be determined. Individuals with an Apo-B value that is higher than their LDL cholesterol value typically have small, dense cholesterol particles and need to place a high priority on lowering their cholesterol.
Who Needs a Lipid Panel?
The American Heart Association recommends that everyone over the age of 20 get a cholesterol test. Healthy adults should have a lipid panel done every four to six years. This will give you an important piece of information about your health that will help you to make healthy well-informed decisions going forward. However, there are many other important factors that may indicate the need to get a lipid panel done much sooner. If you have any risk factors for high cholesterol or heart disease, your doctor may want to order a lipid panel. Some risk factors include:
- Smoking cigarettes
- Being overweight or obese
- Consuming an unhealthy diet
- Physical inactivity
- A family history of heart disease
If you have diabetes or pre-diabetes, your doctor is likely to order a lipid panel to determine if your cholesterol levels are unhealthy and putting you at risk for further health problems. Those with hypertension, defined as blood pressure at or above 140/90, may need a lipid panel as well. If you've previously had heart disease or a heart attack, a lipid panel can help you assess whether you're likely to experience these problems again or if your efforts to improve your heart health have been successful.
Women who are over the age of 50 and men over the age of 45 may need to increase the frequency of their regular lipid panels. This is also true for people with an HDL cholesterol under 40 mg/dL and those with a total cholesterol over 200 mg/dL. If you're concerned about your cholesterol for any reason, speak with your doctor to discuss whether the time is right to schedule a lipid panel.
How Is a Lipid Panel Different for Children, Adolescents, and Young Adults?
The American Academy of Pediatrics recommends one lipid test for healthy children between the ages of 9 and 11 and another between the ages of 17 and 21. Children with high-risk factors such as a family history of heart disease, diabetes, or obesity should get tested earlier, between the ages of 2 and 8. This can help identify children who are at a higher risk for developing heart disease when they're adults.
The ideal numbers for a lipid panel vary somewhat by age. Children, adolescents, and young adults need to look for different numbers on their results. For children and adolescents, total cholesterol readings are:
- Acceptable: less than 170 mg/dL
- Borderline: 170 to 199 mg/dL
- High: 200 or higher mg/dL
Non-HDL cholesterol readings for children and adolescents are:
- Acceptable: less than 120 mg/dL
- Borderline: 120 to 144 mg/dL
- High: 145 or higher mg/dL
Young adults have slightly higher numbers, but these should still remain on the low end. Young adult total cholesterol readings are:
- Acceptable: less than 190 mg/dL
- Borderline: 190 to 224 mg/dL
- High: 225 or higher mg/dL
Young adult non-HDL cholesterol readings are:
- Acceptable: less than 150 mg/dL
- Borderline: 150 to 189 mg/dL
- High: 190 or higher mg/dL
Speak with your doctor for more information on the ideal readings for younger individuals. There are many different factors that come into play for children. Your doctor can help you understand where your lipid panel numbers should be and what you can do to keep them in a healthy range long into the future.
How Should I Prepare for a Lipid Panel?
In preparation for a lipid panel, you are typically asked to fast for nine to 12 hours. This means that you can consume nothing but water in the time leading up to your test. Some labs can offer non-fasting lipid tests, but it's important to check well in advance. If you're getting a standard lipid test and fail to fast beforehand, you will have to reschedule the test and prepare for it again.
There are some additional considerations that may impact the results of your lipid panel. You should ask your doctor for more specific instructions on how to prepare for your test. In general, you should try not to have a lipid panel performed within two days of drinking alcohol or within a week of a major change in diet. If you're not eating normally, your lipid panel won't give you accurate results. As most diets are used on a short-term basis, it's important to understand that your results during a brief diet may not give you an accurate picture of your health or your risk factors for cardiovascular disease. While it may seem tempting to “trick” the lipid panel by changing your diet beforehand, it's important to understand that you can't trick your body in the same way. You'll simply rob yourself and your physician of accurate information about your health. Your cardiovascular risk won't actually drop as a long-term result unless you follow a long-term lifestyle change.
What Can I Learn From a Lipid Panel?
A lipid panel is a helpful tool if you want to know if you have high levels of unhealthy cholesterol. If you have too much cholesterol in the body, it is deposited as plaque on the walls of your blood vessels. This can narrow the blood vessels dangerously or even block them in extreme cases. Over time, the plaque buildup causes hardening of the arteries — known as atherosclerosis. This increases your risk for many serious heart problems including stroke and heart disease.
