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A Guide to Your Cholesterol
Dr. Chad Travers shares what the new lipid guidelines mean for your health, the difference between LDL, HDL, and triglycerides and advice on how to lower your cholesterol for a longer, healthier life.
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Learn more about Dr. Chad Travers
Chad Travers, MD, Bryan Heart
Dr. Chad Travers is a cardiologist with Bryan Heart.Learn more about Dr. Chad Travers
Transcription:
A Guide to Your Cholesterol
Melanie Cole, MS (Host): Have you been told your cholesterol is too high? Do you even know what cholesterol is or why they say it’s bad for you? My guest today is Dr. Chad Travers. He’s a cardiologist with Bryan Heart. Dr. Travers, let’s start with just the basic definition. What is cholesterol? Is it all bad for you? And what do you want us to know about it?
Chad Travers, MD (Guest): Yeah, well thanks for having me on today. Cholesterol we hear a lot about. We hear a lot about through the lay media as well. For the most part, cholesterol gets a fairly bad wrap. We think that all cholesterol is bad. When, in fact, cholesterol is a naturally occurring substance in the body. Now what exactly cholesterol is is it is a waxy fat-like substance that is in the body. However, it has many purposes. It’s useful for cell structure in the body. In fact, it’s in all cells of the body. It does have some beneficial effects. It is responsible for synthesis of hormones in the body. Sex hormones, hormones that regulate blood pressure. So, cholesterol is an important substance in our body. That being said, too much cholesterol, we know, can be very harmful. So that is something that we watch.
We also know that cholesterol is something that is synthesized by the body. In fact, all the cholesterol that one-person needs can be made by the body itself. We do eat a significant amount of dietary cholesterol, which typically comes from animal products. Meats, dairy products, eggs all have significant amount of cholesterol in them. So, in people that do eat a significant amount, the body will regulate this amount. It’s something that we just need to keep an eye on what each person’s total cholesterol is in their body.
Host: What are the different types? People hear good cholesterol and bad cholesterol and total triglycerides. HDLs, LDLs, VLDLs. Tell us what those mean and why are they called good and bad cholesterol.
Dr. Travers: Yeah, absolutely. So, this is the talking point on a daily basis, and it can actually be quite confusing. So, a couple numbers that you’ll see when you do get a cholesterol panel, you’ll first get a total cholesterol. This measures all the different particle sizes of cholesterol in the body. That number, you’ll see typically has a reference range of 200 or less. That’s just a starting point for patients. The next cholesterol that we look at is the HDL cholesterol. HDL stands for high-density lipoprotein. That’s the good cholesterol in the body. So, if you think HDL cholesterol, you're thinking good cholesterol. What HDL cholesterol does, it actually transports cholesterol in the body back to the liver where the liver can then package it up and the excess cholesterol can then be excreted.
The LDL cholesterol is the bad cholesterol. This is the form of cholesterol that causes plaque buildup in the arteries. Arteries of the heart, arteries of the legs, carotid arteries. So, this is the one that we really look at for risk factors in people with concern to cardiovascular health. There’s the VLDL cholesterol, which is similar to LDL cholesterol. This is a very low-density lipoprotein. This is responsible for transferring the triglycerides in the blood. So, again, the VLDL cholesterol is a significant risk factor for cardiovascular health along with the LDL cholesterol.
Host: How does high LDL cholesterol affect a person’s heart health? And even HDL cholesterol. If that’s high because you're in good shape or you exercise a lot, how does that effect a person’s heart health?
Dr. Travers: Yeah. So, the LDL cholesterol we know is plaque forming. Now plaque is buildup of cholesterol inside the arteries, say of the heart. We know that the higher the LDL cholesterol, the higher your risk for clinical heart disease. So, what that means is that the higher the LDL cholesterol, the more plaque formation you have, which can predispose you to heart attacks or strokes.
HDL cholesterol, on the other hand, we think is protective against cardiovascular disease. HDL cholesterol, like I said, takes that bad cholesterol back to the liver so that the body can excrete excessive amounts. So, we look at HDL cholesterol as being protective to the body. Wen we look at a lipid panel that you may have drawn with your doctor or cardiologist, we like to see that HDL cholesterol… We say higher the better on HDL cholesterol. The converse is true for LDL cholesterol. We like to see that as low as possible for prevention of cardiovascular disease.
