"There is something you can do about it," says Daniel Edmundowicz, MD, associate professor of medicine and director of preventative cardiology at the University of Pittsburgh Medical Center. "I always harp on the fact that this is a preventable condition. Now's the time to make a lifestyle change."
Of course, breaking lifelong habits is never easy. Edmundowicz notes that when it comes to managing cholesterol levels, each patient has his or her individual barriers to success.
"For some patients, it's not so much denial, it's 'so what?'" he says, adding that apathy is more common among older patients. "I'll have folks tell me, a heart attack is not a bad way to go -- it's quick." But when he mentions the likelihood of stroke and its long-lasting aftereffects, "that captures their attention."
One Step at a Time
Patients can easily be overwhelmed by the sheer volume of information on food regimens, smoking cessation and physical activity that often accompanies a diagnosis of high cholesterol.
"We try not to use the words, 'diet and exercise,'" says Edmundowicz, who instead emphasizes TLC, or "therapeutic lifestyle changes."
Simply walking the dog or gardening are a good start. Eventually, you should get yourself moving 30 minutes a day, five times a week. But the American Heart Association notes that those 30 minutes don't have to occur all at once. It's OK, for example, to break up your activity time into three, 10-minute periods a day.
The AHA also recommends, when starting any exercise program, to start slowly, dress comfortably, stay hydrated and vary your routine to avoid boredom or "burn out." And working out with another person or a group can help to keep the motivation going. Remember also to talk with your doctor if you've been physically inactive for a long period or if you have other health concerns.
Toward a Healthier Diet
Unhealthy foods can be gradually replaced with healthier options. Maureen Mays, MD, assistant professor of medicine and director of preventative cardiology at Oregon Health and Science University in Portland, begins any discussion of diet with sugars, especially in drinks.
"The first thing I do with all my patients -- it's kind of a rite of passage -- is ask them to give up all sugary liquids," she says. "Sugary foods and sweet liquids are what drive triglyceride levels."
Edmundowicz agrees: "People will go through a two-liter bottle of Pepsi like it's water." And in addition to colas and soft drinks, sugars often hide in healthy-seeming beverages like energy drinks, bottled teas and fruit juice cocktails.
After reducing or eliminating sugary drinks, Mays focuses on eating smaller servings of foods. "Basically, it's to get them to stop eating like an American," she says.
Portion control can be a particular problem when eating out; some restaurants specialize in large portions better suited to elite athletes than the average person. The AHA suggests requesting smaller portions, sharing an entrée with a dinner companion or asking that a portion of your meal be wrapped-up for eating later.
Perhaps the most obvious way of managing blood cholesterol levels is to first manage the amount of dietary cholesterol and fats. Whole dairy products, high-fat meats, whole eggs, fried foods and baked goods made with oils high in saturated fats can be replaced with low-fat or no-fat dairy products, lean meats, egg whites and fruits, vegetables and whole grain products.
Statins, or cholesterol-reducing medications, are an effective way to reduce cholesterol levels, but they may not be needed by all patients, especially those who are willing to follow through on simple lifestyle changes. "Obviously, some people like the easy way out," Edmundowicz says of statin use. But he also warns his patients, "You can eat your way through any medication I give you."
Daniel Edmundowicz, MD, University of Pittsburgh Medical Center. Telephone conversation, 3 Oct. 2008. 412-310-1892.
Maureen Mays, MD, Oregon Health and Science University. Telephone conversation, 10 Sep. 2008. 503-494-1775.
"How Can I Lower High Cholesterol?" americanheart.org. Oct. 2007. American Heart Association. Accessed 2 Oct. 2008 <http://www.americanheart.org/downloadable/heart/1196285395045LwrHighCholest.pdf>.
"Tips for Eating Out." americanheart.org. 8 Apr. 2008. American Heart Association. Accessed 1 Oct. 2008 <http://www.americanheart.org/presenter.jhtml?identifier=531>.
"Top 10 Tips for Starting a Physical Activity Program." americanheart.org. 8 Apr. 2008. American Heart Association. Accessed 2 Oct. 2008 <http://www.americanheart.org/presenter.jhtml?identifier=528>.
"Eat a Heart-Healthy Diet." americanheart.org. 8 Apr. 2008. American Heart Association. Accessed 1 Oct. 2008 <http://www.americanheart.org/presenter.jhtml?identifier=1510>.