Cholesterol is often something people don’t worry about until it causes a health problem. But recognizing the role cholesterol plays in heart disease is important, according to Hassan Pervaiz, M.D., a cardiologist with Texas Health Heart & Vascular Specialists, a Texas Health Physicians Group practice in Dallas.

“It’s critical to understand if you have or are at risk for high cholesterol to address it sooner rather than later,” he says. “Cholesterol and its effect on the heart, and to other organs, is cumulative. So the more time we have to correct it, the better.”

High cholesterol can often go undetected and may produce no symptoms in the early stages. A blood test is the only way to monitor cholesterol levels, which is why Pervaiz says regular checkups with your doctor are essential.

“Sometimes externally the person looks fine,” he says. “There’s often no way of knowing they have high cholesterol just by looking at them.”

He stresses that there’s hope for people with high cholesterol, through a mix of medical interventions, new treatments and tried-and-true lifestyle modifications.

Cholesterol Basics

Cholesterol is a waxy, fat-like substance that circulates in your blood. It’s needed to build healthy cells and make vitamins and other hormones.

The liver makes cholesterol needed for survival. Humans, however, get excess cholesterol in their bodies from eating certain foods. These include processed meats such as bacon and hot dogs, full-fat dairy products, unhealthy oils, and other foods high in saturated and trans fats.

There are two main types of cholesterol:

• Low-density lipoprotein (LDL), or “bad” cholesterol, transports cholesterol particles throughout the body and can build up in the walls of arteries, making them hard and narrow.
• High-density lipoprotein (HDL), or “good” cholesterol, picks up excess cholesterol and takes it back to the liver.

Too much of the bad cholesterol, or not enough of the good cholesterol, can cause problems.

Who’s at Risk?

Health risks increase when there is more “bad” cholesterol circulating in your blood. This excess can lead to fatty deposits in blood vessels, clog arteries and increase the risk of chest pain, heart attack, peripheral artery disease or stroke.

Pervaiz uses a risk assessment to help determine who is most likely to have cardiovascular problems. This allows him to personalize a plan for each patient based on their age, gender, overall heart health, other medical conditions, family history and more.

He says it’s important to understand the factors that may contribute to an increased chance of high cholesterol. For instance, genetics plays a role in how much cholesterol your liver produces and how efficiently your body removes LDL cholesterol from your blood. Family history — having a close relative who had high cholesterol or other heart ailments — may increase your risk as well.

According to Pervaiz, other at-risk groups include women who had complicated pregnancies or who started menopause early, certain ethnic groups such as South Asians, people with diabetes, smokers, and people with obesity and other medical conditions.

He generally advises people to get baseline blood work and a cholesterol check at age 20 and then every four to six years after that, depending on their risk profile. More frequent tests may be necessary if you have a family history of high cholesterol or other risk factors.

For children with extensive risk factors or who have a family history of extremely high cholesterol or early cardiovascular disease, the baseline check may be needed earlier. 

Ways to Stay Healthy

Get your cholesterol checked and talk to your health care provider about your numbers and how they impact your overall risk for heart disease and stroke. The best approach to risk reduction goes beyond cholesterol levels alone. It considers overall risk along with measures for reducing risk.

You can find out your risk with the American Heart Association’s Check. Change. Control Calculator. In minutes, you can learn your risk for a heart attack or stroke.

Making healthy lifestyle changes is the first step in reducing your risk. Pervaiz suggests adding healthy habits that can benefit you at any age.

Some of these lifestyle changes include:

• Increasing physical activity. The American Heart Association recommends at least 150 minutes per week of moderate-intensity aerobic activity, such as brisk walking.
• Maintaining a diet that emphasizes fruits, vegetables, whole grains, low-fat dairy products, poultry, fish and nuts.
• Cutting down on red meat and choosing fish, skinless poultry or lean vegetable proteins instead.
• Using healthier fats when cooking, such as olive, corn, safflower or canola oil.
• Avoiding processed meats, such as cold cuts, deli meat, bacon, hot dogs, bologna and sausage.
• Minimizing added sugar to no more than 150 calories (nine teaspoons) per day for men, and no more than 100 calories (six teaspoons) per day for women and children.
• Losing excess weight.
• Quitting smoking.
• Limiting or avoiding alcohol.
• Managing stress.

Cholesterol Treatment Options

When medication is needed to lower LDL cholesterol, there are multiple choices based on your individual needs. Sometimes a combination of medications is needed.

Statins, which block a substance your liver needs to make cholesterol, are “the cornerstone of cholesterol treatment,” Pervaiz says. But statins can come with side effects, such as muscle weakness and liver problems.

A newer class of drugs to treat high cholesterol is known as PCSK9 inhibitors. These injectable medications allow the liver to absorb more LDL cholesterol, which lowers the amount circulating in your blood. These are primarily used for people who have a genetic condition that causes very high levels of LDL cholesterol. They are also used for patients who have a history of coronary disease and an intolerance to statins or other cholesterol medications.

Though promising, PCSK9 inhibitors are very expensive. For this reason, they are usually used in the highest-risk patients.

Other cholesterol treatments your doctor might recommend include niacin, bile-acid sequestrants, fibrates and omega-3 fatty acids. The best advice, Pervaiz says, is to find a doctor who opts for an individualized treatment plan for each patient.

“When we’re treating cholesterol, the protocol is not the same for everyone. People have more options than ever to stay heart healthy. Our goal is to always make treatment patient-focused, and to share decision-making about the best treatment options with you,” he says.

Take charge of your cholesterol and heart health by finding a heart and vascular specialist near you.

Texas Health Physicians Group providers are employed by Texas Health Physicians Group and are not employees or agents of Texas Health Resources hospitals.

This article was developed by the American Heart Association for Texas Health.