More and more Americans are working to prevent heart problems by detecting high cholesterol and lowering it. Those efforts appear to be paying off: between 2006 and 2010, the percentage of Americans with coronary artery disease—the cause of nearly all heart attacks—fell by 10%.
Yet despite this decline, cardiovascular disease still is the No. 1 cause of death for men and women in the United States. One in every six adult Americans has high cholesterol, making them about twice as likely to develop heart disease as those with lower cholesterol.
On the plus side, high cholesterol is something you can change. How? Healthy dietary choices and regular exercise are among the most effective weapons in the fight against high cholesterol. Medications can also help.
What to do about High Cholesterol, a Special Health Report from Harvard Medical School, offers up-to-date information to help you, or a loved one, keep cholesterol in check. The report spells out healthy, and unhealthy, cholesterol levels, and offers specific ways to keep cholesterol in line. The report explains cholesterol tests, the genetics of cholesterol, and treatments based on the latest scientific evidence. It covers the pros and cons of statins and other medications, and provides the lowdown on other substances advertised to lower cholesterol. What to do about High Cholesterol can also help you work with your doctor to individualize your treatment.
This Special Health Report was prepared by the editors of Harvard Health Publications in consultation with Faculty Editor Mason Freeman, M.D. Dr. Freeman is Chief of the Lipid Metabolism Unit at Massachusetts General Hospital (MGH), Director of the Translational Medicine Group at MGH, and a Professor of Medicine at Harvard Medical School. 48 pages (2012).
One cholesterol-lowering diet does not fit all
Every body is different, so it shouldn't come as a surprise that people respond differently to the same dietary change. In some people—call them responders—the amount of cholesterol in the bloodstream closely reflects the amount of cholesterol and unhealthy fats (saturated fats and trans fats) in their diets. In others—call them nonresponders—cholesterol levels more closely mirror how much cholesterol their livers make rather than the amount of cholesterol and unhealthy fats they consume.
A study done at the Human Nutrition Research Center on Aging at Tufts University looked at how 120 men and women responded to the National Cholesterol Education Program (NCEP) Step Two diet. It is a widely recommended low-fat, low-cholesterol diet. All the participants ate the same thing, since the researchers provided them with all their food and drink. On average, the level of harmful low-density lipoprotein (LDL) cholesterol dropped 16%. But that average masked a wide range of LDL responses, ranging from a 55% decrease to a 3% increase among men, and a 39% decrease to a 13% increase among women.
There are two important messages from research like this:
1. Determine which dietary changes work for you. Say your cholesterol is creeping upward and your physician suggests that you try a lower-fat, lower-cholesterol diet for three to six months. You make an effort to do so. But at the end of the trial period, a blood test shows that your cholesterol levels haven't budged. Your physician might misinterpret the lack of change and chide you for not sticking with the new diet. But if you have followed the diet carefully, make sure the doctor knows it. You may need a different kind of diet, such as a higher-protein, lower-carbohydrate eating pattern. Or you may need medication to control your cholesterol.
2. One size doesn't fit all. When a friend or relative tells you how much his or her cholesterol dropped after trying a particular diet, you may be tempted to try it. But if, after a few months, you discover that the diet has no effect, chalk it up to genetic and physiological differences. There just isn't a one-size-fits-all recommendation for diet or cholesterol consumption. That means you may have to try several different approaches to find one that works for you.
The take-home lesson here is to make sure your doctor knows whether or not you followed you prescribed diet — and how closely. If you followed it closely and your cholesterol numbers didn't change, you might need a different diet, or a cholesterol medication. Taking medication doesn't mean giving up on the diet, though. Even if a healthy diet doesn't lower your cholesterol, it will keep your body healthy in many other ways.
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I was recently diagnosed with high cholesterol and purchased this report. It gave me easy to understand explanations of everything from how food becomes cholesterol to what a lipid test reveals to the various treatment options. It’s packed with lots of charts and illustrations that make even the most complex topic easy to understand and use. Jim M., CT
This report is extremely helpful. At one level,the report reiterates what our doctors are always nagging us about anyway (diet, exercise, etc.) But more importantly, the report clearly explains why all these things are important and how they work, so maybe we will actually be moved to do what our doctors say. Even on the easier recommendations, such as omega-3 fish oil for high triglycerides -- I learned here why that works (makes blood platelets less sticky and helps protect the linings of arteries). And it does work, very well indeed -- nothing else brought my triglycerides down, for decades, but fish oil did a dramatic job very quickly. This report has very clear explanations & brilliant diagrams (e.g. "how statins work"). I highly recommend it. Bob C. AR
Admittedly I am a skeptic about the worry of high cholesterol. I'm 65, have 480 LDL and zero plaque. None. I think cholesterol may correlate but it certainly doesn't "cause" heart disease all by itself. I wrote to the author, Mason Freeman, with a sample of what I consider errors in this report and I was sort of surprised by his responses. He agreed with me that total cholesterol " is not useful in predicting CAD events in people over 70" (not stated in report), he agreed that "lower carbohydrate diets work to lower TGs" (not mentioned in report), he seemed to me unconcerned that the NIH risk calculator gave me a more than 10x risk of heart disease compared to direct imaging of my coronary arteries simply because my cardiologist "used an entirely different data set...". The idea that two "predictors" of risk vary wildly is apparently not cause to reject the incorrect method. He also admitted in his email that "one-third of men who have very high cholesterol levels and did not have heart attacks or the two-thirds of women...", but I certainly didn't feel these concepts were emphasized in the booklet.
It is my opinion that the report has more errors and I whole-heartedly do not recommend it. Read works by U. Ravnskov, MD, PhD for quite a different perspective on cholesterol.
My cholesterol is higher than it should be but I am trying to lower it with the help of diet, exercise and fish oil. This report was an excellent source for understanding cholesterol, where it comes from, how your body processes it and helpful hints to manage it. I am so glad I ordered this invaluable guide and I refer back to it again and again.