Assess Your Risk
How much you need to bring your cholesterol down depends on your coronary heart disease (CHD) risk factors.
In a nutshell, the greater your risk for a heart attack or stroke — in other words, the more risk factors you have — the lower your ideal cholesterol level.
If you have high cholesterol, the main goal is to lower your LDL (low-density lipoprotein). Why, you might ask, is this true when your ratios of HDL (high-density lipoprotein) and LDL to total cholesterol are what count the most? First, because it’s much easier to lower LDL than raise HDL. Few drugs or supplements reliably raise HDL (niacin is probably the best). Intense physical activity is effective, but few people are willing to work that hard. Alcohol also moves the needle, but of course the “dose” is limited by alcohol’s inherent dangers. Lowering LDL is also the most direct way to slow plaque buildup, since LDL plays the most direct role in forming the stuff.
Perhaps the best way to think about your cholesterol goal is in terms of improving your HDL/LDL ratio. This can be done by raising HDL, lowering LDL, or both. And since it’s easier to reduce LDL, that’s where the focus falls.
To figure out how low your LDL target should be, you should assess your heart disease risk. Take into consideration factors such as smoking, high blood pressure, HDL cholesterol, family history, and age. Remember, the greater your risk, the lower your cholesterol target should be.
Personalizing Your Goals
Healthy lifestyle changes, such as a balanced diet, regular exercise, and not smoking, is ideal for anyone, regardless of your cholesterol level. But special attention must be given to particular areas if you have metabolic syndrome or high triglycerides. For instance, you may need to exercise more, limit calories, and take certain supplements.
If You Have Metabolic Syndrome
People who have metabolic syndrome tend to be overweight, with much of their fat settled around their abdomens. They also tend to have insulin resistance (in other words, are on their way to developing diabetes) and are relatively inactive. If you have metabolic syndrome, you’ll need to lose weight. There’s simply no way around this recommendation. To set your goal most effectively you must determine a daily caloric target based on your sex, age, physical activity level, and current weight. You’ll also need to follow your plan very closely if you have metabolic syndrome. No cheating, no halfway there for you. Certain elements, particularly fish-oil supplements, soluble fiber (from beans, whole grains, etc.), and exercise will be particularly important to help you increase your HDL and reduce your triglycerides. And your doctor may start you on a medication such as metformin, which has been shown to improve insulin resistance and even help prevent the development of diabetes. You should also:
Consider chromium supplements. Some research suggests chromium supplements may improve insulin sensitivity.
Control your alcohol intake. While alcohol will increase your HDL, too much can also increase triglycerides. Our advice to you is the same we’d give anyone else — if you drink, drink moderately. That means no more than one drink a day for women and anyone over 65, and no more than two drinks a day for men under 65.
Control your blood pressure. Lifestyle modifications should help lower your blood pressure, but your doctor may also decide to start you on blood pressure medication, such as a calcium channel blocker or ACE inhibitor. Beta-blockers, another type of blood pressure medication, may increase triglycerides and reduce HDL. While they may be the best choice for some patients, they’re generally not the first choice for most.
If You Have High Triglycerides
If your triglyceride level is high, you usually also have an increase in VLDL (very low-density lipoprotein) remnants, and thus a high VLDL count. Treatment depends on just how high your triglyceride level is.
Borderline High Triglycerides (150-199)
Eat a balanced diet with supplements. If your BMI is 26 or higher, you need to lose weight — one of the best ways to lower your triglycerides. The Plan also calls for fish-oil supplements, which can reduce triglycerides.
Six days of physical activity a week. Although most people trying to lower their cholesterol can get away with at least four days of moderate to intense physical activity, if you have a high triglyceride level, you must increase that activity to six days. Of course, if you aren’t used to exercising, get the green light from your doctor first, and start slowly.
Talk to your doctor about medication. If you have CHD or other risk factors (such as diabetes), your doctor may consider treating you with the cholesterol-lowering drugs nicotinic acid or fibrates.
High Triglycerides (200-499) The recommendations above apply to you also. Plus, it’s more likely your doctor will start you on medication. You should also try to avoid alcohol, excess calories, and simple starches/processed carbohydrates.
Very High Triglycerides (more than 500) It’s very important that you get your triglycerides into a safer level as quickly as possible to prevent acute pancreatitis, an inflammation or infection of the pancreas. So it’s quite likely your doctor will start you on medication (most likely fibrates and nicotinic acid), particularly if your triglyceride level is more than 1,000.