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Good vs. bad cholesterol

Can cholesterol actually be good for your arteries? The answer: yes and no. If you’re one of the 17 percent of Americans who has high blood cholesterol, you are likely taking steps to lower it with the help of your physician. However, there is a type of cholesterol your body may need more of to function properly.

High-density lipoprotein (HDL) cholesterol “is the helpful cholesterol,” says Joe Miller III, M.D., a cardiologist and expert in preventative medicine at Piedmont Heart Institute.   “HDL is responsible for reverse cholesterol transport, which means it removes bad cholesterol from the bloodstream and takes it to the liver, which gets rid of it,” he explains.

Low-density lipoprotein (LDL) is commonly known as the “bad” cholesterol because over time it causes plaque formation in the arteries. Plaque buildup will eventually clog the arteries, leading to coronary artery disease.  Think of it this way, says Dr. Miller: “HDL is a vacuum cleaner and LDL is fuel for the fire.” An LDL level below 130 mg/dL is desirable, while an HDL level below 40 mg/dL for men or 50 mg/dL for women is considered low.

High cholesterol means that LDL levels are too high and can result from a high-fat diet or genetics. “The liver can produce too much cholesterol,” says Dr. Miller. “Diet is responsible for about 10 to 12 percent. For folks who have higher cholesterol, but are thin, they are predisposed to have it.” Controlling cholesterol is crucial for long-term wellness because high levels of LDL and low levels of HDL can lead to heart disease (which kills more Americans than every cancer combined), stroke and heart attack.

Lifestyle Modifications and Medications

So how do you lower bad cholesterol while increasing the good kind?

  • Quit smoking
  • Manage your blood sugar and triglyceride levels, particularly if you are diabetic
  • Exercise regularly. Dr. Miller recommends at least 20 minutes, four days a week.
  • Reduce your stress levels. High stress situations can raise your blood pressure (further increasing your risk of heart disease) and may tempt you to overeat high-fat foods, which in turn raises LDL cholesterol.
  • Watch your weight. Weight loss can both raise HDL and lower LDL. 
  • Maintain a healthy diet that is low in saturated and trans fat:
    • Base your meals around fresh vegetables, fruit and whole grains
    • Choose low-fat or nonfat dairy products
    • Limit red meat
    • Eat fish at least twice a week
    • Reduce sodium intake
    • Avoid sugary beverages

If your cholesterol levels do not respond to lifestyle modifications, there are several classes of medication that can help, including:

  • Statins
  • Bile acid sequestrants
  • Nicotinic acid (niacin)
  • Fibrates
  • Ezetimibe

Cholesterol Screening Recommendations

“I recommend a cholesterol check around age 20,” he says. “Some pediatricians are doing it earlier, but this is something to discuss with your physician. Most people should get it checked about once a year after age 30.” To learn more about your risk for a serious heart event, take Piedmont’s seven-minute HeartAware assessment.

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