By Georgeanna Rechner, PharmD Candidate 2011
University of Illinois at Chicago College of Pharmacy
UIC Pharmacy
The phrase “high cholesterol” is usually associated with middle-age, heart attacks, or obesity. However, high cholesterol doesn’t develop overnight – it takes years to develop high cholesterol and starts sooner than one would expect. Twenty percent of 12 to 19-year-olds have higher than normal cholesterol levels, and 85% of 21 to 39-year-olds have fatty streaks in the arteries that supply the heart with blood.1,2 To help increase awareness of cholesterol and how to prevent the damage high cholesterol will inevitably cause if unmanaged, the National Heart, Lung, and Blood Institute has designated September as National Cholesterol Education Month.
How does cholesterol cause damage?
Cholesterol is not a bad thing as long as levels stay within the normal range; in fact, the body makes most of the cholesterol it needs.3 Not only is cholesterol found in many foods, the body also produces cholesterol from some of the saturated and trans fats found in food. The body also uses cholesterol to produce vitamin D and hormones, like testosterone and estrogen. As cholesterol levels increase, more can incorporate into blood vessels and decrease flexibility, eventually leading to atherosclerosis or hardening of blood vessels. Plaques of cholesterol also form within blood vessels and may eventually slow or block the flow of blood to vital organs. Chest pain, heart attacks, and strokes occur when blood vessels in the heart or brain become partially or completely blocked, which can negatively impact quality of life and are major causes of death and disability in the United States.
What can I do to prevent high cholesterol?
Before taking steps to manage cholesterol, it is good to know baseline laboratory values so progress can be measured. It is recommended that individuals 18 years and older have their cholesterol measured every 5 years as long as the results are within normal limits.1,4 If levels are higher than normal, cholesterol should be checked more frequently. Low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides should be tested along with total cholesterol (referred to as a lipid panel). Lipoproteins contain cholesterol and the proteins needed to help the oily cholesterol mix well with blood.3 Total cholesterol measures free cholesterol and any cholesterol found in LDL and HDL. Low-density lipoprotein, the “bad” cholesterol, causes atherosclerosis and the formation of plaques by depositing cholesterol into tissue. High-density lipoprotein, the “good” cholesterol, counteracts the effects of LDL by removing cholesterol from tissue. Triglycerides are another form of fat found in the blood that contributes to total cholesterol. Cholesterol tests or lipid panels can either be fasting (i.e. after abstaining from food or drink for at least 9 hours prior to the test), or non-fasting. If a non-fasting test measures total cholesterol to be >200 mg/dL or HDL <40>4 Table 1 lists the desired levels for a lipid panel in young adults. If levels are higher than normal, alterations in lifestyle may lower levels before medication is needed. Initiating these changes slowly will increase the likelihood that these changes will last a lifetime.3,4
Table 1. Desired lipid panel results.
Goal Levels (mg/dL) | |
LDL* | <130 |
HDL | |
Women | >50 |
Men | >40 |
Total Cholesterol | <200 |
Triglycerides | <150 |
*Low-density lipoprotein goal for young adults in good health; if you are being treated for any condition, speak with your healthcare provider about your personal LDL goal. | |
What about diet—what should I avoid?
· Less than 7% of daily calories should come from saturated fats, and 25% to 35% of daily calories should come from total fat.
o A 2,000 calorie diet should include 13 grams of saturated fat or less daily.
· Consume less than 200 mg of cholesterol per day.
· Consume approximately 10 to 25 grams of soluble fiber per day to prevent absorption of fats and cholesterol from other foods.
· Table 2 lists some of the foods that have high amounts of saturated fat, trans fat, and cholesterol that should be avoided as much as possible and foods high in fiber and unsaturated fats that can help lower cholesterol levels.
Table 2. Selection of foods associated with worsening or improving cholesterol levels.
Foods to Avoid | Beneficial Foods | |||||
Saturated fats | Fiber | |||||
fatty meat | whole grain breads, pastas | |||||
skin-on poultry | oatmeal | |||||
whole milk products | barley | |||||
coconut oil | whole fruit | |||||
palm oil | whole vegetables | |||||
beans | ||||||
Trans fats | lentils | |||||
hydrogenated vegetable oil | chick peas | |||||
stick margarine/shortening | black-eyed peas | |||||
crackers | ||||||
cookies | Unsaturated fats | |||||
doughnuts | nuts | |||||
french fries | avocados | |||||
fried chicken | tuna | |||||
potato chips | mackerel | |||||
salmon | ||||||
Cholesterol | olive oil | |||||
egg yolks | canola oil | |||||
shrimp | sunflower oil | |||||
whole milk products | peanut oil | |||||
butter | safflower oil | |||||
ice cream | soybean oil | |||||
cheese | ||||||
organ meats | ||||||
What are the benefits of exercise?
· Lowers LDL, raises HDL, and decreases weight
· You should do 30 minutes of aerobic exercise per day, 5 to 7 days a week
· Start slow—not all 30 minutes has to be done at once and exercise can be distributed throughout the day.
What is a healthy weight?
· The number of inches around the waist can be used as an indicator for risk of heart disease–women should be less than 35 inches and men should be less than 40 inches around the waist.
· A body mass index (BMI) of 18 to 24.9 kg/m2 also indicates a healthy target weight. A free BMI calculator is located here.
Get started now!
As another semester begins, class assignments, exams, and increasingly busy schedules may prevent you from going to the gym or eating healthy foods. Fortunately, starting new habits now can reverse any damage that may have already been done and prevent any consequences of high cholesterol in the future. High cholesterol can no longer be thought of as a disease of the middle-aged and obese. Addressing the issue of high cholesterol as a young adult is a way to protect your health for years to come.
By Georgeanna Rechner, PharmD Candidate 2011
University of Illinois at Chicago College of Pharmacy
References
1. Gooding HC, de Ferranti SD. Cardiovascular risk assessment and cholesterol management in adolescents: getting to the heart of the matter. Curr Opin Pediatr. 2010;22(4):398-404. 2. Berenson GS, Srinivasan SR, Bao W, Newman WP III, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. N Engl J Med. 1998;338(23):1650-1656.
3. National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services. Your Guide to Lowering Cholesterol with TLC. Bethesda, MD: National Heart, Lung, and Blood Institute; 2005. NIH publication 06-5235. Available at: http://www.nhlbi.nih.gov/health/public/heart/chol/chol_tlc.pdf. Accessed July 19, 2010.
4. National Cholesterol Education Program Expert Panel. The third report of the expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. JAMA. 2001;285(19):2486-2497.
