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WHAT IS IT?
Cholesterol: the dreaded word. You probably hear about cholesterol all the time-how it causes heart disease and other health problems. But cholesterol doesn’t have to be bad. In fact, your body needs some in order to work well. When you have more than your body needs, though, it can build up in your blood vessels and lead to atherosclerosis-clogged and narrowed arteries. When that happens, your risk of heart attack, stroke, peripheral vascular disease, and a host of other diseases goes way up.Too many of us have high cholesterol. Nearly 100 million Americans have levels too high for good health-200 milligrams per deciliter (mg/dl) of blood or higher. About 40 million of us have even more harmful levels, 240 mg/dl or higher.

The good news: You can do a lot to prevent high cholesterol by making smart choices about such things as the foods you eat and your exercise habits. And if your cholesterol is already too high, these same smart choices can help you lower it and head off serious problems such as heart disease and stroke.
WHAT IS HAPPENING?
Your liver makes all the cholesterol you need. (It’s a waxy substance with no odor or taste.) Your body uses it for energy, to maintain cell walls, and to produce hormones, including sex hormones such as testosterone and estrogen. Cholesterol is also found in some foods, and when you eat too much of these foods, you get more of it than you need.

Foods with cholesterol come only from animals. Foods from plants have none. Your body also converts some types of fats to cholesterol. These fats include the so-called saturated fats found in meat, milk, and some vegetable oils.

Since your body has no use for it, the excess cholesterol you get from foods can wind up in your blood and begin to damage your arteries. Healthy arteries are smooth inside so blood flows through them easily. But when extra cholesterol begins to streak their walls, they become diseased. The body tries to protect itself by growing tissue over the streaks, which thickens and hardens into plaque.

The buildup of plaque is called atherosclerosis. In the United States, where many people eat fatty foods and don’t exercise enough, it may begin in the late teens and continue to get worse for years. But symptoms of heart and artery disease such as angina-chest pains-don’t show up until the arteries are already badly narrowed.
WHAT YOU CAN DO FOR YOURSELF
You can do a lot yourself to prevent high cholesterol, or to lower it if it’s already too high.

Eat the right stuff
A low-fat, low-cholesterol diet can help prevent and even reverse the problem.

The cholesterol in your foods can raise the levels in your blood, of course. It isn’t the only cause, though, or even the main one-fat is. That’s because many of the fats in your foods turn into cholesterol after you’ve eaten them. And while all fats are fattening, some are worse for your arteries than others, above all saturated fats.

Saturated fats come from animals and some plants, including palms and coconuts. These fats are solid at room temperature. They raise cholesterol levels and lead to clogged arteries.

Hydrogenated vegetable oils are oils that food makers have turned into saturated fats. They’re found in margarine, vegetable shortening, and many packaged foods. They clog your arteries just as saturated fats do.

Unsaturated fats come from plants and fish and are liquid at room temperature. The two types are polyunsaturated and monounsaturated. They may help lower cholesterol and prevent clogged arteries-but the jury is still out on this. Until we know for sure, eat as few fats of any kind as you can. Remember, too much of any type of fat is fattening.

Simple things you can do to cut fat and cholesterol in your diet:

Read food labels to know what you’re getting. The important things to look for are calories, calories from fat, total fat, saturated fat, and cholesterol. Also, note if hydrogenated or partially hydrogenated vegetable oil is on the list of ingredients and try to steer clear of foods that contain it.
The American Heart Association advises keeping your fat intake under 30 percent of your total calories each day. That could mean only 750 calories a day, or even fewer, from fat. (Just one tablespoon of butter has about 100 calories.) Not everyone agrees with the 30 percent recommendation, however. Some experts think you should go for 20 percent or less, while others say if you’re trim and lean, you can be healthy if you get as much as 40 percent of your daily calories from fat, as long as most of this fat is the unsaturated kind.

