You can reduce your symptoms or your risk for heart attack or stroke by controlling your cholesterol level. Cholesterol is a waxy, fat-like substance found in the walls of cells throughout the body. However, too much cholesterol in your bloodstream can cause fatty deposits, or plaque (plak), to build up on the inside of your artery walls. As plaque builds up, the arteries become “hardened” and narrowed. Blood flow through narrowed arteries is slowed down or blocked. Typically, if you have narrowed arteries due to plaque in your legs, the vessels supplying blood to your heart and brain are also narrowed. So the steps you take to control cholesterol for treating P.A.D. will also help prevent heart attack and stroke.
Determining Your Cholesterol Level
A blood test, called a lipoprotein profile, is used to measure total cholesterol levels, LDL (or “bad”) cholesterol, HDL (or “good”) cholesterol and triglycerides. Many doctors recommend that you have a cholesterol test once a year. If you already take medications for your cholesterol, you may need the blood test more often. Your lipoprotein profile will show the levels of the most important types of cholesterol and fat in your blood. They are:
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Understanding your cholesterol levels can be confusing. Listen as Dr. Kimberly A. Skelding, Geisinger Medical Center, explains the meaning behind the numbers.
- LDL (Low-density lipoprotein). LDL cholesterol is often referred to as “bad” cholesterol because it causes plaque to build up inside the arteries. An LDL cholesterol reading of over 130 (130 mg/dl) – or 100 if you already have a blockage) places you a higher risk of P.A.D., heart attack or stroke. People with P.A.D. are advised to keep their LDL cholesterol at less than 100. If you have P.A.D. and you’re also at a high risk for heart attack or stroke, you will be advised to reduce your LDL cholesterol to 70 or lower. Your risk for heart attack and stroke is considered high if you smoke or have high blood pressure or diabetes. To lower your risk, it’s important that all risk factors be controlled.
- HDL (High-density lipoprotein). HDL cholesterol is called “good” cholesterol because it helps keep cholesterol from building up inside the vessels. An HDL cholesterol reading below 40 indicates an increased risk for P.A.D., heart attack or stroke.
- Triglycerides are the third type of blood fat measured by the test. A triglyceride level of 200 or more indicates an increased risk of P.A.D., heart attack or stroke, as well as inflammation of the pancreas.
What You Can Do to Control Your Cholesterol Levels
You may want to consult with a dietitian or nutritionist for help in developing a plan to achieve your cholesterol goal. Some key steps you can take include:
- Eat less saturated fat. Reducing the amount of saturated fat in your diet is one of the best ways to lower your LDL cholesterol. Saturated fats are found in fatty meats, chicken or turkey with skin on, butter, whole or 2 percent milk, cream, cheese, lard, shortening, some cooking oils (for example, palm and coconut) and baked goods.
- To help control your cholesterol, switch to low-fat (1 percent) or non-fat dairy products, such as low-fat cheese, sour cream, yogurt and milk. And when choosing oils, choose those that can protect your heart and blood vessels, including olive oil, canola oil, corn oil, sunflower oil, safflower oil and cholesterol-lowering margarines. For additional protection for your heart, eat fish two or three times per week. Choose salmon, sardines, herring, albacore tune, rainbow trout and other types that are high in beneficial Omega-3 fatty acids.
- Avoid high cholesterol foods. Foods containing saturated fats are the worst for heart and blood vessel health, but foods that contain cholesterol also contribute to higher than normal cholesterol levels. Because both saturated fats and cholesterol are found in many of the same foods, avoiding foods high in saturated fats also helps you lower your intake of foods high in cholesterol. Among the foods that contain both unsaturated fat and cholesterol are high-fat meat and chicken and turkey with the skin, high fat dairy products, and liver and other organ meats.
- Eat more fiber. Dietary fiber refers to the parts of plants that our bodies cannot digest. There are two types of fiber – soluble and insoluble. Both are important to health. But when regularly eaten as part of a diet that is low in saturated fats and cholesterol, foods containing soluble fiber have been shown to help lower cholesterol. Foods rich in soluble fiber include vegetables, fruits, dried beans and peas, oatmeal and whole grain breads, cereals and pastas.
Regular physical activity can help control your cholesterol. Before beginning new activities, you may want to consult with your health care team for advice on a regular exercise program. But don’t let the lack of a plan stop you from working more activity into your day:
- Take advantage of opportunities to be active: Take the stairs instead of the elevator, walk around while you’re on the phone, clean your house, etc.
- Work up to 30 minutes of brisk exercise a day, five times a week. Consider walking, swimming, biking, dancing and other activities that get your heart pumping.
- Lift weights – they don’t need to be heavy – two or three times a week.
- Stretch to increase your flexibility and reduce stress.
Keep Your Weight Under Control
If you’re overweight, you can help lower your cholesterol by losing weight. Reduce or control your weight by eating less and moving more. Avoid high-calorie foods, eat smaller portions, and be active throughout the day.
Giving up tobacco products is one of the most important things you can do to lower your chance of having a heart attack or stroke. Read more about how to quit.
Take Cholesterol-Lowering Medications Prescribed by Your Doctor
Depending on your symptoms, your doctor may prescribe one or more types of cholesterol-lowering medications, each of which acts in a different way to address cholesterol levels in your blood The main types of cholesterol-control medications include:
- Statins (Lipitor, Zocor and Pravachol) to prevent inflammation – and clot formation – in arteries where plaque has built up.
- Fibric acid derivatives, such as Lopid and Tricor, drugs that lower triglyceride levels (triglycerides are another type of fat in the arteries).
- Niacin (also called nicotinic acid) to raise your HDL “good cholesterol” level.
- Other medications may include cholesterol absorption inhibitors, such as ezetimube (Zetia) which works to reduce the amount of cholesterol the body absorbs, and bile acid sequestrants, such as cholestyramine (Questran), colestipol (Colestid) and colesevelam (Welchol). These medications help rid the body of bile acids. This causes the liver to replace the lost bile acids by converting more cholesterol into bile acids – a process that reduces the level of cholesterol in the blood.
How to take them?
- Always follow your doctor’s instruction.
- Statins are taken once per day at bedtime.
- Fibric acid derivatives (Lopid) are taken 30 minutes before breakfast and dinner.
- Niacin is taken 30 minutes after aspirin.
Possible side effects
Aching muscles are an infrequent side effect. Also liver function should be monitored. With niacin, side effects can include headache, flushing and stomach upset.
Be sure to ask your doctor what the medicines are for and how and when you should take them. And don’t hesitate to let your doctor know if you have side effects. There may be other medications that work better for you.