The Good, the Bad and the Triglycerides: What You Need to Know about Cholesterol
By Lisa Larkin, MD, FACP, NCMP, IF Founder and CEO, Ms.Medicine
Most adults understand that “high cholesterol” is bad, but according to the Center for Disease Control and Prevention (CDC), many Americans are unaware of their cholesterol levels, and only slightly more than half (55%) of Americans who could benefit from taking cholesterol lowering medications actually do. A cholesterol blood test is a simple data point for you and your physician to understand your risk for developing heart disease. In recognition of September as Cholesterol Education Month, here are four things to know about cholesterol:
What is it? Cholesterol is a fatty substance produced by your liver (it is also present in some foods). Your body needs some cholesterol to make some important hormones and also to produce bile acids that help break down food. But too much cholesterol can be dangerous as it can cause a build-up of plaque in artery walls, which can lead to heart disease and put you at greater risk for heart attack and stroke.
What are the types? Your total cholesterol count is actually a combination of three components:
- “HDL” – high density lipoprotein – is known as the “good” cholesterol (think ‘H’ as in “healthy”)
- “LDL” – low density lipoprotein – or the “bad” cholesterol (think ‘L’ as in “lousy”)
- Triglycerides are another type of fat circulating in the body, and high levels of triglycerides have also been associated with increased risk of heart disease—especially for women.
You want healthy amounts of the HDL, and low amounts of LDL and triglycerides. According to the 2018 guidelines published by the American College of Cardiology, a healthy cholesterol measurement is a total score of 200 or lower, an HDL score of 60 (optimal, but 40 or higher for men and 50 or higher for women is acceptable), an LDL score of less than 100, and triglycerides score of less than 100 (but no more than 149).
Are there differences for men and women? In general, men are at higher risk for high cholesterol. But like so many other things about women’s bodies, menopause changes this. Pre-menopause, women typically have higher HDL level; post-menopause, women’s HDL levels tend to decrease and LDL levels tend to increase. Certain factors also make women more susceptible to high triglycerides, such as medications (like birth control pills and hormone replacement therapy), or conditions like lupus and PCOS (Polycystic Ovary Syndrome.)
What can you do? While genetics can play a role in your cholesterol levels, lifestyle factors are incredibly important. Advice for healthy cholesterol reads much like advice for prevention of many other illnesses and conditions: don’t smoke; drink in moderation; exercise regularly; and eat a healthful, plant-based diet (like the Mediterranean diet). Doctors also suggest consuming “healthy” fats found in olive oil, some nuts and fatty fish, like salmon. And, of course, if you have a family history of heart disease or have other conditions (like diabetes, high blood pressure or obesity) that increase your risk for heart attack or stroke, your doctor might advise you to take cholesterol medication, such as a statin. Women should also work with their healthcare provider to review other risk factors of heart disease, including emerging risk factors specific to women, such as autoimmune disorders, depression, age at menopause and pregnancy factors. The bottom line? Make sure you talk with your doctor at your next annual exam about your cholesterol levels and what you need to do to stay healthy.