The Great Cholesterol Myth

The Great Cholesterol Myth

You most likely remember one test number from your most recent physical, even if you might not remember all: your cholesterol level.

It is okay if it is higher than desired. Nearly 12% of American adults aged 20 and older had high total cholesterol, which is defined as having a cholesterol level of more than 240 mg/dL, between 2015 and 2018, according to the U.S. Centers for Disease Control and Prevention. One component of that total, LDL (or “bad”) cholesterol, is the kind that doctors are most concerned about.

Why does cholesterol matter so much to doctors? The first is that “it predicts risk,” according to cardiologist Dr. Jeffrey Berger, also the head of NYU Langone’s Center for the Prevention of Cardiovascular Disease in New York City. Hundreds of research have likely demonstrated that elevated LDL cholesterol is linked to an increased risk of heart attack, stroke, or premature death. The important thing is that this risk factor may be changed. Numerous studies have demonstrated that lowering cholesterol lowers the chance of a cardiovascular incident, according to Berger.

Myth: Cholesterol is always bad for you.

For optimum health, several types of cholesterol are essential. To carry out vital functions like hormone synthesis and cell formation, your body needs cholesterol. The proteins known as lipoproteins carry cholesterol through the blood.

The body uses two different kinds of lipoproteins to transport cholesterol: high-density lipoprotein (HDL), sometimes known as “good” cholesterol, and low-density lipoprotein (LDL), also referred to as “bad” cholesterol.

An excess of low-density lipoprotein (LDL) cholesterol can accumulate in the walls of your blood vessels. We term this accumulation plaque.

To produce cholesterol, the liver needs “good” cholesterol, or HDL cholesterol. After that, the liver eliminates it from the body. A high HDL cholesterol level can reduce your risk of stroke and heart disease.

Your blood arteries constrict as plaque accumulates inside them over time. Your heart’s and other organs’ blood flow may be restricted or even stopped as a result of this restriction. A heart attack or angina (chest discomfort) can result from a blockage in the heart’s blood supply.

Facts:
Frequently characterized as a waxy, fat-like material, cholesterol is vital to human health and plays a significant part in embryonic development. It contributes to cell membranes and stimulates the synthesis of important hormones. However, too much of it can lead to issues, such as blocked arteries and an increased risk of heart disease. Low-density lipoprotein is typically expressly mentioned by doctors and researchers when discussing the negative effects of cholesterol.

According to Nathalie Pamir, an associate professor of preventive cardiology at Oregon Health & Science University in Portland, LDL carries cholesterol throughout the body and deposits it in blood arteries. Since it usually transports cholesterol from other areas of the body to the liver, its smaller relative, high-density lipoprotein (HDL), has long been regarded as the “good” cholesterol.

Because HDL and LDL are distinct, physicians are less concerned about total cholesterol levels. Aiming for lower LDL (ideally, less than 100 mg/dL) and greater HDL (at least 60 mg/dL, but not less than 40 md/dL) is what they often advise instead.

Myth: “Good” cholesterol is completely protective.

Facts:
The narrative has become increasingly intricate. According to Dr. Leslie Cho, division director of preventive cardiology and rehabilitation at the Cleveland Clinic, “With current research, there is no level where having it really low is dangerous.” LDL is still viewed as a bad actor. According to her, individuals with diabetes and those at extremely high risk of coronary artery disease should strive for fewer than 55 mg/dL, while those with heart disease should aim for less than 70 mg/dL.

However, the HDL story is more intricate. Experimental medications have not been shown to lower cardiac events in trials, and studies have questioned the notion that the greater HDL levels, the better. In a research published in the Journal of the American College of Cardiology in November, Pamir and associates tracked heart attacks and heart attack-related deaths over ten years, measuring biomarkers in over 24,000 persons without heart disease. Only white persons had low HDL levels linked to higher risk, although LDL and another kind of lipid, triglycerides, “modestly predicted” risk in both white and Black adults. Additionally, neither white nor black people were protected by high HDL levels.

One possible explanation, according to Pamir, is that the HDL’s functionality may be more important than its number. According to some data, elevated levels might be a sign of dangerous inflammation, Wright continues. Additionally, excessive alcohol use or metabolic problems may raise HDL levels without improving health.

As of the present, there is no test to determine HDL quality. Pamir and colleagues continue their investigation into the complexities of HDL. Cardiologists advise those with high HDL levels to take the lifestyle changes that are known to improve heart health, to consult their doctors about medication if other factors indicate a higher risk of heart disease, and to avoid assuming that their high HDL levels will protect them from heart problems until more conclusive answers are available.

