Understanding Your Risk
Heart disease is the leading cause of death in the United States. But it doesn't have to be —heart disease can be prevented. One of the best ways to prevent heart disease is to keep your blood cholesterol at healthy levels. High blood cholesterol can lead to coronary artery disease, heart attack, and stroke.
You can make lifestyle changes to take control of your heart health. Managing your cholesterol level is one such important lifestyle change. Others include controlling high blood pressure, keeping your weight within normal limits (maintaining or re-establishing your ideal body weight), not smoking, exercising, and controlling diabetes and stress.
If you have a number of risk factors, such as having diabetes, being overweight, having high blood pressure, smoking, and having a high cholesterol level, they add up and greatly increase your risk for heart disease. Some risk factors you cannot control, such as being a man aged 45 years or older or being a woman aged 55 years or older. Some people have a family history of heart disease.
Reduce the risks as much as you can, and that includes knowing your lipids (LDL, HDL, triglycerides, and coronary risk ratio). You can estimate your risk for heart disease using the National Institutes of Health interactive tool.
If your cholesterol numbers indicate you are at increased risk for coronary artery disease and stroke, your health care provider may recommend that you try diet and exercise to lower and control your cholesterol first. Diet and exercise can effectively lower cholesterol. You should try these strategies before you consider taking cholesterol-lowering medication.
Where to Get Cholesterol Tested
Measuring your cholesterol involves taking a sample of blood. The best place to get a complete lipid panel that includes all the different measures of cholesterol is at your health care provider’s office.
Other handy places might be these:
* Screenings held in shopping centers
* Community health fairs
* Neighborhood medical clinics
* Home testing devices
* Work site testing
Cholesterol Management Using Diet
Discuss with your health care provider how you can make diet and other lifestyle changes to affect your blood cholesterol levels. If you can truly change your daily habits, you may not have to take medication. Cholesterol-lowering medications are available, but they are not a substitute for exercise and dietary changes. Lifestyle changes should be employed first.
Dietary intakes high in saturated fat are linked to high total blood cholesterol counts and pose an increased risk for heart disease and other vascular diseases. To simplify the whole issue, reduce all fats in your diet, paying particular attention to saturated fats.
The American Heart Association suggests that fats should represent no more than 30% of all calories you consume in a day, but 25% or 20% is even better. Of that 20%, very little should come from saturated fat.
* Decide how many total calories you need a day to maintain your desired weight. As a rule of thumb, you multiply your desired weight in pounds by 11, if your life is sedentary; 13 if moderately active; and 15 if active. The total gives you your recommended daily calorie count.
* Determine how many grams of fat you should eat in a day (see chart). Don't get distracted by trying to measure the grams of saturated and unsaturated fat (this information is on food labels). Simply focus on total grams of fat.
Certain foods really do have health benefits for controlling cholesterol and overall heart health beyond providing basic nutrition. The International Food Information Council identifies these food choices:
* Broccoli (heart health, blood pressure, cholesterol, cancer)
* Fish or fish oil (heart health, blood pressure, cholesterol)
* Green leafy vegetables (heart health, blood pressure, cholesterol, cancer)
* Oranges or orange juice (heart health, blood pressure, cholesterol, cancer)
* Carrots (heart health, blood pressure, cholesterol, cancer)
* Garlic (heart health)
* Fiber (heart health)
* Oats/oat bran/oatmeal (heart health)
Lower cholesterol levels should start at the grocery store. Read food labels and buy foods low in saturated fat and low in cholesterol (cholesterol itself is found in some foods, and this type of cholesterol is different from blood cholesterol).
To help you know what to look for when grocery shopping, use this shopping list from the National Heart, Lung, and Blood Institute:
* Breads such as whole wheat, rye, pumpernickel, or white
* Soft tortillas, corn or whole wheat
* Hot and cold cereals except granola or muesli
* Rice (white, brown, wild, basmati, or jasmine)
* Grains (bulgur, couscous, quinoa, barley, hominy, millet)
* Fruits: Any fresh, canned, dried, or frozen without added sugar
* Vegetables: Any fresh, frozen, or (low salt) canned without cream or cheese sauce
* Fresh or frozen juices, without added sugar
* Fat-free or 1% milk
* Cheese (with 3 grams of fat or less per serving)
* Low fat or nonfat yogurt
* Lean cuts of meat (eye of round beef, top round, sirloin, pork tenderloin)
* Lean or extra lean ground beef
* Chicken or turkey, white or light meat (remove skin)
* Fish (most white meat fish is very low in fat, saturated fat, and cholesterol)
* Tuna, light meat canned in water
* Peanut butter, reduced fat
* Eggs, egg whites, egg substitutes
* Low-fat cookies or angel food cake
* Low fat frozen yogurt, sorbet, sherbet
* Popcorn without butter or oil, pretzels, baked tortilla chips
* Nuts such as walnuts, pecans, and macadamia nuts
* Margarine (soft, diet, tub, or liquid)
* Vegetable oil (canola, olive, corn, peanut, sunflower)
* Non-stick cooking spray
* Sparkling water, tea, lemonade
Cholesterol Management Using Exercise
Regular aerobic exercise helps prevent high blood pressure and raises your HDL (the good) cholesterol level. At least 30 minutes a day is the minimum suggested by the Surgeon General and most heart health organizations. The bottom line on exercise is that more is probably better, but some is still better than none.