Host: How often should we have it checked? Tell us what those numbers mean when you say we like to see it as low as possible. Now there’s been some recent new guidelines, correct, on cholesterol numbers. Tell us about that.
Dr. Travers: Yeah, absolutely. So, first question is how often should we have this checked? Everyone should have their cholesterol checked by the age of 18. That being said, people that are very high risk for cardiovascular disease, people that have a really strong family history, may even have it checked before the age of 18. After the age of 18, between the ages of 20 to 45, just roughly think that every five years or so you should have your cholesterol checked. Men between the ages of 45 and 65 should probably have their cholesterol checked every one to two years. Women between the ages of 55 and 65 should have their cholesterol checked every one to two years as well.
As far as what the numbers mean. When you see a lipid panel or cholesterol panel, it’s going to give you reference ranges. Now those ranges are for the general population. So, people without cardiovascular disease. These are for 20-year-old people without any significant risk factors. So, when you look at a cholesterol panel, you really have to look at each individual person and what their cardiovascular risk is. Now an LDL cholesterol of 120 may be perfectly fine for someone that has no significant cardiovascular risk factors. However, an LDL cholesterol of 120 for somebody with coronary artery disease is much too high. So, again, you have to take each person’s individual risk into account.
Host: What about our diet and exercise? Where do they fit into this picture, Dr. Travers, and what can we do to lower our cholesterol naturally?
Dr. Travers: Yeah. That’s always the first treatment strategy when you look at a cholesterol panel. We know that diet and exercise play a big role in your cholesterol panel. We know that lack of physical activity and poor diet increase your LDL cholesterol and decrease your HDL cholesterol. We also know that smoking does the same. Smoking will cause your LDL cholesterol to go up and decrease your HDL cholesterol. So those are things that we always need to talk about before we talk about treatment.
If a person has done everything they can with their diet, their lifestyle, their exercise, and their LDL cholesterol or total cholesterol remains high, their HDL remains low. Then we do talk about medications. The group of medications that are first line for this are the statin medications. So, statin medications are well talked about in the lay press. We do know that they do reduce your risk of heart attack and stroke. You always have to balance this with potential side effects. So, each person needs to talk to their physician on individual basis. That being said, one thing that the new guidelines would recommend is that each person also needs to sit down and have a risk assessment. Take into account the age, the person’s gender, family history, diabetes, hypertension. Each person needs to have the risk calculated from a cardiovascular standpoint.
Host: People have heard about some natural remedies to try and lower their cholesterol. Whether it’s oat bran, eating oatmeal, or some of these other things. Garlic supplements. What do you think about that? Does oatmeal really work?
Dr. Travers: Yeah. That’s an interesting discussion. Again, I think oatmeal may be beneficial. I think when you look at more whole grains, I think there’s something behind that. I think decreasing your carbohydrate intake will certainly lower your triglyceride level and likely lower your bad cholesterol levels as well. We also know that eating more fruits and vegetables in the diet will certainly help. I do caution my patients on the amount of dietary cholesterol that they take in. That, again, comes in all different forms. It can come in the form of meats or oils. There’s certainly good forms of fat out there and then there are harmful forms of fat. When I say that, harmful forms of fat do cause more plaque buildup in the arteries. So, it’s something that we certainly need to keep a close eye on.
Host: Best advice, Dr. Travers. What you want us to know about how exercise can help us and raise those HDLs, lower those LDLs, and what you want us to know about the importance of knowing those cholesterol numbers and keeping them within those required or acceptable ranges.
Dr. Travers: Yeah. I think the biggest thing about exercise is just to get out and do something. They just came out with some new guidelines about that. I think when you think about exercise, a lot of people think it’s a pretty daunting task. What I will tell my patients is just do something. That can involve walking. That can be riding a bike. That can be walking a dog. The biggest thing, and what the American Heart Association would stress, is that I would like to see my patients and all people get 30 minutes of exercise five days a week. So, we’re looking at 150 of exercise a week, which may sound like a lot. If a person is sedentary to start with, maybe you start out at lower increments. Maybe you try 10 minutes a day and work your way up to that level. Again, exercise we know reduces your cardiovascular risk. We know it reduces your bad cholesterol, and we know it increases your good cholesterol. From a lifestyle standpoint, there’s much to be said about just exercise in a person’s everyday routine.
