Cholesterol Basics

WHAT IS CHOLESTEROL?
Cholesterol is a waxy, fat-like substance found in all parts of your body, and is needed to help make cell membranes, some hormones and vitamin D. Cholesterol comes from your own body's production and from food. Blood cholesterol is made in your liver, which produces all the cholesterol your body needs. Dietary cholesterol comes from animal foods like meats, egg yolks, high fat dairy foods and fish. Eating too much dietary cholesterol is one way to make your blood cholesterol go up.

WHAT OTHER FACTORS DETERMINE BLOOD CHOLESTEROL LEVEL?
A high intake of saturated fat, as well as excess calories leading to obesity can increase blood cholesterol levels. Your heredity, physical activity, and age also influence your risk for developing high blood cholesterol.

WHY IS CHOLESTEROL IMPORTANT TO HEALTH?
Elevated cholesterol levels are linked to increased risk for heart and vascular disease, such as heart attacks and strokes. There is also evidence that high fat diets increase the risk of certain cancers, such as uterine and colon. The good news is that there is substantial evidence that lowering cholesterol levels greatly reduces these risks.

WHAT DO CHOLESTEROL NUMBERS MEAN?
Total cholesterol includes measurement of several different fractions: HDL, LDL and Triglycerides. There are different proteins that carry cholesterol in the blood. LDL ("bad cholesterol") deposits cholesterol in the arteries and leads to heart and blood vessel disease. HDL ("good cholesterol") helps carry the fat and cholesterol away from arteries to the liver to be removed from the body. Triglycerides are larger fats in the blood, which are now thought also to be harmful to blood vessels, and are affected to some degree by carbohydrate intake as well as fat intake. It is recommended to have a fasting lipid profile done by age 21 to evaluate these levels in your blood.

WHAT ARE DESIRABLE CHOLESTEROL LEVELS?
The other risk factors that you have for heart disease affect the target level for your individual LDL cholesterol goal. These risk factors include: age (men over 45 years and women over 55 years), smoking, high blood pressure, HDL less than 40, family history of father or brother with heart disease at an age younger than 55, or a mother or sister with heart disease younger than 65 years. Risk analysis tables are included later in this handout. Those with cardiovascular disease, diabetes, or ten year risk of greater than 20% have a goal of LDL cholesterol less than 100. Those with two or more risk factors or a ten year risk of 10-20% have a goal of LDL cholesterol less than 130, and those with 0-1 risk factor or a ten year risk of less than 10% have an LDL goal of less than 160.

WHAT CAN I EAT TO IMPROVE CHOLESTEROL LEVELS?

• Choose foods low in saturated fat and total fat
• Choose foods low in dietary cholesterol
• Eat more fruits and vegetables each day
• Consume more than 25 grams of fiber per day from whole foods (beans, whole grains, nuts and seeds, soy foods, fruits and vegetables)
• Limit sugar and alcohol

WHAT ELSE CAN I DO TO IMPROVE MY CHOLESTEROL?

• Don't smoke. It lowers HDL "good cholesterol" and is an independent risk factor for heart disease (see risk table).
• Be more physically active. Exercise will also help lower blood pressure and weight. Incorporate exercise in your daily life by walking to class, taking stairs.
• Maintain a healthy weight. You can reduce your total calorie intake by reducing your intake of high fat foods, since fat has twice as many calories per gram than protein and carbohydrate.
• Schedule a visit with a dietitian at McKinley Health Center to learn more about the specific dietary recommendations to lower your cholesterol.

CALCULATE YOUR RISK

Table B1 - Estimate of 10 year risk for MEN (Framingham Point Scores)						Table B2 - Estimate of 10 year risk for WOMEN (Framingham Point Scores)
Age, Y			Points			Age, Y			Points
20-34			-9			20-34			-7
35-39			-4			35-39			-3
40-44			0			40-44			0
45-49			3			45-49			3
50-54			6			50-54			6
55-59			8			55-59			8
60-64			10			60-64			10
65-69			11			65-69			12
70-74			12			70-74			14
75-79			13			75-79			16
Total Cholest. Mg/dL	Points					Total Cholest. Mg/dL	Points
	Age 20-39	Age 40-49	Age 50-59	Age 60-69	Age 70-79		Age 20-39	Age 40-49	Age 50-59	Age 60-69	Age 70-79
< 160	0	0	0	0	0	< 160	0	0	0	0	0
160-199	4	3	2	1	0	160-199	4	3	2	1	0
200-239	7	5	3	1	0	200-239	8	6	4	2	1
240-279	9	6	4	2	1	240-279	11	8	5	3	2
> 280	11	8	5	3	1	> 280	13	10	7	4	2
	Age 20-39	Age 40-49	Age 50-59	Age 60-69	Age 70-79		Age 20-39	Age 40-49	Age 50-59	Age 60-69	Age 70-79
Non Smoker	0	0	0	0	0	Non Smoker	0	0	0	0	0
Smoker	8	5	3	1	1	Smoker	9	7	4	2	1
HDL, mg/dl			Points			HDL, mg/dl			Points
> 60			-1			> 60			-1
50-59			0			50-59			0
40-49			1			40-49			1
< 40			2			< 40			2
Systolic BP,  mm HG		If untreated		If treated		Systolic BP, mm HG		If untreated		If treated
< 120		0		0		< 120		0		0
120-129		0		1		120-129		1		3
130-139		1		2		130-139		2		4
140-159		1		2		140-159		3		5
> 160		2		3		> 160		4		6
Point Total			10-Year Risk, %			Point Total			10-Year Risk, %
< 0			<1			<9			<1
0			1			9			1
1			1			10			1
2			1			11			1
3			1			12			1
4			1			13			2
5			2			14			2
6			2			15			3
7			3			16			4
8			4			17			5
9			5			18			6
10			6			19			8
11			8			20			11
12			10			21			14
13			12			22			17
14			16			23			22
15			20			24			27
16			25			> 25			30
17			> 30

Above table is from JAMA, May 16, 2001 - Vol. 285, No. 19. Information contained addresses the National Cholesterol Education Program
Adult Treatment Panel III - Cardiovascular Risk Factor Analysis Tables.  Reprinted with permission.

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