Cholesterol: Know Your Numbers, Know Your Risk
Hello, team. First, a small update since the last post. I have signed up for my FIRST 10K! I’ve never run a 10K before (only 5Ks in the past, all as fundraisers for my kids elementary school). I’ve told my kids about it, which means I have to come through! What have you decided to do for yourself and your health? Who are you getting healthy for?
So far, we have discussed two major ways to reduce your risk of developing heart disease:
- Control your blood pressure
- Get regular exercise
Today, we’ll tackle another:
3 . Know your cholesterol numbers and what they mean for your overall risk.
I know, I know, as my kids would say “Mom, that’s BOR-ING.” Don’t close the browser window yet. High cholesterol is another major risk factor for heart disease. As the smart, strong woman I know you are, you should know what your cholesterol is, and what those numbers mean for your long term risk of heart attack and stroke.
The thing that trips up most people about cholesterol, is that everyone’s goals for cholesterol can be different. Yes, this makes it slightly more complicated, but let me walk you through it.
First, cholesterol is reported as 4 different numbers:
- Total cholesterol: this takes into account all three values of cholesterol/fat listed below.
- Triglycerides: another type of fat (not cholesterol). Having high triglycerides can increase your risk of heart attack and stroke.
- HDL: Good cholesterol. Having higher HDL seems to reduce your risk of heart attack and stroke.
- LDL: Bad cholesterol. Higher levels of LDL increase your risk of heart attack and stroke.
The goals for your individual cholesterol all depend on your PERSONAL risk of developing heart disease over time. That risk depends on a whole lot of factors—some of which you control (exercise, blood pressure, weight, smoking) and some which you don’t (family history, diabetes, your age).
The general rule of thumb is that you want the triglycerides and LDL to be low (and lower is better) and the HDL to be high. Most of the medications we use for cholesterol are focused on lowering the LDL, because in lots of scientific studies, lowering the LDL is how we can reduce people’s risk of heart attack and stroke.
Your doctor will take your cholesterol numbers and use them along with age, smoking history, current blood pressure, and other medical problems, to calculate your risk of heart disease and stroke over 10 years and potentially over your lifetime. Then, depending on how high that risk is, she will help you figure out what you should do with your cholesterol to lower that risk.
Let’s take the following woman and her cholesterol profile as an example of what your doctor could do to evaluate your risk of heart disease.
A 41-year-old female cardiologist (one guess as to who we are talking about) without diabetes, or high blood pressure wants to evaluate her risk of developing heart disease or stroke. She has never smoked.
Her cholesterol is: total cholesterol: 198, triglycerides: 106, HDL: 49, LDL: 128
Her blood pressure is 118/62 (this is normal).
Now because she has never been diagnosed with heart disease and has never had a stroke, she can use the ACC/AHA risk calculator, plug in her numbers and demographics and get a risk score.
Based on the ACC/AHA risk calculator (available online for anybody who wants to use it—link below), her 10year risk of developing heart disease or stroke is 0.6%. Woohoo! Interestingly, this is the first time I have ever done that calculation on myself!
Based on such a low risk, she should continue to exercise and eat a healthy diet to prevent her LDL cholesterol from going up further, but there is no reason for her to start on medication for cholesterol at this point in time.
Now, what if my risk had come out much higher because of a higher age and/or a history of high blood pressure, but with the same cholesterol numbers? Let’s say I had a 15% risk of heart attack or stroke over the next ten years. Then my doctor and I would have a discussion about what else we could do (like using medication) to bring my cholesterol down further in order to lower my overall risk.
So that is why (with some exceptions) no single cholesterol result is necessarily good or bad. Any one number could be “fine” or “high” depending on the total risk.
If I can calculate my 10-year risk of heart disease and stroke, so can you. So get into your primary care doctor’s office to review your risk and discuss what can and should be done to mitigate that risk. You deserve to take care of yourself. You deserve to put your health first. You deserve to know your risk. Find our your cholesterol numbers, and find out what they mean for you.
I’m getting mine checked again later this spring (PCP appointment made?—check).
Links to calculate your risk of developing heart disease or stroke. Both contain the same risk calculator, the information is just presented somewhat differently in each.