A lipid panel is commonly used as part of a full cardiac risk assessment. It is an essential tool to help to determine your risks of developing heart disease. The lipid panel is used in conjunction with other information on your known risk factors and lifestyle to determine how likely you are to develop heart disease and what you need to do to lower your risk. This informative test can give you details that you need to make smart and educated choices in the future. Knowing what your readings are on a lipid panel may influence your choice of what to eat, which activities you want to pursue, and which medications to take. Understanding a lipid panel will help you see the value of this test.
A lipid panel may also help your health care provider diagnose existing conditions such as lipid disorders, liver disease, kidney disease, and thyroid disease. If you're having health problems but need more tests to get to the bottom of the issue, a lipid panel is a well-rounded tool that can help you do so. Otherwise healthy individuals can use a lipid panel as a helpful predictor of future health. This will give you valuable information to guide your future choices.
What Should I Do If I Get Abnormal Results on My Lipid Panel?
If your lipid panel reveals numbers that are abnormally high or low, you should take action to get your cholesterol numbers back to a healthy range. Don't simply ignore high cholesterol. There are several things that you can do to improve your health, using your lipid panel as a helpful guide toward increased wellness.
Speak to your health care provider about the results of your lipid panel. He or she will help you understand your test results in relation to other key health factors. Your physician will likely suggest one or more plans involving your:
- Exercise regiment
If you need to lower your LDL cholesterol, you can begin by adjusting your diet. Increase your intake of soluble fibers. These bind cholesterol in the digestive system, so it exits the body without entering the bloodstream. You can find soluble fiber in oat bran, seeds, beans, lentils, and nuts. You can start the day right with a healthy dose of soluble fiber by eating oatmeal or oat-based cereal with a banana or strawberries, all of which provide this key nutrient.
Polyunsaturated fats work directly to lower LDL cholesterol. These are found in walnuts, salmon, trout, albacore tuna, mackerel, herring, sunflower seeds, poppy seeds, flax seeds, chia seeds, and almonds. Enjoy less red meat and more fish, and find ways to work these healthy nuts and seeds into your salads or snacks. Making smart swaps will go a long way toward improving your cholesterol by eliminating foods that raise cholesterol and bringing in better options that will help lower it. Trade the fatty French onion dip for healthy hummus, and use ground turkey in place of ground beef. Dark chocolate is a sweet replacement for high-sugar milk chocolate. Since cholesterol is consumed, paying more attention to exactly what you eat will help you resolve issues with an unsatisfactory lipid panel.
Getting more exercise will help you improve your cholesterol as well. Aim for a minimum of 40 minutes of moderate to vigorous aerobic activity at least three or four times a week. To really boost heart health, add strength training twice a week. In some cases, medication is necessary to keep your cholesterol levels in check and protect your heart health. After evaluating your lipid panel, your doctor may recommend certain medications to help you lower your LDL cholesterol. Statins are a common choice as they both lower LDL and moderately raise HDL cholesterol. Some examples of common statins are Lipitor, Lescol, Crestor, and Zocor. By ordering further lipid panels in the future, your doctor can determine how well a particular medication is working for you.
A lipid panel is a great place to start if you have questions about your cholesterol or heart health. Though it may be tempting to ignore some of this information, getting a grasp on the numbers now can help you protect your heart and prevent cardiovascular disease for a healthier future. A lipid panel is a quick and simple blood test that will give you tons of information you can use for years to come.
Knowing What Causes High Cholesterol
High cholesterol, or hypercholesterolemia, is a disorder characterized by abnormally high levels of cholesterol in the blood. While a certain amount of cholesterol is necessary to support vital bodily functions, too much can cause a variety of dangerous health problems. As levels rise to unhealthy levels in the blood stream, LDL cholesterol, commonly known as “bad” cholesterol, will begin to deposit on the walls of arteries, gradually narrowing these blood vessels. This is the first stage of arteriosclerosis, often referred to as hardening or narrowing of the arteries, which, left untreated, can lead to heart attack as coronary arteries are affected, or stroke as arteries supplying the brain narrow. High cholesterol also contributes to the development of metabolic syndrome, a condition typically characterized by hypertension, abdominal obesity, insulin resistance, high triglyceride levels and low HDL(good) cholesterol. Metabolic syndrome is a major risk factor for heart disease.
Much research has been done over the past several decades to determine what causes high cholesterol, which is defined as levels over 200 mg/dL as determined by blood testing, with 200-239 mg/dL considered borderline high and levels over 240 of great concern. These are the top five reasons for high cholesterol:
- Diets high in saturated fats, most commonly found in animal products, and trans-fats, prevalent in margarines, shortenings and many processed foods, are known to contribute to high blood cholesterol levels.
- Sedentary lifestyles raise the risk of high cholesterol, as does being overweight or obese and smoking.