Host: Thank you so much Dr. Travers or coming on with us today and explaining what cholesterol really is and why it’s so important that we know our numbers. If you're concerned about your heart health, take our free, quick, and confidential heart aware online screening at bryanhealth.org/heartaware. That’s bryanhealth.org/heartaware. This is Bryan Health podcast. I’m Melanie Cole.
A Guide to Your Cholesterol
Melanie Cole, MS (Host): Have you been told your cholesterol is too high? Do you even know what cholesterol is or why they say it’s bad for you? My guest today is Dr. Chad Travers. He’s a cardiologist with Bryan Heart. Dr. Travers, let’s start with just the basic definition. What is cholesterol? Is it all bad for you? And what do you want us to know about it?
Chad Travers, MD (Guest): Yeah, well thanks for having me on today. Cholesterol we hear a lot about. We hear a lot about through the lay media as well. For the most part, cholesterol gets a fairly bad wrap. We think that all cholesterol is bad. When, in fact, cholesterol is a naturally occurring substance in the body. Now what exactly cholesterol is is it is a waxy fat-like substance that is in the body. However, it has many purposes. It’s useful for cell structure in the body. In fact, it’s in all cells of the body. It does have some beneficial effects. It is responsible for synthesis of hormones in the body. Sex hormones, hormones that regulate blood pressure. So, cholesterol is an important substance in our body. That being said, too much cholesterol, we know, can be very harmful. So that is something that we watch.
We also know that cholesterol is something that is synthesized by the body. In fact, all the cholesterol that one-person needs can be made by the body itself. We do eat a significant amount of dietary cholesterol, which typically comes from animal products. Meats, dairy products, eggs all have significant amount of cholesterol in them. So, in people that do eat a significant amount, the body will regulate this amount. It’s something that we just need to keep an eye on what each person’s total cholesterol is in their body.
Host: What are the different types? People hear good cholesterol and bad cholesterol and total triglycerides. HDLs, LDLs, VLDLs. Tell us what those mean and why are they called good and bad cholesterol.
Dr. Travers: Yeah, absolutely. So, this is the talking point on a daily basis, and it can actually be quite confusing. So, a couple numbers that you’ll see when you do get a cholesterol panel, you’ll first get a total cholesterol. This measures all the different particle sizes of cholesterol in the body. That number, you’ll see typically has a reference range of 200 or less. That’s just a starting point for patients. The next cholesterol that we look at is the HDL cholesterol. HDL stands for high-density lipoprotein. That’s the good cholesterol in the body. So, if you think HDL cholesterol, you're thinking good cholesterol. What HDL cholesterol does, it actually transports cholesterol in the body back to the liver where the liver can then package it up and the excess cholesterol can then be excreted.
The LDL cholesterol is the bad cholesterol. This is the form of cholesterol that causes plaque buildup in the arteries. Arteries of the heart, arteries of the legs, carotid arteries. So, this is the one that we really look at for risk factors in people with concern to cardiovascular health. There’s the VLDL cholesterol, which is similar to LDL cholesterol. This is a very low-density lipoprotein. This is responsible for transferring the triglycerides in the blood. So, again, the VLDL cholesterol is a significant risk factor for cardiovascular health along with the LDL cholesterol.
Host: How does high LDL cholesterol affect a person’s heart health? And even HDL cholesterol. If that’s high because you're in good shape or you exercise a lot, how does that effect a person’s heart health?
Dr. Travers: Yeah. So, the LDL cholesterol we know is plaque forming. Now plaque is buildup of cholesterol inside the arteries, say of the heart. We know that the higher the LDL cholesterol, the higher your risk for clinical heart disease. So, what that means is that the higher the LDL cholesterol, the more plaque formation you have, which can predispose you to heart attacks or strokes.
HDL cholesterol, on the other hand, we think is protective against cardiovascular disease. HDL cholesterol, like I said, takes that bad cholesterol back to the liver so that the body can excrete excessive amounts. So, we look at HDL cholesterol as being protective to the body. Wen we look at a lipid panel that you may have drawn with your doctor or cardiologist, we like to see that HDL cholesterol… We say higher the better on HDL cholesterol. The converse is true for LDL cholesterol. We like to see that as low as possible for prevention of cardiovascular disease.
Host: How often should we have it checked? Tell us what those numbers mean when you say we like to see it as low as possible. Now there’s been some recent new guidelines, correct, on cholesterol numbers. Tell us about that.