How much exercise?
Walking 2 miles in 30 minutes 3 times a week constitutes a moderate level of aerobic exercise. That may be enough to raise your HDL cholesterol from 1 to 3 points (higher is better). Exercising more vigorously may not raise your HDL any more, but will likely lower your LDL cholesterol (lower is better).
If you can't get in a 30-minute block of exercise all at once, do a few minutes of exercise here and there throughout the day (climb the stairs at work, walk around the block on your lunch break, park and walk). The more physical activity you engage in, the better it will be for your blood pressure too.
Research on Exercise
Duke University Medical Center researchers have demonstrated that exercise —without accompanying weight loss —has a positive impact on improving cholesterol levels.
Also, they report that it is the amount of activity, and not necessarily any changes in fitness or intensity of exercise, that is important for cholesterol improvement. In the process of their studies, the Duke researchers also demonstrated that the standard lipid panels used by doctors to measure the so-called LDL (bad) and HDL (good) forms of cholesterol do not necessarily provide the most accurate information in determining your risk of developing heart disease.
The results of the Duke study, published on Nov. 7, 2002 in the New England Journal of Medicine, show that exercise has a positive effect on the number and size of the particles that carry cholesterol through the bloodstream.
Cholesterol, an energy-rich fat, or lipid, must attach to protein particles in order to circulate throughout the bloodstream and nourish tissues. This combined lipid-protein unit is known as a lipoprotein, and abnormal levels of these lipoproteins have been linked to the progression of atherosclerosis (blockage in the arteries carrying oxygen to the heart) and heart disease.
"It appears from our study that cholesterol carried by smaller, denser protein particles appears to cause cardiovascular disease more efficiently than cholesterol carried by large, fluffy particles," said Duke cardiologist William Kraus, MD, who led the study.
"We showed that increasing amounts of exercise increased the size of the particles carrying both the good and the bad cholesterol," Dr. Kraus said. "By using new methods of measuring the particles carrying cholesterol, we found that some exercise is better than no exercise, and conversely, those patients in the control group who did not exercise actually showed worsening cholesterol levels."
According to Dr. Kraus, past studies of the effects of exercise on cholesterol have been unable to find a link because the measurements were based on the standard lipid levels, as opposed to the actual cholesterol-carrying particles.
"This study had to be done because there was very little scientific information indicating whether or not exercise training would have beneficial effects on cholesterol when conducted in a state-of-the art, randomized fashion, comparing individuals who exercised to those who did not," Dr. Kraus said.
For example, exercise guidelines issued recently by the Centers for Disease Control and Prevention and the National Academy of Science are based more on expert opinion and consensus than data gained from controlled clinical studies, Dr. Kraus said.
Researchers put 84 inactive and overweight men and women with high lipid levels in one of three groups: high, intense activity equivalent to jogging 20 miles a week; low but intense activity equivalent to jogging 12 miles a week; and low, moderate activity equivalent to walking briskly for 12 miles a week. A control group did not exercise at all. The study groups included significant numbers of African American participants.
In order to determine the role of exercise alone, participants were not allowed to change their diet during the course of the study. Each participant followed a 2- to 3-month "ramp-up" exercise period, followed by 6 months of exercise, which was carried out on exercise bikes, treadmills, or elliptical trainers in a supervised setting.
Throughout the course of the study, researchers took blood samples from participants, and then used 2 new and different methods to determine the subtle and specific changes in cholesterol particle size and number. While Dr. Kraus, an ardent proponent of the benefits of exercise, believed that it would have a beneficial effect on cholesterol, he was most surprised by what appeared to happen to the control group that did not exercise during the course of the study.
"We were actually surprised that the individuals who did not exercise deteriorated as rapidly as they did in measurements of blood cholesterol, weight gain, and overall health," he said. "This is characteristic of what is happening to the American population. So if we can get these people exercising, perhaps we can prevent bad things from happening."
Kraus believes that during the next 10 years, doctors will gradually move away from using the standard lipid profile and begin to look more closely at particle size to determine their patients' risk for heart disease. According to Dr. Kraus, inactivity ranks closely behind smoking as the greatest risk factor for heart disease, and, like smoking cessation, exercise is a lifestyle modification proven to protect the heart.
"Exercise can be a very powerful way of reducing risk, not only by improving lipids as our study has shown, but also by having a positive effect on glucose levels [to prevent diabetes] and mood modification [prevention of depression]," he said. "We should understand that patients do not need to lose weight or focus so much on the scale, but they do need to exercise to decrease their risk of heart disease."
