Frequently Asked Prevention Questions
Every day, our experienced team of cardiologists, cardiothoracic surgeons and vascular surgeons answer heart health questions from people in the community. You can review a list of Frequently Asked Questions on the topics below, or contact our heart experts to submit your own question.
How can you lower cholesterol without taking medication?
Cholesterol is a natural substance produced by the body to keep us healthy. Cholesterol and other fats can't dissolve in the blood; they are carried to the cells by particles called lipoproteins, including low-density lipoprotein (LDL, or bad cholesterol) and high-density lipoprotein (HDL, or good cholesterol).
Too much LDL can clog arteries, increasing your risk of heart attack and stroke; HDL helps remove cholesterol deposits from the lining of your arteries. If you want to lower your LDL levels (and raise HDL), first try some simple lifestyle changes, such as:
- Reducing how much saturated fat you eat: Choose lean protein options, such as fish, poultry or chicken instead of red meat; drink 1% or fat-free milk; reduce consumption of cheese.
- Avoiding simple sugars, such as candies, candy bars, ice cream, and desserts.
- Increasing your fiber intake; aim for 30 grams a day.
- Quitting smoking.
- Eating a handful of almonds a day. Other nuts may also be good, but almonds have consistently shown effects on cholesterol and heart health.
- Studies show that plant sterols may reduce cholesterol: Try adding plant sterols such as CholestOff to your diet. Other supplements may also help; they include green tea extract, red yeast rice and berberine. Remember to talk to your doctor before taking any supplements.
- Increasing your intake of omega-3 acids: Try eating more fish or taking fish oil supplements.
If your LDL cholesterol levels are still high after making changes like these, you may need medication. If you have existing medical conditions, such as a prior heart attack, diabetes or hypertension, or if you have a family history of heart disease, you may need to go on medication if your LDL is above 130 mg/dL; if your LDL levels are above 190 mg/dL, you will likely need to go on medication irrespective of other conditions.
My father has diabetes but is in good health. His cholesterol is a little high. Should I be worried?
Diabetics suffer from heart disease and stroke at twice the rate of everyone else. Due to diabetic neuropathy (nerve damage), diabetics are less likely to feel the symptoms of heart disease, such as chest pain. That said, they can control their risk of heart disease by monitoring blood sugar and lipid levels (blood fats, including cholesterol). A cardiologist can also watch for high lipid levels and atherosclerosis, (hardening of the arteries), which are precursors to heart disease.
Like all diabetics, your father should also avoid smoking, engage in regular exercise, lose excess weight, and consume a diet high in fiber, fruits, vegetables, fatty fish and whole grains, and low in processed sugars for a lower risk of heart disease and increased quality of life.
What’s the link between type 2 diabetes and heart disease?Show/Hide Answer
What’s the best exercise program for your heart?
The best exercise is the one you like to do! Like all things in life, if you enjoy what you’re doing, you are much more likely to make it part of your life. The goal for good health is to get regular aerobic exercise every day -- non-stop movement that makes you feel like you’re moving, lasting 20 minutes or more (the American Heart Association recommends at least 150 minutes a week). You might choose to spend those 20 minutes in an exercise class, riding a bike or swimming. Remember, a brisk walk is an excellent form of aerobic exercise, and it’s right outside your door. The benefits of exercise are many: it lowers blood pressure, improves blood sugar and blood fat levels, it may help you lose weight, and it is a natural anti-depressant. If you take medicines for high blood pressure, diabetes or cholesterol, exercise will help them all work better.
At what age should I start getting heart-related screening tests?
Starting at age 20, healthy adults should get checks of their blood pressure every two years, cholesterol every five years, body mass index (BMI) at every regular health care visit, and waist circumference as needed, according to the American Heart Association. Starting at age 45, blood glucose also should be checked every three years. If any of your results are abnormal, you may need to have them checked more frequently. More comprehensive screening may be needed for those with diabetes, high cholesterol, high blood pressure, a history of smoking and/or a family history of heart disease or stroke.
How can I tell if I have heart disease?
Blood pressure, blood sugar and cholesterol levels can help to determine a person’s risk of heart disease. However, 50 percent of people with heart disease experience a heart attack as their first symptom. To detect heart disease sooner, there are now more sophisticated ways to screen for it, such as the coronary artery calcium score, a non-invasive test that uses modern low-dose radiation CAT scanning to detect plaque (atherosclerosis) in the heart arteries—before symptoms develop. The scan may be considered for people with, diabetes, high cholesterol, high blood pressure, obesity, a family history of heart disease and past or present smokers.
Is it more important to raise good cholesterol or lower bad cholesterol?
First, cholesterol itself isn’t good or bad. It’s a natural substance that’s created by the body to keep us healthy. Cholesterol and other fats can’t dissolve in the blood; they are carried to the cells by carrier particles called lipoproteins, including low-density lipoprotein (LDL) and high-density lipoprotein (HDL). Too much LDL can clog arteries, increasing your risk of heart attack and stroke; HDL may help to remove cholesterol deposits from the lining of your arteries. Your ideal LDL cholesterol level depends on many factors, including age, activity level, blood pressure, whether you smoke or have diabetes, and your family medical history. The best way to treat low HDL cholesterol is by making healthy lifestyle choices, such as partaking in regular cardiovascular exercise, eating a heart healthy diet, watching your weight and quitting smoking.
I haven’t exercised in years. How do I start a new exercise program?
Remember: Some exercise is better than none. If you haven’t been exercising in a while, start slow: Do just 10-15 minutes a day, three times a week. Gradually build up the number of days to ideally five days a week, and then as you feel stronger, try to increase your time in five-minute increments each week with a goal of 30 minutes, five days a week. The type of exercise you choose (such as walking, cycling or swimming) should be something that you enjoy and can sustain in the long term. To lose weight or improve fitness, you will need to exercise 60-90 minutes a day. The intensity of your exercise should be just enough to get you breathing a little harder, but still comfortable having a conversation.
I have been having some concerns about my heart health. Is my resting blood pressure a concern: 115/65, with a pulse of 47?
Your blood pressure is actually excellent. Your pulse is lower than normal, but that is not necessarily a problem if you are otherwise healthy and feel well. If you haven’t discussed your pulse with your primary care provider, I would recommend that you do so. He or she may want to perform an ECG (electrocardiogram).
Which is better for your heart? Margarine or butter?
Neither one is optimal for heart health for two important reasons:
Butter contains high levels of saturated fat and cholesterol, which increases blood cholesterol levels and the risk of heart disease.
Many margarines, while containing mainly vegetable oils, also contain trans fats (partially hydrogenated fats). Trans fats, along with saturated fats, increase blood cholesterol levels and your risk of heart disease.
More important is that you read the label of margarines and stay away from “partially hydrogenated” or “trans fats.” Look for products such as Smart Heart and Promise Activ, fortified with plant stanols and sterols that can actually help decrease cholesterol levels.
I have some arteries that have extremely high calcium scores on a CT (one is 700+) and others that are zero. Does that tell you anything? I have never had symptoms and I bike 10 miles a day.
The finding of a high calcium score in one of your coronary arteries is important. While you may not be having symptoms, this is a sign of significant coronary artery disease. You will need to work with your health care provider on lifestyle modifications as well as medical therapy to reduce your risk of having a heart problem in the future. Additionally, a stress test can be considered in people with a calcium score above 400.
If stents do not help a heart problem, what is the next step? My husband has three stents and is ready for another.
I would look at factors which impact the progression of his coronary artery disease. Often, seeing a cardiologist with a focus on prevention might identify additional risk factors which might impact intensity of treatment via nutrition, exercise and medications.