Dr. Travers: Yeah, absolutely. So, first question is how often should we have this checked? Everyone should have their cholesterol checked by the age of 18. That being said, people that are very high risk for cardiovascular disease, people that have a really strong family history, may even have it checked before the age of 18. After the age of 18, between the ages of 20 to 45, just roughly think that every five years or so you should have your cholesterol checked. Men between the ages of 45 and 65 should probably have their cholesterol checked every one to two years. Women between the ages of 55 and 65 should have their cholesterol checked every one to two years as well.
As far as what the numbers mean. When you see a lipid panel or cholesterol panel, it’s going to give you reference ranges. Now those ranges are for the general population. So, people without cardiovascular disease. These are for 20-year-old people without any significant risk factors. So, when you look at a cholesterol panel, you really have to look at each individual person and what their cardiovascular risk is. Now an LDL cholesterol of 120 may be perfectly fine for someone that has no significant cardiovascular risk factors. However, an LDL cholesterol of 120 for somebody with coronary artery disease is much too high. So, again, you have to take each person’s individual risk into account.
Host: What about our diet and exercise? Where do they fit into this picture, Dr. Travers, and what can we do to lower our cholesterol naturally?
Dr. Travers: Yeah. That’s always the first treatment strategy when you look at a cholesterol panel. We know that diet and exercise play a big role in your cholesterol panel. We know that lack of physical activity and poor diet increase your LDL cholesterol and decrease your HDL cholesterol. We also know that smoking does the same. Smoking will cause your LDL cholesterol to go up and decrease your HDL cholesterol. So those are things that we always need to talk about before we talk about treatment.
If a person has done everything they can with their diet, their lifestyle, their exercise, and their LDL cholesterol or total cholesterol remains high, their HDL remains low. Then we do talk about medications. The group of medications that are first line for this are the statin medications. So, statin medications are well talked about in the lay press. We do know that they do reduce your risk of heart attack and stroke. You always have to balance this with potential side effects. So, each person needs to talk to their physician on individual basis. That being said, one thing that the new guidelines would recommend is that each person also needs to sit down and have a risk assessment. Take into account the age, the person’s gender, family history, diabetes, hypertension. Each person needs to have the risk calculated from a cardiovascular standpoint.
Host: People have heard about some natural remedies to try and lower their cholesterol. Whether it’s oat bran, eating oatmeal, or some of these other things. Garlic supplements. What do you think about that? Does oatmeal really work?
Dr. Travers: Yeah. That’s an interesting discussion. Again, I think oatmeal may be beneficial. I think when you look at more whole grains, I think there’s something behind that. I think decreasing your carbohydrate intake will certainly lower your triglyceride level and likely lower your bad cholesterol levels as well. We also know that eating more fruits and vegetables in the diet will certainly help. I do caution my patients on the amount of dietary cholesterol that they take in. That, again, comes in all different forms. It can come in the form of meats or oils. There’s certainly good forms of fat out there and then there are harmful forms of fat. When I say that, harmful forms of fat do cause more plaque buildup in the arteries. So, it’s something that we certainly need to keep a close eye on.
Host: Best advice, Dr. Travers. What you want us to know about how exercise can help us and raise those HDLs, lower those LDLs, and what you want us to know about the importance of knowing those cholesterol numbers and keeping them within those required or acceptable ranges.
Dr. Travers: Yeah. I think the biggest thing about exercise is just to get out and do something. They just came out with some new guidelines about that. I think when you think about exercise, a lot of people think it’s a pretty daunting task. What I will tell my patients is just do something. That can involve walking. That can be riding a bike. That can be walking a dog. The biggest thing, and what the American Heart Association would stress, is that I would like to see my patients and all people get 30 minutes of exercise five days a week. So, we’re looking at 150 of exercise a week, which may sound like a lot. If a person is sedentary to start with, maybe you start out at lower increments. Maybe you try 10 minutes a day and work your way up to that level. Again, exercise we know reduces your cardiovascular risk. We know it reduces your bad cholesterol, and we know it increases your good cholesterol. From a lifestyle standpoint, there’s much to be said about just exercise in a person’s everyday routine.
Host: Thank you so much Dr. Travers or coming on with us today and explaining what cholesterol really is and why it’s so important that we know our numbers. If you're concerned about your heart health, take our free, quick, and confidential heart aware online screening at bryanhealth.org/heartaware. That’s bryanhealth.org/heartaware. This is Bryan Health podcast. I’m Melanie Cole.