Build your meals around fruits, vegetables, and grains. They have little fat and no cholesterol and are loaded with vitamins, minerals, and fiber. Fiber is important. It lowers cholesterol and blood pressure and helps keep your arteries open. Foods rich in fiber include apples, oranges, potatoes, squash, peas, carrots, soybeans and other beans, oats, and barley.
If you eat red meat, make it a once-in-a-while treat, not a regular item, and keep it lean. Look for cuts graded “select,” which means they have the least fat. Other low-fat cuts include pork loin, lean center-cut ham, venison, veal chops or roast, and lamb flank. Before cooking chicken, remove the skin and fat. Don’t use chicken injected with salt and fat-read the package label to make sure it isn’t. Eat no more than six ounces of meat, poultry, or fish a day. Keep servings to three ounces-a cut of meat about the size of a deck of cards, half a skinless chicken breast or leg, or three-fourths cup of flaked fish.
Some studies suggest that eating fish two or three times a week can lower your risk of heart attack. While fish may be important, the way you cook it is even more so. Broil instead of frying or sauteing in butter or oil.
Don’t fry foods. Bake, broil, steam, or saute with water or vegetable broth in a nonstick pan.
If you eat dairy foods, go for low-fat or nonfat versions such as skim or 1 percent milk, and choose nonfat yogurt, ice milk, or sherbet instead of ice cream.
Egg yolks contain a lot of cholesterol. Eat no more than three or four a week, including eggs in baked goods. In recipes, replace one whole egg with two egg whites, or use an egg substitute.
For salads, try an oil-free dressing. If you use oil, make it one high in unsaturated fats, such as olive, canola, safflower, or sunflower.
Read the labels on frozen dinners to see how much fat they contain. Aim for meals that have less than 10 grams of fat per serving.
Other dietary changes that can help
Use less salt. The body needs only about 200 milligrams of sodium a day, but most of us get much more than even the very generous 2,400 mg recommended by most health experts (the amount in about one teaspoon of salt). Too much sodium makes your body hold water and other fluids. If you have high blood pressure, extra fluid may raise it even higher. But people react to salt differently. Some can eat salty foods with no effect on their blood pressure. For others, eating the same foods will make their blood pressure shoot up. If you have high blood pressure and you know salt is a problem for you, watch out for canned and prepackaged foods. Many are loaded with salt-much more, in fact, than the amount people usually sprinkle on food at the table. Also steer clear of potato chips, pizza, fast foods, frozen dinners, and processed meats. And don’t put extra salt on your food.
Get plenty of vitamins B-6, B-12, C, and E, folic acid, and the minerals calcium, magnesium, and potassium; they’re necessary for a healthy heart and arteries. A varied diet provides all you need, but if you want to be sure, take a daily multivitamin that contains recommended amounts.
Calcium and potassium may help if you have high blood pressure. People who get plenty of calcium and potassium from their foods tend to have lower blood pressures that those who don’t get enough of either.
Aim for at least the minimum daily allowance of 1,000 milligrams of calcium every day (or 1,200 mg if you’re over 50). Good calcium sources include dairy products, green leafy vegetables, tofu, soybeans, and canned sardines and salmon. If your diet is typical, you’ll probably need a calcium supplement. It’s best to take small doses of less than 500 mg with meals. Calcium carbonate, as found in Tums or Rolaids, is a good choice.

There’s no recommended dietary allowance (RDA) for potassium, but experts suggest at least 3,500 mg a day. You’ll get plenty if you stick to a well-balanced diet with lots of fruits and vegetables. Good sources of potassium include avocados, bananas, oranges, dried apricots, prunes, spinach, potatoes, milk, and lentils. If you’re concerned about getting enough, though, consider potassium supplements: Take one 500 mg pill in the morning and another 500 mg at night.

Be careful with alcohol
Studies show that moderate drinking may help cut the risk of heart disease slightly. On the other hand, too much alcohol can raise your blood pressure and cause heart problems. If you drink, don’t drink much. A rule of thumb for men is no more than two drinks a day; for women, no more than one. A drink is one bottle of beer (12 ounces), one glass of wine (5 ounces), or one jigger of hard liquor (1 1/2 ounces).

Exercise
Regular physical activity, at least three times a week, can help you lower your overall cholesterol level and in turn raise your HDL levels and lower your LDL. Exercise also helps to open up clogged arteries, lower blood pressure, make clots less likely to form in coronary and brain arteries, and keep off extra weight.

The idea of exercising may be a little scary after finding out you have high cholesterol, or if you haven’t exercised for a long time, but those are the times when exercise is even more important. Try these tips to make it safe and easy:

Start by being a bit more active each day. Any activity will help; even brief workouts will lower your blood pressure and cholesterol. Take the stairs instead of the elevator. Walk the dog for 15 minutes each evening; your pooch and your blood vessels will thank you.
When you’re used to being active, add some activities that are more aerobic to your routine. These should make you breathe harder and sweat a bit, and get your heart pumping. Brisk walking, running, biking, and swimming are all ideal. Take a couple of months to work up to 20 to 30 minutes at a time most days of the week.
Almost any exercise is better than none, but until your blood pressure is under control, avoid pushing and straining, as in weight lifting. If you do move on to lifting weights, don’t hold your breath as you lift.
Find something you enjoy-it’s easier to keep exercising when you like to do it.
If you have symptoms of angina or a heart attack while exercising, stop and call 911 right away.
Don’t smoke
While your risk for many serious health problems shoots up with your first puff, there’s good news: As soon as you stop smoking, your body begins to recover. Within a year, your risk for heart disease drops to half that of a smoker. And 15 years after stopping, your risk for heart disease is the same as that of a person who never smoked.

Control your weight
Start dropping any extra pounds. This will help lower cholesterol levels and blood pressure. Taking off weight may sound daunting, but it doesn’t have to be. The best approach? Combine smart eating with exercise.

Extra calories-those you don’t need for energy right away-pack on the pounds. Exercise burns them off. To lose a pound of fat, you need to use 3,500 more calories than you take in. That’s because one pound of fat has 3,500 calories. (A fast-food lunch of burger, fries, and a shake is loaded with about 1,700 calories; an apple has only 80.)