- Cholesterol levels increase with aging.
- Certain medical conditions or diseases play a role in cholesterol levels, such as diabetes, thyroid disease, liver disease, kidney disease and some viral and bacterial infections.
- Heredity also plays a role in high cholesterol, with individuals with a family history of the disorder at greater risk.
How To Maintain Normal Cholesterol Levels
Today, most people are aware of the importance of normal cholesterol levels for cardiovascular health. However, many assume that it isn't an issue of concern until they've reached middle age or beyond, a misconception that can have serious effects on health and well-being. Levels of cholesterol and triglycerides frequently begin to rise much earlier in life, especially for individuals with a genetic predisposition to cholesterol problems. For that reason, it is important that cholesterol and triglyceride levels are tested early and often to ensure that problems are detected and addressed before they take a toll on overall health. The CDC recommends that everyone over the age of 20 undergo a fasting lipid panel, which is a blood test, every 5 years to assess cholesterol and triglyceride levels. People with borderline or high cholesterol and triglyceride numbers should be tested more frequently, at least once annually.
Lowering Your Cholesterol
If your total cholesterol, LDL cholesterol or triglycerides are borderline high or your HDL cholesterol numbers are low, changes in diet and lifestyle are usually the first line of treatment. However, if your levels of total cholesterol or LDL cholesterol rank in the high or very high category, your doctor may recommend cholesterol lowering medications along with those diet and lifestyle changes to bring them down to safer levels; particularly if the cholesterol is of the dense variety. Here is a selection of diet and lifestyle changes that have proven effective in improving cholesterol levels:
Moderate Exercise – Regular, moderate physical activity has been shown to reduce LDL (bad) cholesterol and triglycerides and increase HDL (good) cholesterol. A sedentary lifestyle is a risk factor for cholesterol problems. The American Heart Association recommends 30 minutes of exercise daily, which can be done in 10 minute intervals and can be as simple as brisk walking, bike riding or swimming. Just be sure to check with your doctor before beginning a new exercise program and if you've been living a fairly sedentary lifestyle, work up to that goal of 30 minutes a day slowly. Just 30 minutes of moderate exercise daily can significantly reduce that risk, helping to maintain normal cholesterol levels.
Weight Loss – If you're carrying around a few extra pounds, losing weight can lower your cholesterol levels. According to the Mayo Clinic, losing as little as 5 to 10 percent of your body weight can significantly reduce cholesterol. Being overweight raises levels of both bad cholesterol and triglycerides, so keeping your weight within a healthy range is essential to maintaining normal cholesterol levels. According to the CDC, a body-mass index (BMI) between 18.5 and 24.9 is ideal.
Reduce Saturated Fats In Your Diet – Saturated fats raise total cholesterol and LDL (bad) cholesterol. Reducing your intake of them is considered the best way to lower cholesterol and can be done by limiting your consumption of red meats, choosing low-fat dairy products, and using healthy oils – such as olive, peanut and canola oils – instead of margarine or butter to cook or flavor foods. A healthy diet can help keep cholesterol in check. Limit foods containing saturated fats, trans-fats and cholesterol, which can lead to high bad cholesterol, and reduce consumption of alcohol, sugars and other carbohydrates, which can increase triglycerides and lower good cholesterol. Since food labels can be confusing, consulting a dietitian for help in formulating a healthy eating plan may be wise.
Switch to Whole Grains – Use brown rice, whole wheat pastas, whole grain bread and whole wheat flour in place of their highly-processed and bleached counterparts. Less processing means more vitamins, minerals and fiber, all of which help lower cholesterol and protect cardiovascular health.
Focus on Fiber – More dietary fiber means less cholesterol, since fiber helps reduce absorption of fats and cholesterol from the intestine into the bloodstream. You can increase your fiber intake by adding more fruits and vegetables to your diet. Fresh is best in terms of high fiber content, so eat lots of fresh fruits and garden salads.
Increase Your Intake of Omega-3 Fatty Acids – Essential nutrients that most of us aren't getting enough of in our daily diets, omega-3 fatty acids aid in controlling cholesterol and are found in fatty fish, such as salmon and mackerel, walnuts, almonds and flaxseeds.
Stop Smoking – Smoking, aside from its many other detrimental health effects, has been shown to lower levels of good cholesterol, reducing protection against atherosclerosis, heart disease, hypertension and stroke. Secondhand smoke can have the same effects, so avoid exposure to other people's cigarette smoke as well.
If your cholesterol levels are high, lowering them is an essential step in protecting your cardiovascular health. In many cases, that can be done through diet and exercise, a task that will be largely your doing. However, since high cholesterol levels can be indicative of a number of health conditions and diseases, it is important that you follow up with your doctor if your levels test high to ensure that you're checked over for any other issues that could impact your overall health.
