Cholesterol: Fact vs. Fiction

Learn how to prepare yourself against this silent killer

Every cell in your body contains cholesterol. You can’t live without it. But, everyone also knows its central role in developing heart disease. So, how can you best prepare yourself against this silent killer? Vigilance.

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Have your cholesterol checked. And, understand how cholesterol works, recommends Cleveland Clinic heart surgeon Marc Gillinov, MD, and cardiologist Steven Nissen, MD. Can you tell fact from fiction?

1. Diet is the most important factor in determining your cholesterol level.

False. Eighty percent of the body’s cholesterol is made by the liver. That means, only 20 percent comes from your diet. That’s why it is so hard to lower cholesterol through diet alone. By banning nearly all cholesterol from your diet, you might be able to reduce your total cholesterol level by about 20 percent.

Understanding this can often make the choice to take cholesterol-lowering drugs easier. If you need to reduce your cholesterol by 50 percent, you cannot accomplish this through diet alone. You’ll need a good diet and the right medication.

2. Total cholesterol is more important than LDL (bad cholesterol) alone.

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False. Although attention was paid to total cholesterol in years past, today the focus is on LDL. Your LDL level is the best predictor of your risk of heart attack and stroke. Simply put, lower is better. For example, if you have two 55-year-old men, the one with an LDL of 125 has a higher risk of developing heart disease than the one with an LDL of 90 – even though both of their LDL levels are in the normal range.

So, what should your LDL be? If you have coronary heart disease, your LDL cholesterol should be 70 mg/dL or less. If you have major risk factors for coronary artery disease, your LDL should be 100 mg/dL or less. A LDL of greater than 130 mg/dL is unhealthy even if you don’t have heart disease.

3.  No cholesterol pill can cancel out the effects of a Big Mac.

True.  British cardiologists proposed a tongue-in-cheek solution to our infatuation with fast food. Why not take a statin with your burger, fries and milkshake? No cholesterol-lowering pill can make up for a steady diet of Big Macs and other foods filled with excess calories and saturated fats. The authors suggest, “Better ways to reduce your risk of disease from heart attack include: eating healthily, exercising, maintaining a healthy weight, and not smoking.” We wholeheartedly agree.

Marc Gillinov, MD, heart surgeon and Steven Nissen, MD, cardiologist and chair of Cardiovascular Medicine are authors of the new book Heart 411.

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Update 1/20/2012

Thank you all for taking the time to comment on this article. Our mission at the Cleveland Clinic is to provide people with information that is both accurate and guided by research. It sounds as though some of you have had success with improving your lipid profile with a plant based diet. For others, this is not the case.

It is important to  remember  that all patients are not created equal, and we recommend that you work with a preventive cardiology team (including doctors, nurses, exercise specialists and dietitians) that can evaluate your lipids and risk profile and work with you to create a plan to help you reach your goals. Optimizing your lipid profile requires a heart-healthy diet (low in saturated fat and cholesterol and rich in vegetables and fiber) and exercise. The extent of dietary changes one wants to make is individualized. People with a very high LDL cholesterol will usually require a combination of medications and dietary measures. When patients do choose to follow a strict and very limited diet, we encourage  them to see a dietitian to make sure you are not missing out on important nutrients needed by  the  body.

Last,  some comments suggested taking vitamins, supplements and herbals. Please speak to your doctor first before taking any of these.   Supplements may be costly and may not provide any benefit. In addition, some supplements can interact with medications and cause harm. Our Preventive Cardiology Clinic staff is always available to work with you either by appointment or e-consultation.

Good luck to all of you in your efforts to be heart-healthy!

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