Myth: Until you reach the age at which heart attacks are most common, you do not need to have your cholesterol tested.

Facts:
The American Heart Association advises that all low-risk persons aged 20 and above get their levels examined every four to six years, however, recommendations differ on when to begin. If you have a personal or family history of heart disease, you will probably be screened more often. Additionally, all children should get a high cholesterol screening between the ages of 9 and 11 (earlier if they have risk factors, such as a family history of early heart disease), the American Academy of Pediatrics states.

To assess cholesterol, a blood sample is taken. As per the 2016 rules, it is often not required to fast before your exam. (To be sure, ask your doctor in advance.)

Myth: People who are young and skinny do not need to be concerned about their cholesterol levels.

There are several risk factors for high cholesterol, even though being overweight and/or elderly might be contributing factors. Even young, slender individuals should be mindful of their cholesterol levels. These are the risk factors:

• Family background. High cholesterol can be inherited in some ways. Familial hypercholesterolemia puts a person at extremely high risk for a heart attack and causes significantly increased cholesterol. Their levels might need to be tested more often.
• Diabetes. In addition to worsening bad cholesterol, diabetes can diminish good cholesterol.
• Insufficient exercise or physical activity. Even if you are not fat or overweight, a sedentary lifestyle has been demonstrated to impact your cholesterol.
• Becoming older. For women in particular, cholesterol levels rise with age.

Myth: Your cholesterol levels are out of your control.

Facts:
You indeed have no control over certain factors that affect cholesterol. According to Cho, LDL cholesterol levels “keep going up and up” as we age, whereas they are extremely low in newborns. Triglycerides and LDL levels rise in women when they enter menopause and estrogen, which controls lipid levels, declines.

It is a natural part of aging. According to Cho, it is not a moral failing. Additionally, there are racial disparities. According to a survey by the American Heart Association, between 2015 and 2018, around 9.2% of Black male adults and 10.5% of Black female adults had high cholesterol, whereas white men and women had levels of 10.1% and 13.1%, respectively.

There are, however, certain things you can do, like exercising, to control your cholesterol. Regular high-intensity exercise, such as brisk cycling or running, can reduce cholesterol by at least 10%, according to Wright. In addition to improving sleep, exercise also lowers stress, which benefits your heart and general well-being. “The physiological benefits of exercise cannot be replicated by any medication,” Wright claims.

You do not need to drop a lot of weight to get results, even though it might be challenging. Even reducing 5–10% of your weight, or 10–20 pounds for a 200-pound individual, led to “significant” decreases in total cholesterol, LDL cholesterol, and triglycerides, according to a 2016 assessment of weight-loss research. (More weight loss was linked to greater improvements.)

Myth: You will not have a heart attack if your cholesterol is low.

Facts:
According to Cho, this is “not at all” true. Although cholesterol is a significant risk factor, it is not the sole nor the most reliable indicator. According to the American Cardiac Association (AHA), additional cardiac risk factors include male gender, age (older persons are more at risk), diabetes, obesity, and tobacco use.

According to Dr. R. Scott Wright, a professor of cardiology at the Mayo Clinic in Rochester, Minnesota, “an estimated 20% of total risk for what causes someone to have a heart attack is unknown.” Therefore, try not to focus too much on that number. According to Berger, “you would choose the first option if you could live a life with high cholesterol and a low risk of heart attack and stroke, or the opposite—low circulating LDL cholesterol and a high risk of heart disease.” “You are concerned about the possibility of suffering a heart attack or stroke.”

The myth: Eggs should be avoided if you want to maintain low cholesterol.

Facts:
If you are of a certain age, you might recall the days when food packaging was completely covered in the word “cholesterol-free.” Previously, it was advised by the U.S. Department of Agriculture to consume dietary cholesterol in amounts below 300 mg daily.

Part of the reason it stopped suggesting a certain amount in the 2015–20 dietary recommendations was because Americans were generally not going over that. The American Heart connection also said that “evidence from observational studies conducted in several countries generally does not indicate a significant association with cardiovascular disease risk” in a 2019 scientific advisory on dietary cholesterol.

Additionally, for most people, eating more cholesterol in their diet does not always result in greater blood cholesterol. Additionally, the body may adapt to compensate for insufficient or excessive food intake. Cho notes that certain persons are extremely sensitive to dietary cholesterol changes, and reducing intake will result in a sharp drop in blood levels.

According to Cho, the kinds of fat that are “solid at room temperature” do appear to raise LDL cholesterol. Among them are saturated fats found in meat, butter, and dairy products. On the other hand, unsaturated fats, which are liquid at room temperature, are good. Additionally, consuming too many simple carbohydrates might cause weight gain, according to Wright.