Individuals with a genetic predisposition to high cholesterol may see levels rise despite a healthy diet and lifestyle. For that reason, people with a family history of cholesterol problems should be especially vigilant about regular cholesterol testing. If lifestyle changes alone are not enough to maintain normal cholesterol levels, there medications that your physician can prescribe to help. However, it is important to remember that these medications are most effective when used in conjunction with, rather than instead of, a healthy diet and lifestyle.
Better known as coronary heart disease (CHD) it is also called coronary artery disease or coronary atherosclerosis and occurs when the coronary arteries (vessels that nourish the heart) can no longer properly provide blood irrigation of the heart muscle due to narrowing or obstruction.
Some medical experts refer to CHD as “the greatest health threat to Americans today.” Despite tremendous medical advances, heart disease remains a leading cause of death in many Western countries. Excessive levels of cholesterol, high blood pressure, stress, certain diseases and poor lifestyle choices all contribute to the development of heart problems. An estimated 82 million American adults have cardiovascular disease, which includes coronary heart disease, stroke, high blood pressure, heart failure and abnormal cholesterol levels. Since many of the factors that cause heart disease are preventable, learn as much as you can about this widespread killer.
Blood Vessel Disease: Symptoms, Risk And Detection
Seven Types of Vascular Disease
Blood vessel disease, also commonly called vascular disease, includes any condition that affects the veins and arteries that circulate blood through the body, as well as blood disorders that affect the circulatory system. Below are some common blood vessel diseases and the symptoms they can cause.
Coronary Artery Disease (CAD)
Coronary artery disease is atherosclerosis, or plaque build-up, in the arteries that carry blood to the heart, limiting its blood supply. Symptoms of this blood vessel disorder can include chest pain, shortness of breath, heart palpitations and fatigue, and the main risks of this condition are heart attack and sudden cardiac death.
Coronary Microvascular Disease (MVD)
Coronary microvascular disease damages the inner lining of tiny blood vessels that branch off from coronary arteries, causing spasms that decrease blood flow to the heart. Symptoms of MVD may include chest pain, shortness of breath, sleep problems and fatigue.
Peripheral Artery Disease (PAD)
Peripheral artery disease affects arteries outside the heart that supply blood to areas of the body like the arms, legs, and head. This type of arteriosclerosis leads to reduced blood flow to the body’s extremities. Often there are no symptoms, but when they are present they may include pain in legs and/or hips, sores on legs or feet that won't heal and cold, pale feet and/or hands. PAD increases risk of heart attack and stroke, and can lead to non-healing skin ulcers and infection.
Renal Artery Disease
Another of the many blood vessel diseases that can be caused by atherosclerosis, this condition occurs when the renal artery cannot provide adequate blood flow to the kidneys. Symptoms can include fluid retention, weakness, fatigue and uncontrollable high blood pressure.
Vasculitis is characterized by inflammation in blood vessels that causes them to narrow or close, restricting blood flow. Vasculitis may occur due to an infection, medication or other existing conditions. Symptoms may include fever, weight loss, aches and pains and fatigue, although they can vary widely according to the areas of the body affected.
Venous Blood Clots
This condition occurs when blood clots form in veins; the blood vessels that return blood to the heart. It includes deep vein thrombosis, or a blood clot in a deep vein that restricts blood flow, often causing swelling and pain. It can also result in a pulmonary embolism, which is a blood clot that breaks free from a vein and travels to the lungs; a condition that can be fatal.
An aneurysm is a bulge in the wall of an artery that can thin and weaken that wall over time, causing it to rupture. It can occur most anywhere in the body, but is most common on the aorta, the heart's main artery, where, if it bursts, an aneurysm can cause dangerous bleeding and/or death. When an aneurysm occurs in a blood vessel of the brain, a rupture can cause stroke. Typically, there are no symptoms with this disorder, and aneurysms are usually detected through medical imaging – often by accident.
What all of these blood vessel disorders have in common is risk factors – including high blood pressure, high cholesterol, diabetes, inactivity, overweight and obesity and smoking, among others. Given the severe, often deadly, consequences of these conditions, reducing some risk factors through lifestyle changes and monitoring others via regular blood pressure, cholesterol, blood glucose, and inflammation.
Increased Risk Of Stroke And Heart Attack With Irregular Schedules
For many workers on holiday work schedules, overnight shifts, swing shifts and other irregular work schedules, getting enough rest and living a healthy lifestyle can be difficult. New research suggests that in addition to increasing worker discomfort and inconvenience, however, it can also be dangerous. People who work these irregular schedules have a greatly increased risk ofdiabetes, high blood pressure, obesity and other negative health indicators, which could lead to more heart attacks and strokes.
