Question: Do I need to worry about lowering my blood cholesterol now that I'm over 65?

Answer: Yes. Older Americans have the Nation's highest rate of coronary heart disease (CHD) and can benefit greatly from lowering elevated cholesterol. Cholesterol lowering also has been shown to reduce the risk of strokes. For seniors who do not have heart disease, cholesterol lowering will reduce their high risk of developing CHD. Older Americans should have their cholesterol numbers (total cholesterol, LDL, HDL, and triglycerides) measured once every 5 years. Older Americans should keep their cholesterol low by following an eating pattern lower in saturated fat, total fat, and cholesterol, being physically active, and maintaining a healthy weight.

Question: Should I be concerned about my child's blood cholesterol?

Answer: Yes. Everyone older than age 2 should care about cholesterol to reduce the risk of developing heart disease as an adult. Children as well as adults can improve the health of their hearts by following a low-saturated-fat and low-cholesterol diet, avoiding obesity, and being physically active. Only children from families in which the father or grandfather has had heart disease at the age of 55 or younger, or the mother or grandmother has had heart disease at the age of 65 or younger, or in which a parent has high blood cholesterol (240 mg/dL or higher), should have their cholesterol levels tested. If a child from such a "high-risk" family has a high cholesterol level, it should be lowered under medical supervision, primarily through dietary changes and increased physical activity.

Question: How useful is it to know my cholesterol ratio?

Answer: Although the cholesterol ratio can be a useful predictor of heart disease risk, especially in the elderly, it is more important for treatment purposes to know the value for each level separately because both LDL- and HDL-cholesterol separately affect your risk of heart disease and the levels of both may need to be improved by treatment. The ratio is useful if it helps you and your doctor keep the entire picture of your LDL and HDL levels in mind, but it should not take the place of knowing your separate LDL and HDL levels.

Question: What is a heart-healthy diet?

Answer: A heart-healthy diet emphasizes foods low in saturated fat, total fat, and cholesterol to help lower blood cholesterol. This is the recommended eating pattern for Americans older than 2:

• 8-10 percent of calories from saturated fat;
• An average of 30 percent of calories or less from total fat; and
• Less than 300 mg a day of dietary cholesterol.

Saturated fat increases blood cholesterol more than anything else you eat, so choose foods low in saturated fat to reduce blood cholesterol. If you are overweight, losing weight is important for lowering blood cholesterol. Being physically active also helps improve blood cholesterol levels because it can raise HDL ("good") cholesterol and lower LDL ("bad") cholesterol, as well as help you lose weight, lower your blood pressure, and improve the fitness of your heart and blood vessels.

Question: Is margarine better than butter in a cholesterol-lowering eating pattern?

Answer: Yes. Butter is high in saturated fat, which raises blood cholesterol more than anything else you eat. Most margarines are made from vegetable oils that are hardened through a process called "hydrogenation." Hydrogenation forms a type of unsaturated fat called "trans" fat that appears to raise blood cholesterol more than other unsaturated fats but not as much as saturated fats. There are now margarines available that contain no "trans" fats. You can also read food labels and choose margarines that contain liquid vegetable oil as the first ingredient (rather than hydrogenated or partially hydrogenated oil) and the least amount of saturated fat.

Question: My last cholesterol level was within my goal. Does that mean I do not have to worry about my cholesterol any more?

Answer: High cholesterol and heart disease are not cured but are only controlled by diet and drug therapy. Stopping your treatment quickly returns your cholesterol to the level that existed before therapy was started.

Question: How does smoking affect my cholesterol?

Answer: Smoking has several harmful effects on cholesterol. Smoking reduces HDL ("good") cholesterol and in all likelihood changes LDL ("bad") cholesterol to a form that promotes the buildup of deposits in the walls of the coronary arteries. In addition, smoking has harmful effects on the heart and blood vessels. In these ways, smoking substantially raises the risk for coronary heart disease if you are healthy and multiplies that risk many more times if you have other risk factors such as high blood cholesterol. All in all, smoking is the leading preventable cause of death.

Question: How can I raise my HDL ("good") cholesterol?

Answer:

• Quit smoking. The more you smoke, the lower your HDL cholesterol is likely to be.
• Lose weight if you're overweight. Being overweight is often associated with low HDL levels.
• Increase physical activity. This has a slow but steady elevating effect on HDL, which tends to rise in direct proportion to the amount of physical activity per week.

Question: Is lowering my cholesterol safe?

Answer: Yes. Cholesterol lowering itself is safe, as is the diet used to lower cholesterol. Like all medications, drugs used to lower cholesterol can have side effects, but when used by people who have a high risk of developing coronary heart disease (CHD), the benefits outweigh the risks. Four recent studies, three in patients who already had CHD and one in people free of CHD, showed that, over a period of 5 years, large reductions in total and LDL ("bad") cholesterol substantially reduced the chances of having a heart attack or dying from heart disease, reduced overall death rates, and produced no increase in any noncardiovascular causes of death, such as cancer, suicide, homicide, or accidents. These results have been confirmed by a combined analysis of 16 recent studies.

Question: I'm young and healthy. Do I need to have my cholesterol checked?

Answer: Yes. Young adults 20 years of age and older should have their cholesterol measured. Studies have shown that the buildup of plaque in the arteries that supply the heart begins in late adolescence and early adulthood, and a cholesterol level measured at about age 20 predicts the risk of a heart attack over the following 30 to 40 years. Waiting until midlife to measure and lower cholesterol reduces the benefit that can be obtained. Checking your cholesterol and discussing it with your doctor can help you make lifestyle changes-eating right, being physically active, and controlling weight-to maintain good health now and prevent heart disease later in life.

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