Your Not Alone Statistics on Cholesterol
Knowing the statistics on how cholesterol levels and certain lifestyle behaviors affect outcomes in patients at risk for heart disease and stroke is important. Knowing the numbers can affect the recommendations you make to help your patients achieve better health.
Estimates are that 99.5 million American adults have total blood cholesterol values of 200 mg/dL and higher, and about 39.9 million American adults have levels of 240 or above. In adults, total cholesterol levels of 240 mg/dL or higher are considered high, and levels from 200 to 239 mg/dL are considered borderline-high.
CHOLESTEROL
AHA Scientific Position
Cholesterol is a soft, waxy substance found among the lipids (fats) in the bloodstream and in all your body's cells. It's an important part of a healthy body because it's used to form cell membranes, some hormones and other needed tissues. But a high level of cholesterol in the blood -- hypercholesterolemia (hi"per-ko-les"ter-ol-E'me-ah) -- is a major risk factor for coronary heart disease, which leads to heart attack.
Cholesterol and other fats can't dissolve in the blood. They have to be transported to and from the cells by special carriers called lipoproteins (lip"o-PRO'te-inz). There are several kinds, but the ones to be most concerned about are low-density lipoprotein (LDL) and high-density lipoprotein (HDL).
What is LDL cholesterol?
Low-density lipoprotein is the major cholesterol carrier in the blood. If too much LDL cholesterol circulates in the blood, it can slowly build up in the walls of the arteries feeding the heart and brain. Together with other substances it can form plaque, a thick, hard deposit that can clog those arteries. This condition is known as atherosclerosis (ath"er-o-skleh-RO'sis). A clot (thrombus) that forms in the region of this plaque can block the flow of blood to part of the heart muscle and cause a heart attack. If a clot blocks the flow of blood to part of the brain, the result is a stroke. A high level of LDL cholesterol (130 mg/dL and above) reflects an increased risk of heart disease. That's why LDL cholesterol is often called "bad" cholesterol. Lower levels of LDL cholesterol reflect a lower risk of heart disease.
What is HDL cholesterol?
About one-third to one-fourth of blood cholesterol is carried by high-density lipoprotein or HDL. Medical experts think HDL tends to carry cholesterol away from the arteries and back to the liver, where it's passed from the body. Some experts believe HDL removes excess cholesterol from atherosclerotic (ath"er-o-skleh-ROT'ik) plaques and thus slows their growth. HDL cholesterol is known as "good" cholesterol because a high level of HDL seems to protect against heart attack. The opposite is also true: a low HDL level (less than 40 mg/dL) indicates a greater risk.
What about cholesterol and diet?
People get cholesterol in two ways. The body -- mainly the liver -- produces varying amounts, usually about 1,000 milligrams a day. Another 400 to 500 mg (or more) can come directly from foods. Foods from animals (especially egg yolks, meat, poultry, fish, seafood and whole-milk dairy products) contain it. Foods from plants (fruits, vegetables, grains, nuts and seeds) don't contain cholesterol. Typically the body makes all the cholesterol it needs, so people don't need to consume it.
Saturated fatty acids are the chief culprit in raising blood cholesterol, which increases your risk of heart disease. Trans fats also raise blood cholesterol. But dietary cholesterol also plays a part. The average American man consumes about 337 milligrams of cholesterol a day; the average woman, 217 milligrams.
Some of the excess dietary cholesterol is removed from the body through the liver. Still, the American Heart Association recommends that you limit your average daily cholesterol intake to less than 300 milligrams. If you have heart disease, limit your daily intake to less than 200 milligrams. Still, everyone should remember that by keeping their dietary intake of saturated fats low, they will also be able to significantly lower their dietary cholesterol intake. Foods high in saturated fat generally contain substantial amounts of dietary cholesterol.
People with severe hypercholesterolemia (hi"per-ko-les"ter-ol-E'me-ah) may need an even greater reduction. Since cholesterol is present in all foods from animal sources, care must be taken to eat no more than six ounces of lean meat, fish and poultry per day and to use skim (fat-free) and low-fat dairy products. High-quality proteins from vegetable sources such as beans are good substitutes for animal sources of protein.