According to a large-scale study published in the British Medical Journal, people who work the graveyard shift, as well as workers who have split shifts and unreliable schedules, suffer from an increased risk of vascular disease, as well as previously-known health indicators like diabetes. This study looked at 34 previous studies including a total population of more than two million people working non-standard schedules.
Shift workers had an almost 25 percent greater risk of heart attack than those on conventional daytime work schedules and a five percent increase in the risk of stroke. These factors were worse in people who worked the overnight shift. Unfortunately, most workers in shift jobs don't have a lot of say in the hours they work and may not be aware of the potential risks. The shifts themselves may not be the direct cause of these health problems, of course. Many outside factors associated with shift work are much more likely to be the culprits. For instance, most people who work overnight shifts have trouble getting enough sleep at the right time. Their sleeping hours are interrupted by light, phone calls, road construction and other daytime noises.
Many people on these shifts also have trouble getting an adequate diet since their hours conflict with normal mealtimes. They end up eating large amounts of unhealthy convenience foods instead. A large percentage of overnight and split shift workers also have trouble getting enough physical activity, which is one of the biggest risk factors for poor health.
In addition, most shift work jobs tend to pay less and offer considerably fewer benefits than jobs scheduled on a normal 9 to 5 schedule. According to a professor of medicine at Northwestern University, this could lead to increased health risks, too. Lower income and a restricted schedule means reduced access to health care, especially preventive care, which can increase the chance of cardiovascular disease.
Researchers did note that even when they accounted for the above factors, shift workers still had a greater risk of heart attacks and strokes than those who worked standard hours. One possibility is the fact that shift work tends to disrupt the body's natural circadian rhythm, something that can have an effect on a person's blood pressure and heart rate. There is, unfortunately, little that workers can do to prevent this. Since almost a third of the population's workers are stuck in shift work or other unusual schedules, quitting and getting a daytime job isn't usually an option. Instead, researchers recommend that people in these situations pay extra attention to other health factors. They should get regular exercise and maintain the highest level of physical fitness possible. Whenever possible, they need to consume a healthy diet and work to get regular sleep.
Arterial Fibrillation And Middle-Aged Men
Atrial Fibrillation, better known as Afib, is best described as a glitch in the heart’s electrical system, resulting in a disruption of normal heartbeat. The most common type of irregular heartbeat, it affects about 2.5 million Americans, with fit, middle-aged men possibly more susceptible according to recent studies. (Research is conflicting and still underway to determine this correlation).
However, men in general tend to be diagnosed at a younger age than women, with a median age of diagnosis 66.8 years for men and 74.6 years for women. In fact, men of any age are more likely than women to develop Afib.
What Happens in Afib and What are its Signs and Symptoms?
Afib results when the two upper chambers of the heart (atria) quiver while the two lower chambers (ventricles) beat in an irregular pattern. A normal range for an adult heartbeat is 60-100 beats a minute.
Left untreated, it can increase the risk for stroke and heart failure. Some healthcare experts say that people with Afib are up to five times more likely to have a stroke than those without it. That’s because in Afib, blood is not pumped efficiently through the heart and may pool, clot and travel to the brain to produce a stroke.
While signs of Afib can include dizziness, weakness, breathlessness and fatigue, not everyone has obvious symptoms. In fact, Afib is often discovered during a routine medical checkup with no symptoms reported. Regardless of your age or gender, it’s important to identify symptoms early and begin treatment to avoid complications. Check with your healthcare provider if you experience any of the following:
- Uneven pulse
- Racing or pounding heart
- A “fluttery” feeling in the chest
- Chest pain, especially if severe
What Causes Afib
While not all causes are known, experts say there are several triggers that can strain the heart and result in Afib. Among the most common triggers:
- Heart failure already established
- High blood pressure
- Heart valve problems
- Coronary artery disease with or without a heart attack
- In rare cases, serious infections or thyroid disorders may trigger Afib
Other factors include being a male over the age of 60 and having a family history of Afib. Along with aging, other risk factors include high blood pressure, obesity, sleep apnea, diabetes, lung disease, excessive alcohol consumption and stimulants including illegal drugs and nicotine.
In a 2013 study published in the journal Arrhythmia and Electrophysiology, more than 2,000 Norwegian men between the ages of 40 – 59 participated in a cardiovascular survey that included standardized bicycle tests over a three-year period. They were followed for the next 35 years and data gathered on their low exercise heart rate on a moderate workload. All had been defined as healthy if they had no evidence of heart disease or hypertension when the study began.