Cardiologists now advocate a balanced dietary pattern that includes monounsaturated fats, more nutritious proteins like fish, and an abundance of fruits and vegetables rather than praising particular meals. Cardiologists argue that the Mediterranean diet is a good match and has been linked to protection against cancer and diabetes, among other illnesses.

Myth: If I had high cholesterol, I could sense it.

High cholesterol typically does not have any warning indicators. Until it is too late, such as after a heart attack or stroke, you might not be aware that your cholesterol levels are harmful. It is crucial to have your cholesterol levels examined at least every five years because of this.1 Find out more about having your cholesterol examined.

Sometimes, xanthomas—yellowish growths on the skin that are high in cholesterol—appear in some persons. Individuals who have xanthomas may have elevated cholesterol levels.

Myth: Consuming meals that are high in cholesterol will not raise my cholesterol levels.

Facts:
It is not always easy. It is common knowledge that foods high in saturated fat also tend to have high cholesterol. You should pick foods with less saturated fat since saturated fats might raise your cholesterol levels. Foods derived from animals, such as cheese, butter, and red meat, are high in saturated fat.

Instead, make an effort to consume meals like beans and oats that are high in fiber. Furthermore, almonds, avocados, and olive oil are good sources of unsaturated fats.

Myth: There is nothing I can do to lower my cholesterol.

There are several ways to raise and maintain healthy cholesterol levels!

Unless your doctor instructs you differently, be tested at least every five years. One Find out more about testing for cholesterol.
Make wholesome dietary choices. Eat fewer foods that are high in saturated fats. Select foods that are naturally abundant in unsaturated fats and fiber.

Engage in physical activity each day. Adults should engage in 150–300 minutes of moderate physical activity each week, according to the Physical Activity Guidelines for Americans.

Do not use tobacco products or smoke. Smoking destroys blood vessels, accelerates artery hardening, and significantly raises the risk of heart disease. Do not start smoking if you do not already. If you smoke, you can reduce your risk of heart disease by stopping.

Discuss measures to control your cholesterol with your medical team. If you are taking medication to control your cholesterol, use it as directed.

Learn about your family’s past. You should likely get more frequent cholesterol tests if your parents or other close relatives have high cholesterol. You may be suffering from familial hypercholesterolemia (FH).

Myth: Without the use of medicine, you can always manage your cholesterol levels.

Facts:
Not every risk factor can be fixed. There is nothing you can do to alter your genetic composition or age. Approximately 1 in 200 persons are born with elevated LDL cholesterol levels due to a genetic condition known as familial hypercholesterolemia, which will continue to climb throughout childhood and maturity. Although it may be addressed with medicine and lifestyle changes, the American Heart Association states that it typically results in heart disease. Although it is an uncommon disorder, genetic impacts are also present in other risk variables, such as body type and weight.

Your doctor may prescribe medicine to control your cholesterol even if you lose weight and exercise. The most popular ones lower LDL levels and are known as statins. They are frequently administered to those who have already experienced a heart attack to avoid another one, as well as to those who are more susceptible to prevent a heart attack altogether. According to a U.S. Preventive Services Task Force revised evidence study released in August 2022, statin use was linked to a decreased risk of cardiac events and mortality in at-risk groups. According to the research, the advantages were shown “across diverse demographics and clinical populations.”

According to Berger, statins are “by far the most well-known [medication], and have the most amount of data.” He adds that more recent medications like PCSK9 inhibitors and ezetimibe are also available. The most recent guidelines set the threshold at a 7.5% risk over the next ten years, or 5% if the patient has additional high-risk characteristics, he adds. Risk calculators that estimate the 10-year risk of heart disease are frequently used to make pharmaceutical prescription decisions. You should discuss the advantages and disadvantages of drugs in full with your doctor.

Nevertheless, Berger stresses that diet and exercise should be tried first because they enhance general health as well as cholesterol. A healthy lifestyle (including nutrition and exercise) was linked to a 46% reduced relative risk of coronary events than an unhealthy one among those with a high hereditary risk of heart disease, according to research published in the New England Journal of Medicine.

FAQs

References:

• Hobson, K. (2023, June 19). 7 Myths about Cholesterol, debunked. TIME. https://time.com/6287926/cholesterol-myths-debunked/
• Cholesterol myths and facts. (2024, May 15). Cholesterol. https://www.cdc.gov/cholesterol/about/myths.html
  https://communityhealth.mayoclinic.org/featured-stories/cholesterol-myths
• Primary care in Rochester and Kasson. (n.d.). Mayo Clinic Health System. https://communityhealth.mayoclinic.org/featured-stories/cholesterol-myths