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How to keep your cholesterol in check

Dr. Ramesh M. Gowda, director of endovascular services at Mount Sinai Beth Israel, tells us everything we need to know about managing our cholesterol levels.
Following a heart-healthy diet high in fruits, vegetables and unsaturated fats can help you manage your cholesterol. Photo: ISTOCK

Cholesterol is one of those things on which headlines can be contradictory and confusing. For a long time, margarine was thought to be healthier than butter, and eggs and red meat were off-limits for anyone keeping track of their health. Now, things seem to have swung in the opposite direction. To get the facts, we talked to Dr. Ramesh M. Gowda, director of endovascular services and associate director of interventional cardiology at Mount Sinai Beth Israel.

What are the risks associated with high cholesterol?

The risks associated with high cholesterol include heart attack, stroke and peripheral arterial disease. The mechanism for these is similar – the buildup of cholesterol deposits in the blood vessels supplying important organ systems that lead to a reduction in vital blood flow to these organs.

What’s an ideal cholesterol reading? Is there such a thing as cholesterol that’s too low?

There is no such thing as an ideal cholesterol reading; what is more important is your risk for cardiovascular events. However, desirable cholesterol levels include total cholesterol of less than 200 mg/dL, LDL less than 100 mg/dL, triglycerides less than 150 mg/dL and HDL greater than 60 mg/dL. If HDL is less than 50 mg/dL for women and less than 40 mg/dL for men, then there is a higher risk for heart disease. There is no such thing as cholesterol that is too low, and there is no consensus on a specific number but most experts agree that an LDL less than 40 mg/dL may be too low. A low cholesterol level can lead to reduced libido, low vitamin D, liver and digestive issues, mood changes and fatigue, memory loss and an increased risk of neurodegenerative disease.

What is the difference between good and bad cholesterol? How does each function in the body?

HDL is “good” cholesterol and LDL is “bad” cholesterol. LDL cholesterol gets clogged up in arteries and leads to heart attacks or strokes. HDL cholesterol brings this LDL cholesterol away from the arteries and back to the liver, where it can be broken down and excreted from the body. Thus, HDL cholesterol protects against heart attacks and strokes.

Who is most at risk for cholesterol problems?

People with a family history of high cholesterol are predisposed to cholesterol problems. There is an entity called familial hypercholesterolemia that is genetic and can lead to people having high cholesterol at younger ages and thus heart disease at younger ages. As people grow older (men aged 45 and older and women aged 55 and older), there is an increased risk for cholesterol problems. Postmenopausal women are also at risk for cholesterol problems.

When should people start getting their cholesterol checked?

The American Heart Association recommends all adults age 20 or older have their cholesterol, and other traditional risk factors, checked every four to six years.

What food should people who are watching their cholesterol avoid?

Based on current recommendations and guidelines from major European and American societies, people who are watching their cholesterol should avoid saturated fat and trans-fat. Foods that contain saturated fat include animal products such as beef, lamb, pork and poultry with skin, butter, cream, cheese and other dairy products made from whole or 2 percent milk. There are also foods from plants that contain saturated fat for example coconut, coconut oil, palm oil and palm kernel oil (often called tropical oils) and cocoa butter. The American Heart Association recommends reducing saturated fat to no more than 5 percent to 6 percent of total daily calories and minimizing the amount of trans fat in one’s diet. Trans fat is contained in baked or fried foods like pastries, cookies, etc.

Are there any myths you’d like to address about cholesterol? For example, for years eggs were demonized, but apparently they are okay to eat a few times a week?

It is true that eggs have a substantial amount of dietary cholesterol but not all this cholesterol ends up in one’s bloodstream. Eggs in moderation (fewer than 4-6 times a week) may still be okay for patients with high cholesterol. Eggs are an excellent source of protein and contain unsaturated fat. Nearly half of the protein and most of the minerals and vitamins are in the egg yolk so it is important not to skip the yolk all together.

 How high cholesterol is best managed?

The management of high cholesterol is best done by lifestyle modifications and with the use of cholesterol lowering medications. Lifestyle modifications include eating a diet that is healthy for your heart, regular exercise, quitting smoking and in patients that are overweight or obese, losing weight. Cholesterol lowering medications are prescribed to patients based on their risk factors and their 10-year risk for cardiovascular disease. Once your doctor asks you to get your blood tested for cholesterol, also called a “lipid panel,” she or he will use those results to calculate your risk for cardiovascular events and prescribe a cholesterol lowering medication if required.

What lifestyle behaviors contribute to lower cholesterol?

Lifestyle behaviors that contribute to lower cholesterol are eating a heart-healthy diet, losing weight, regular exercise, healthy sleep habits and avoiding tobacco smoke.