The data indicated that fit, healthy men might be at increased risk of atrial fibrillation due to a relative predominance of vagal tone (the degree of activity within the nervous system resulting in changes to the heart rate). High blood pressure substantially strengthened the risk. Other studies have shown up to a fivefold increase in A-fib risk and middle-aged endurance athletes, but the science is conflicting and some studies show no “statistically significant association” between normal exercise and A-Fib. Most experts agree that more research is needed to explore any relationship between increased vagal response both at rest and during exercise, even in those who are fit.
Why is Afib Different in Men versus Women?
Men tend to be diagnosed with Afib at a younger age than women and it does tend to strike more men than women. However, women report worse symptoms. likely due to faster heart rates in smaller bodies. Women are also more likely than men to develop complications, including strokes, bleeding from taking blood thinners and are more likely to have lower potassium levels that can increase arrhythmias. The goals are the same in both genders, however: reducing the risk of stroke and other complications.
What Does Weight Have to Do With Afib?
Whether you’re a middle-aged man or an older woman, being obese or overweight puts an extra strain on the heart. Even carrying a few pounds can increase your risk for Afib, particularly if you have high blood pressure, a common health condition associated with excess weight. Cardiology researchers say that obese persons can have up to a 50 percent higher risk for developing Afib, with the risk rising as the degree of obesity increases. Some experts say every unit in the body mass index above 25 can increase the risk for Afib by four percent. In addition, a 2011 study in Scotland found that obesity is a risk factor for fatal heart attacks even in those who don’t have high blood pressure. High cholesterol and diabetes play a part in heart disease as well, including Afib. Best health recommendations are to lose weight before Afib has a chance to develop. But once diagnosed, weight loss can still make a difference, lowering cholesterol, lowering blood pressure and reducing overall risk for coronary artery disease and stroke.
Can Diet Help With Afib?
While diet alone won’t prevent Afib, what you eat can go a long way in helping to reduce symptoms and the risk of complications. Here are some simple diet tips if you’ve been diagnosed with atrial fibrillation:
- Reduce your salt intake, which contributes to high blood pressure. Limit the amount you consume to less than 2,400 milligrams a day, including what’s in processed foods.
- Limit saturated fats found in meat and dairy – no more than 10 percent of your total caloric intake. Choose low-fat, no dairy and lean meats. Avoid fried foods.
- Watch your cholesterol intake, less than 300 milligrams a day. For a baseline, remember than one egg yolk has 213 milligrams of cholesterol, so limit eggs with yolk to no more than four a week (egg whites are fine).
- Eat as much and as many fresh fruits and vegetables as you can. Replace processed, sugary baked goods with fresh fruits and low-calorie yogurt.
- Eat more whole grains, up to six servings a day.
- Maintain portion control, especially eating out where restaurant portions are larger than what most people need. Eat half and bring the other half home for leftovers.
- Take it easy on caffeine and alcohol – both known to trigger symptoms of Afib when used in excess. Moderate drinking means one a day for women and two for men. But some individuals are more sensitive than others. Know your limits.
- Learn “heart-healthy” cooking techniques: broiling, roasting and steaming beat out butter-laden and heavy oil frying. Use olive oil or canola and ditch the sugar and salt seasonings.
Living Well with A-fib
So you’re a relatively healthy, middle-aged man who has always taken care of your body and still, you’ve been diagnosed with atrial fibrillation. It’s not the end of the world. Though A-fib is considered a serious health condition, it can be successfully managed through lifestyle changes, medications, and in some cases, low-risk surgical procedures like catheter ablation, similar to an angiogram. Medications are the more commonly prescribed treatment, including those that slow the heart and lessen symptoms. Blood thinners can be used to prevent clots and strokes. Above all, maintain good health habits that serve to improve your quality of life:
- No smoking
- Eating heart-healthy
- Keeping a normal weight
- Moderating alcohol intake
- Managing stress
- Maintaining an exercise routine (about 30 minutes daily) that has been approved by your healthcare provider and works best for you.
Having Afib doesn’t mean your life is over. It could, instead, be the start of a better way to live.
COMMON QUESTIONS ABOUT HEART DISEASE
Who gets heart disease?
About 800,000 Americans have a heart attack as a result of heart disease each year, including people from all walks of life. Celebrities like Barbara Walters, Bill Clinton, Dick Cheney and Robin Williams have all suffered from coronary disease, yet so have teachers, firemen, athletes and homemakers. Heart disease can attack anyone regardless of socio-economic factors, gender or age.