Here are some tips for a program that works:

Check with your doctor to find out how much you should weigh.
Take your time. It’s better to lose weight slowly-no more than 1 percent of your body weight each week. The more gradually you lose weight, the easier it is to keep it off.
Be realistic. Don’t aim for a weight you can’t reach and maintain.
Keep an eye on your total calories, and cut down on fats. Follow the diet guidelines.
Fat-free” and low-fat foods can be a trap. They may not have the fat, but many of them make up for it with sugar, so they’re high in calories.
Stay as active as you can.
Don’t stress out
Too much stress, on the job or at home, can harm your heart and arteries. Your natural response to stress-any problem or demanding situation-causes changes in your body. Your blood pressure goes up, your heart starts to beat faster, and your body releases a number of “fight or flight” chemicals that provide quick energy.

Brief bouts of stress aren’t harmful, but a lot of it day after day can take a toll. Built-up stress raises cholesterol and contributes to high blood pressure, artery and heart disease, and a number of other health problems, including depression, headaches, and sleep problems.

Here are some things that will help you handle your daily challenges, even in these stressful times:

Exercise. People who exercise often tend to feel less anxious and more relaxed.
Laugh more. Studies show that laughter releases stress-busting hormones.
Don’t be a perfectionist. Set reasonable goals and ask whether everything you do has to be the best.
Control your anger. When you’re angry, take a few deep breaths and remind yourself to calm down. Then, ask yourself whether you can do anything to fix the problem. If the answer is yes, don’t seethe silently; figure out what to do to change the situation.
Take breaks during a hectic day to calm down. It doesn’t matter what you do as long as it’s a time-out. Aim for at least 20 minutes twice a day.
Keep a pet. They may shed or slobber, but studies show their owners have fewer health problems than people without pets.
Relax through yoga, deep breathing, meditation, or stretching exercises.
Stay involved
Friendships can do wonders for your health.

Studies show that frequent contact with others cuts your risk for many kinds of disease. Volunteer, join community groups, take classes, and visit your friends.
WHAT YOUR DOCTOR CAN DO FOR YOU
Sometimes lifestyle changes aren’t enough to lower your cholesterol. Your doctor may also advise medication. A number of cholesterol-lowering drugs work well and are safe. Doctors don’t often prescribe them, though, unless your cholesterol is very high or you have high cholesterol along with other risk factors for heart disease, such as high blood pressure or a family history of heart problems.

Reductase inhibitors or statins
These drugs-for instance, lovastatin (trade-named Mevacor) and pravastatin (Pravachol)-can lower LDLs, raise HDLs, make your body produce less cholesterol, and speed the breakdown of cholesterol.

Pro
Work well to lower LDL levels.
Few side effects in most people.
Con
Side effects can include mild abdominal distress, headaches, possible cataracts.
Note: These drugs should not be used along with niacin, gemfibrozil, or drugs that suppress the immune system.
Bile acid resins
These drugs-for instance, cholestyramine (Questran) and colestipol (Colestid)-combine with bile acids and cholesterol in the stomach. They make it hard for cholesterol to dissolve, so it simply passes through the body without harmful effects.

Pro
Help the liver remove LDL from the blood.
Con
Side effects include gas, nausea, constipation, and cramping.
Fibric acid derivatives
These drugs-for instance, gemfibrozil (Lopid)-reduce the amount of cholesterol that ends up in the bloodstream.

Pro
Increase HDLs and lower LDLs in some people.
Con
Side effects include abdominal pain, diarrhea, nausea, fatigue, and joint pains.
Can increase the effects of anticoagulant drugs (which reduce the blood’s ability to clot).
Note: These drugs should not be used along with reductase inhibitors or statins.

Niacin (nicotinic acid)
This B vitamin is often used to lower cholesterol.

Pro
Works well to lower total blood cholesterol and LDLs and to raise HDL levels.
Con
Can cause headaches and flushing of the face.
Note: Don’t take niacin if you’re taking reductase inhibitors or statins.

Anticoagulants
These drugs-such as heparin (Calciparine, Liquaemin) and warfarin (Coumadin)-help prevent blood clots from forming in arteries affected by atherosclerosis.

Pro
May help prevent heart attack and stroke.
Con
May cause dizziness, headaches, nausea, stomach cramps, diarrhea, and vomiting.
Aspirin
Aspirin helps keep blood from clotting and reduces your chances of having a heart attack. If you do have a heart attack, it’s likely to be less severe if you’ve been taking aspirin. Aspirin also lowers the risk of stroke. Experts recommend a half or whole (325 mg) aspirin tablet every day if you’re a man age 50 or older or a woman past menopause with at least one additional risk factor for heart disease, such as high blood pressure or high cholesterol. But aspirin isn’t for everyone; don’t start taking it without talking to your doctor first.

Inexpensive.
Con
Can cause stomach upset. Your doctor may suggest an enteric-coated brand that delays release of the drug until it has passed through your stomach.
Can worsen liver or kidney disease, an ulcer, high blood pressure, asthma, or bleeding problems such as hemophilia.
Can increase bleeding. Stop taking aspirin about five days before any surgery, including oral surgery. But talk to your doctor before quitting if you know you have artery problems.
Can trigger asthma attacks in 5 to 10 percent of people with asthma.