Q. I have borderline high cholesterol and do not wish to take any drugs. I’ve heard that high cholesterol numbers are not as bad as people think they are. Is this true? And if so, should I do something to reduce my cholesterol?
A. Cholesterol numbers are used by health professionals to assess a person’s risk of developing certain diseases. An LDL value, or the number for one component of cholesterol known as low-density lipoprotein, is considered to be a biological marker that can indicate whether there is a heightened risk of heart diseases or other health conditions.
High cholesterol values may pose a hazard because excess cholesterol in the arteries can result in plaque accumulating on the walls of blood vessels. This plaque might ‘rupture’ and lead to a heart attack, or it could continue to build up, gradually narrowing the space within the artery and limiting blood flow and delivery of oxygen to cells throughout the body.
Of course, existing plaque levels could also remain stable and not cause any apparent damage to health. But, generally, plaque in the arteries does carry a risk of a person developing -- and potentially dying from -- heart disease.
But as with any other health risk, there are always exceptions to the rule. A person with normal cholesterol values might get heart disease, and a person with out-of-whack numbers might never get it. But when statisticians compare the values of tens of thousands, or hundreds of thousands of people, there does appear to be a risk that when someone has poor cholesterol numbers, they have a higher risk of heart disease.
Conversely, studies that look at people who have improved their cholesterol numbers in some way can also show that their incidence of heart disease is reduced. So interventions are made to help people keep their cholesterol number within healthy ranges.
Just having high cholesterol in and of itself is not a disease and does not guarantee that you’ll develop a disease. So in that sense, what you’ve heard has a grain of truth. But some people use the fact that cholesterol values aren’t a foolproof predictor that you’ll have a heart attack as a way to justify certain unhealthy eating behaviors (such as high-fat diets). While some people might be able to get away with unhealthful eating habits, just like some people can smoke and never get lung cancer, that doesn’t mean that the behaviors -- and poor cholesterol that may result from them -- are healthy.
Borderline cholesterol numbers can be tricky to evaluate, and different physicians may choose different treatments. Some might put you on a statin drug to lower your LDL, for example, while others might encourage you to eat more plant foods that have been proven to help improve cholesterol levels. Others might opt to ignore it altogether if they consider you to be otherwise healthy.
A new focus in research is looking at cholesterol-related blood values other than the typical HDL, LDL, triglyceride and total cholesterol numbers that most blood tests measure. There is some evidence that different biomarkers may be more useful in some people in predicting their health risks. I’ve written more about new biomarkers for heart disease that might be worth monitoring here.
But what is probably more important than any one marker is to look at the big picture. There are many risk factors for heart disease, both those that are measured in a lab and those that reflect your lifestyle behaviors. A 2012 study in the Journal of the American Medical Association surveyed nearly 45,000 adult men and women. They evaluated seven factors associated with cardiovascular health. These were:
- Smoking
- Cholesterol levels
- Diet
- Physical activity
- Blood pressure
- Blood glucose levels
- Body weight
Those who were in a normal range for most or all of the seven items had a lower risk of death compared to people who were in a normal range for fewer of the items. In other words, a non-smoking, healthy-eating exerciser with normal blood test values had a lower risk of early death than a overweight, inactive person who smoked and had high cholesterol, high blood pressure and ate junk food. Of course, there is a reality check in this study: Only around 2 percent of the adults studied were in a normal range for all seven of the criteria!
This study shows hat cholesterol can play a role in your health, but so do many other things. How best to treat your cholesterol is something that you should discuss with your doctor. But if you focus on some of the other factors that improve your health -- such as eating more fruits and veggies and exercising more -- you will automatically lower the risk of heart disease and dying associated with your borderline cholesterol levels. And, chances are, regular exercise and a healthful diet will improve some of your cholesterol numbers, too.