Once referred to as a “man’s disease,” women are just as likely to have heart disease as men. In fact, despite the high visibility of breast cancer in women, heart disease is the leading cause of death among women of all ages.
Even children are not immune from coronary heart disease. It often begins in childhood through genetics, unhealthy diets and lack of exercise. Many cardiac experts say prevention is the key and should start with children by establishing healthy diets and lifestyles.
How does heart disease begin?
It starts with damage to the smooth layer of specialized cells, called the endothelium, that line the inner walls of blood vessels. These are the vessels through which blood flows on its way to body organs. Smoking, air pollution, toxic chemicals in the blood and high blood pressure are all damaging to the endothelium. So, too, is inflammation. Once damaged, the lining is susceptible to LDL, or “bad” cholesterol, which enters the artery wall and eventually can cause a blockage. Plaques form silently through the years, causing no symptoms in the walls of the coronary arteries. Even people in their teens and twenties can already have plaque build-up.
As advancing age and other risk factors kick in, the chance of developing coronary heart disease rises steadily. In men cholesterol levels rise as they get older; in women after menopause. But the good news is that many of the most important risk factors for CHD can be controlled, including high blood pressure, diabetes and certain lifestyle changes.
What are common symptoms of heart disease in men; in women?
The most common symptom among both men and women is chest pain. However, women are more likely to report additional symptoms, including jaw, neck and throat pain. Other classic heart disease symptoms include: shortness of breath, weakness, a cold sweat, dizziness and nausea. Some people report back pain as well.
Chest pain associated with heart disease is generally of two types: angina, in which there is a temporary reduction of blood flow to the heart muscle, which does not usually result in permanent damage; the second type of chest pain is a heart attack.
Understanding heart disease symptoms in men – a heart attack is often the first sign of cardiac disease in men and chest pain is the single most common symptom of coronary heart disease in both men and women. Other “classic” symptoms reported by men include cold sweats, nausea, and arm pain, a sense of impending doom and shortness of breath.
Understanding heart disease symptoms in women – new research indicates that while women may experience more atypical symptoms of heart disease compared to men, it is not true that chest pain never occurs in women. Unlike men, women are more likely to experience angina without a heart attack, but it is considered a warning sign, characterized by a discomfort or heaviness in the chest that gets worse upon exertion or stress and is relieved by rest or a nitroglycerin dosage. The pain may also travel to the arm, shoulders, jaw, neck, back or upper abdomen.
How do I know if my chest pain is heart-related?
Most healthcare professional say you don’t know. So be suspicious of all chest pain. In other words, when in doubt, get medical attention.
What are the major risk factors in heart disease?
Traditional risk factors include smoking, failure to get regular exercise (five days a week is recommended), obesity, diabetes, high blood pressure (above 140/90), and a family history of heart disease or high cholesterol and total cholesterol levels that stay above 200.
What is cholesterol and what is its role in heart health?
Cholesterol is a waxy, yellowish white substance found in every cell of your body. Eighty percent is made by the liver. You cannot live without cholesterol, for it is a key component within the cell membrane. Cholesterol helps to manage the passage of materials into and out of the cell. It also serves as a building block for important hormones, from estrogen to cortisone. The blood carries cholesterol to our cells and tissues, carried in molecules called lipoproteins.
What do HDL and LDL mean in reading my cholesterol results?
The two main types of lipoproteins in blood-borne cholesterol are low-density lipoproteins (LDL) and high-density lipoproteins (HDL). LDL is the primary carrier of cholesterol in the blood. When the levels are high, oxidation of this “bad” type of cholesterol allows it to enter artery walls and a buildup of artery-clogging plaques to develop. Higher than normal levels of LDL are associated with clogged arteries, a major risk in heart disease and strokes.
High-density lipoprotein (HDL) works just the opposite. This “good” type removes cholesterol from the arteries and returns it to the liver where it is either broken down or removed from the body. That means the buildup of plaque is reduced or, in some cases, cleared from the arteries. High levels of HDL are associated with providing protection from heart disease.
What affects cholesterol levels?
Several things affect your cholesterol levels, including genetics, age and gender. Those are factors over which you have no control. Variables which you can control are diet, weight, physical activity, medication options and knowing your cholesterol numbers for both HDL and LDL.
The most important number when it comes to heart disease is the LDL. Numerous studies confirm the strong correlation between high levels of LDL, heart disease and strokes.
What are normal levels of LDL and HDL?
Together, LDL and HDL comprise your total cholesterol. While “normal” is still debated among healthcare providers and have shifted through the years, American medical experts say a value of 200 is considered the “right” upper limit for total cholesterol, which includes both LDL and HDL.
