For a healthy heart, pay closest attention to your “bad” cholesterol number.

If you want to keep your heart and circulatory system healthy, have your cholesterol levels checked on a regular basis beginning at age 20. Unhealthy cholesterol levels are a major risk factor for heart disease and stroke.

Getting your cholesterol checked is simple: Call your doctor and arrange for a quick blood test. (Your doctor may recommend fasting overnight.)

Making sense of the test results afterward can be a bit more complex. To start with, you are likely to be presented with a confusing array of numbers: one for your total cholesterol level, one for your “good” cholesterol (high-density lipoprotein or HDL), and one for “bad” cholesterol (low-density lipoprotein or LDL). The report also may slip in triglycerides (fats in the blood) for good measure.

Your doctor can help you make sense of the results, of course. But to keep things clear and simple, consider placing most of your attention on just one number: your LDL, or bad cholesterol, level.

“The LDL is what can lead to the buildup of plaque in your arteries over time, increasing your risk for heart attack or stroke,” explains Diane Bild, M.D., deputy director of the division of prevention and population sciences of the National Heart, Lung, and Blood Institute in Bethesda, Md.

Knowing your LDL level will give you a good sense, not only of your risks, but also of what you can do to effectively lower those risks. “Most of the better studies we have on the relationship between cholesterol and the risk for heart disease have to do with LDL,” Bild explains. “We also have better proven treatments for lowering LDL than we have for raising the good form of cholesterol, HDL.”

Learn the Basics
Cholesterol is a fatlike substance found in all the body’s cells. It also floats around in the blood in little packages of protein and cholesterol known as lipoproteins, such as the LDL and HDL mentioned above. A certain amount of cholesterol is necessary for your health and well-being, but your body automatically manufactures all you need, so you don’t need to take in more from the foods you eat.

The problem begins when too much of that LDL, or bad cholesterol, starts circulating in your blood. Over time, LDL can contribute to the formation of plaque, a thick, hard deposit that builds up in the walls of the arteries leading to the heart and brain. Without intervention, plaque can clog the arteries, placing you at serious risk for heart attack or stroke.

Down with the Bad
According to the American Heart Association, an LDL cholesterol level of less than 100 mg/dL is generally considered optimal, while a level of 160 or above is high. To help bring LDL closer to the 100 level:

• Follow a heart-healthy diet. “The first approach is diet,” Bild says. She recommends aiming for a calorie-controlled diet; limiting your intake of saturated fat, trans fat, and dietary cholesterol; and eating more soluble fiber found in beans and oatmeal.
• Maintain a healthy weight. Weight loss can have a beneficial effect on both LDL and HDL levels.
• Get regular physical activity. If possible, engage in aerobic exercise, such as brisk walking, cycling, or lap swimming. Try to exercise at least five times a week.
• Take cholesterol medications as prescribed. Many people find that even if they’re very good about following these lifestyle recommendations, their LDL will not fall into the optimal range. In this case, the next step is to consider cholesterol-lowering medications.

Most commonly prescribed are statins, which are considered quite safe with rare side effects and have been proven particularly effective in lowering LDL and reducing the risk for coronary heart disease.

Other lifestyle changes that may help lower LDL cholesterol include quitting smoking and consuming one or two alcohol drinks per day—red wine in particular.

Up with the Good
Meanwhile, don’t ignore HDL, the good form of cholesterol flowing through the bloodstream. HDL actually appears to protect against heart attack by slowing the growth of plaque in the arteries.

The good news is that some of the things you do to lower bad cholesterol also tend to raise good cholesterol. For example, HDL tends to increase if you lose weight, drink moderate amounts of alcohol, and increase your physical activity.

And what about those triglyceride levels revealed by the blood test? They’re another indicator of heart disease risk. Your level is likely to be high if you are overweight, have diabetes or metabolic syndrome, are eating a very high carbohydrate diet, or have a very high alcohol intake, Bild says.

In the end, all these numbers are only a guide.

“You and your physician should step back a little and not treat individual numbers,” Bild stresses. “Cholesterol is just part of a whole series of factors that affect the risk for coronary heart disease, such as age, family history, and whether you smoke, have diabetes, are overweight, or have high blood pressure. All of these risk factors work together.”

How Often to Check Your Cholesterol
The National Cholesterol Education Program recommends that all adults ages 20 and older have a fasting lipoprotein profile—a blood test that measures total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides—once every five years.

If any of the following situations apply to you, you may need your cholesterol checked more frequently:

• You have a total cholesterol of 200 mg/dL or higher.
• You are a man over age 45 or a woman over age 50.
• Your HDL cholesterol level is less than 40 mg/dL.
• You have additional risk factors for heart disease or stroke.

Your doctor may ask you to fast for nine to 12 hours before your blood test, meaning you’ll need to refrain from having any food, beverages, or medications beforehand. If you don’t fast, you won’t get valid results for LDL (bad) cholesterol or for your triglycerides, since those levels are affected by anything you’ve recently consumed.

Polly Turner spoke with Diane Bild, M.D., deputy director of the division of prevention and population sciences of the National Heart, Lung, and Blood Institute in Bethesda, Md. For more information, visit www.nhlbi.nih.gov and click on “Heart and Vascular Diseases.”

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