How does exercise (physical activity) affect cholesterol?
For some people, exercise affects blood cholesterol level by increasing HDL ("good") cholesterol. A higher HDL cholesterol is linked with decreased risk of heart disease. Exercise can also help control weight, diabetes (di"ah-BE'teez or di"ah-BE'tis), and high blood pressure. Exercise that uses oxygen to provide energy to large muscles (aerobic exercise) raises your heart and breathing rates. Regular exercise such as brisk walking, jogging and swimming also condition your heart and lungs.
Physical inactivity has been established as a major risk factor for heart disease. Even moderate-intensity activities, if done daily, help reduce your risk. Examples are walking for pleasure, gardening, yard work, housework, dancing and prescribed home exercise.
How does cigarette / tobacco smoke affect cholesterol?
Cigarette and tobacco smoke is one of the six major risk factors of heart disease that you can change, treat or modify. Smoking has been shown to lower HDL ("good") cholesterol levels.
How does alcohol affect cholesterol?
In some studies, moderate use of alcohol is linked with higher HDL ("good") cholesterol levels. However, because of other risks, the benefit isn't great enough to recommend drinking alcohol if you don't do so already.
If you drink, do so in moderation. The incidence of heart disease in those who consume moderate amounts of alcohol (an average of one to two drinks per day for men and one drink per day for women) is lower than in nondrinkers. However, with increased consumption of alcohol, there are other health dangers, such as alcoholism, high blood pressure, obesity, stroke, cancer, suicide, etc. In light of these and other risks, the American Heart Association believes it isn't advisable to issue guidelines to the general public that may lead some to increase their intake of alcohol or start drinking if they don't already do so. It's best to consult with your doctor for advice on consuming alcohol in moderation (no more than 1-2 drinks per day).
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Major risk factors for coronary heart disease that cannot be changed
Increasing age -- About 85 percent of people who die of coronary heart disease are age 65 or older. At older ages, women who have heart attacks are twice as likely as men are to die from them within a few weeks.
Male gender -- Men have a greater risk of heart attack than women, and they have attacks earlier in life. Even after menopause, when women's death rate from heart disease increases, it's not as great as men's.
Heredity (including race) -- Children of parents with heart disease are more likely to develop it themselves. African Americans have more severe high blood pressure than whites. Consequently, their risk of heart disease is greater.
Major risk factors for coronary heart disease that can be modified or treated
You can change or treat these factors to lower your risk by focusing on your lifestyle habits or, if needed, taking medicine.
Tobacco smoke -- Smokers' risk of heart attack is more than twice that of nonsmokers. Cigarette smoking is the biggest risk factor for sudden cardiac death: smokers have two to four times the risk of nonsmokers. Smokers who have a heart attack are more likely to die and die suddenly (within an hour) than are nonsmokers. Available evidence also indicates that chronic exposure to environmental tobacco smoke (secondhand smoke, passive smoking) may increase the risk of heart disease.
High blood cholesterol levels -- The risk of coronary heart disease and stroke rises as blood cholesterol levels increase. When other risk factors (such as high blood pressure and tobacco smoke) are present, this risk increases even more. A person's cholesterol level is also affected by age, gender, heredity and diet.
High blood pressure -- High blood pressure increases the heart's workload, causing the heart to enlarge and weaken over time. It also increases the risk of stroke, heart attack, kidney failure and congestive heart failure. When high blood pressure exists with obesity, smoking, high blood cholesterol levels or diabetes, the risk of heart attack or stroke increases several times.
Physical inactivity -- Lack of physical activity is a risk factor for coronary heart disease. Regular, moderate-to-vigorous exercise plays a significant role in preventing heart and blood vessel disease. Even moderate-intensity physical activities are beneficial if done regularly and long term. More vigorous activities are associated with more benefits. Exercise can help control blood cholesterol, diabetes and obesity as well as help to lower blood pressure in some people.