An HDL (good) greater than 40 for men and 45 for women is recommended while LDL (bad) should be less than 130. Triglycerides, a type of fat found in the blood and a major source of energy should be less than 150. All three measurements are an important indicator of heart health.
What does my diet have to do with heart disease?
Though your liver produces most of your cholesterol, the foods you eat, especially saturated and Trans fats, impact your overall cholesterol levels. Trans fats, for example, can adversely affect the balance of production between LDL and HDL. Other foods, especially those high in fiber, can help reduce LDL (bad) levels. Bottom line: it’s okay to eat foods that contain fats, just eat the right type of fats to control your cholesterol.
As a general guideline, limit saturated fats, found in meats and dairy products. Also try to avoid trans fats, found in processed foods that are sugary and high in calories (cake mixes), margarines and other spreads, and especially fast foods (burgers, fries which are notoriously high in trans fats). Use monounsaturated fats for cooking (olive oil, canola oil) and eat more whole grains (oats, beans and barley).
There is no magic bullet in dietary restraints, so resist extreme low-fat diets (which can actually reduce your level of HDL (good) cholesterol. Consider diet and exercise part of an overall approach to controlling your cholesterol levels and talk with your healthcare provider about how you can best achieve an “ideal” number that’s right for you and your current health condition.
What about red wine? Is it really good for your heart?
While it’s hard to get anyone, including your healthcare provider, to encourage alcohol consumption, some medical experts do say that drinking a glass or two of red wine a day may be good for your heart. It is the chemicals in fermented wine, particularly resveratrol, found in red wine, that is showing beneficial effects on arteries and plaque formation.
Scientists believe that alcohol (in all forms) may, in moderation, bring on favorable changes in HDL (good) cholesterol levels and help block the oxidation of LDL (bad) cholesterol, with red wine the most heart-healthy. The effects are seen more clearly in middle-aged individuals who are most at risk for heart disease.
But moderation is the key word. One or two drinks a day is moderate. Excessive alcohol consumption can wreck the liver and create numerous health and other problems above and beyond coronary disease.
Vitamins and Supplements – do they work to help prevent or reduce heart disease?
Supplements have been around for centuries but are more popular than ever today, as more people strive to take better control of their health. However, mixing supplements and prescription drugs can be dangerous, so if you are on medication for heart disease, or to lower your cholesterol levels, always consult with your healthcare provider about taking over-the-counter supplements, including fish oil and omega-3 fatty acids.
Studies on fish oil and the heart are promising, but not fully conclusive. In those with known coronary heart disease, a daily dose of one gram Omega-3 may be beneficial, but the evidence is inconclusive in those without heart disease. Ask your healthcare provider about Omega-3 and recent studies.
Most healthy adults, says medical experts, don’t need calcium or vitamin D supplements as they are found in the foods we eat. The B vitamins have not been shown to reduce risk of heart disease, while antioxidants such as vitamin E have shown no definitive benefits in reducing cholesterol. Remember that all vitamins are medicine too, so consult with your healthcare provider before mixing with prescription drugs.
Who should be screened for heart disease and what tests are most useful?
Tests generally fall into two categories: tests that evaluate risk factors and tests that detect the presence of heart disease in its various stages. As a general rule, anyone could benefit from simple, safe and inexpensive tests that evaluate risk factors. These tests include checking blood pressure, body mass index (BMI) for obesity, blood glucose levels to check for diabetes and a blood lipid profile to measure total cholesterol, both HDL and LDL and triglyceride levels.
A more detailed, sensitive test available is the C - reactive protein (CPR) blood test. CPR in the blood can help determine the level of inflammation in the body. Since coronary artery disease is an inflammatory process, high levels of CPR can be indicative of heart disease (among other conditions). The test can also be used to help decide for or against using statins to control cholesterol levels.
What else can I do to prevent coronary heart disease?
Nearly every medical professional agrees on the following:
- Monitor your diet and control your weight, especially as you age. Overeating and obesity are significant risk factors for heart disease. Reduce salt, which can help lower high blood pressure, another cardiac risk factor.
- Have your blood pressure checked regularly. Increased pressure on the walls of the arteries can contribute to heart disease.
- Get a lipid blood panel to determine your cholesterol and triglyceride levels, as well as your risk for diabetes – another risk factor in coronary heart disease.
- Avoid smoking. Even in moderation, tobacco products can complicate any heart condition.
- Drink only in moderation. One or two glasses of red wine, white wine, beer or spirits should be your limit.
- Exercise at least 30 minutes, a minimum of five times a week. Daily is better. Sedentary lifestyles promote weight gain, hypertension and diabetes, all risk factors for heart attacks and strokes.