Remember the limbo? Just as you were able to shimmy under a low pole, the bar was lowered some more and you had to try again. When you were successful, you felt the thrill of accomplishment, immediately followed by the apprehension of a new challenge. That’s how a lot of people feel about their annual cholesterol checks. You get the rush of satisfaction if your nurse says you hit that 200 or lower total cholesterol target; but many people these days are told to go even lower when it comes to their low-density lipoprotein (LDL) reading. And the challenge begins again.
Cholesterol is produced naturally in our bodies; we also take it in from foods, primarily animal and dairy fats. And it isn’t all bad: We need cholesterol to do things like make bile acids that help break down the fats we eat. But too much cholesterol creates plaque that can clog arteries in your heart, brain or blood vessels. Called hyperlipidemia, this excess of cholesterol and plaque can lead to problems such as heart attacks.
Understanding the readings
Total cholesterol is measured as milligrams per deciliter (mg/dl), so you’ll see your test result as something like 180 mg/dl. In fact, your total cholesterol should be 200 mg/dl or less. A reading of 240 mg/dl or higher is high—this needs drug treatment. Readings of 200 mg/dl to 239 mg/dl are borderline high—your health care provider may suggest treatment or ask you to change your diet or exercise more. A reading below 200 mg/dl is considered the target.
A person’s total cholesterol is made up of LDL and HDL (high-density lipoprotein). HDL is thought to protect your heart and blood vessels by removing plaque from your arteries and taking it to the liver to be broken down. Think of HDL as big baskets that remove cholesterol from your blood, and LDL as little baskets that spill easily, leaving too much cholesterol in your blood. This cholesterol turns to plaque and can build up in your veins and arteries. When enough plaque builds up it can block blood flow. If this happens in the blood vessels that bring oxygen to your heart, it may cause a heart attack. If it builds up in the carotid arteries, the two big vessels in your neck that take blood to the brain, or within the brain itself, it may cause a stroke.
An HDL level of 60 mg/dl or above is considered good for your heart; below 40 mg/dl is thought to put you at higher risk for cardiovascular disease. An LDL level of 100 mg/dl or lower has been considered optimal; 100 mg/dl to 129 mg/dl is good; 130 mg/dl to 159 mg/dl is borderline high, and 160 mg/dl or higher is high risk. But the latest recommendations say an LDL of 70 mg/dl is the new “optimal.” So how low should you go?
Understanding the experts
The leading advisory group, The National Cholesterol Education Program (NCEP) Expert Panel, reviews different types of studies and makes recommendations about cholesterol targets. In 2001, they determined that people with heart disease—or at high risk—should try to get their LDL cholesterol to 100 mg/dl or less and their total cholesterol to less than 200 mg/dl. This LDL level is not as low as these experts think someone could go on their own, but what can reasonably be expected with a combination of lifestyle changes and medications. The goal is to reduce risks for heart attacks.
In 2004, the NCEP guidelines were revised again on the notion that if a person has heart disease, or is at high risk for heart disease, she may be able to further reduce her risk of dying from a heart attack by getting those LDL cholesterol levels even lower, down to 70 mg/dl or less. The NCEP also advised that this reduction in risk might also be possible for people with cholesterol in more normal ranges to begin with.
What does this mean for the average midlife woman? It means that if you have heart disease or you are at high risk for heart disease, experts recommend getting your LDL cholesterol to 70 mg/dl or less—particularly if you have diabetes or a relative who died from heart disease at an early age. But even midlife women with good cholesterol readings may be able to reduce their risk of a future heart attack by getting their LDL cholesterol levels down to less than 70 mg/dl.
Know your numbers
Total Cholesterol Level
200 or lower is best
200 to 239 is borderline high
240 is high; you’re at increased risk for heart disease
LDL Cholesterol Levels
130 or less is best
130 to 159 is borderline high
160 or more means you’re at higher risk for heart disease
HDL Cholesterol Levels
40 or less: you’re at higher risk for heart disease
60 or higher protects against heart disease
Some experts now say an LDL of 70 MG/DL is optimal. So how low should you go?
How to go low
If you’re prescribed cholesterol-lowering medication, the current recommendation is that you should take a dose that will create at least a 30% to 40% drop in your current LDL cholesterol levels. So let’s limbo. Let’s work to lower those cholesterol levels to a point where we reduce our risk of heart attacks as much as we can. Getting to these goals through diet and physical activity is always the best, but if your lifestyle changes are not producing the results you and your health care provider want, ask if adding a medication such as a statin to the mix may help you get as low as you can go for better heart health.
About the Authors:
Pamela Stewart Fahs, RN, DSN, is project director on the Promoting Heart Health in Rural Women study. Elizabeth N. Austin, RN, MS is a research assistant at the Decker School of Nursing at Binghamton University in New York.