Obesity and overweight -- People who have excess body fat are more likely to develop heart disease and stroke even if they have no other risk factors. Obesity is unhealthy because excess weight increases the strain on the heart. It's directly linked with coronary heart disease because it influences blood pressure, blood cholesterol and triglyceride levels, and makes diabetes more likely to develop. If you can lose as little as 10 to 20 pounds, you can help lower your heart disease risk.
Diabetes mellitus -- Diabetes seriously increases the risk of developing cardiovascular disease. Even when glucose levels are under control, diabetes increases the risk of heart disease and stroke. Two-thirds of people with diabetes die of some form of heart or blood vessel disease. If you have diabetes, it's critically important for you to monitor and control any other risk factors you can.
What other factors contribute to heart disease risk?
Individual response to stress may be a contributing factor. Some scientists have noted a relationship between coronary heart disease risk and stress in a person's life, their health behaviors and socioeconomic status. These factors may affect established risk factors. For example, people under stress may overeat, start smoking or smoke more than they otherwise would.
Stealth Fat Lurks in Favorite Foods
Feb. 10, 2003 -- Grab a handful of Nabisco Wheat Thins. A healthy snack? Maybe not. The baked-wheat treats are filled with just as much of an artery-clogging kind of fat -- 2 grams -- as a Burger King Dutch Apple Pie.
Don't bother switching to Sunshine Cheez-It Baked Snack Crackers. Like two Eggo Buttermilk Waffles, they hold 1.5 grams of the stuff. So does 3/4 of a cup of Kellogg's Cracklin' Oat Bran Cereal. I Can't Believe It's Not Butter! Margarine carries 2 grams; there's even a half gram in Quaker Chocolate Chunk Chewy Low Fat Granola Bars. The figures come from tests run on 30 top-selling foods by Consumers Union. They appear in the March issue of Consumer Reports.
The sneak attack on your health comes from trans fat. Don't look for it on the label. Current FDA rules don't require it to be listed along with saturated fat -- the other kind of fat that's particularly bad for you.
"Trans fats are bad," Marvin M. Lipman, MD, chief medical advisor for Consumer Reports, tells WebMD. "They are there and they are not labeled."
But not all healthy baked foods have trans fat. Neither Arnold nor Pepperidge Farm 100% whole wheat bread has any trans fat or saturated fat.
There's a little bit of trans fat in some meats, but this health hazard is almost entirely man made. Trans fats are used in fast-food cooking because they don't spatter. But they also help solidify margarine and baked foods. They are cheap to produce and easy to use. Like saturated fats, they hurt your health.
Saturated fats are the only fats given special treatment on a product's label. Yet trans fats are just as bad. They may even be worse.
"Trans fat increases 'bad' LDL cholesterol -- in some studies more than saturated fat," Lipman says. "It also has a tendency to reduce 'good' HDL cholesterol, which saturated fat doesn't do. They work together as a pretty formidable instigator of clogged arteries and heart disease."
That's not all. Trans fat also increases blood levels of two other bad actors. One is the kind of fat called triglycerides. The other is a particle called lipoprotein(a), which promotes clogged arteries.
Since 1999, the FDA has tried to get manufacturers to label foods for trans fats. The food industry strenuously objected. But a recent report from the prestigious Institute of Medicine now points to trans fats as a health hazard. The result: The FDA will act in March, an FDA spokesperson tells WebMD. Once it does, food manufacturers will have one year to comply.
"Trans fats may be hidden, but they are no worse than other fats," Gene Grabowski, spokesman for the Grocery Manufacturers of America Inc., tells WebMD. "Singling out any kind of fat as being worse than any other is not supported by science."
"Any amount of trans fat is bad," Lipman says. "Nobody knows how much trans fat is too much."
Public awareness of trans fats already is making a difference. Frito-Lay tells Consumer Reports that it plans to eliminate trans fat from Cheetos, Doritos, and Tostitos. And McDonald's says it will cut out nearly half the trans fat in its french fries -- although fast-food fries will never be healthy food.
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