if you do not have heart disease

Source: National Heart, Lung, and Blood Institute

"Why Should I Worry? I've never been sick a day in my life."
Even if you don't now have any signs of heart disease, it doesn't mean you never will. Now is the best time for prevention. Otherwise, a high blood cholesterol level, as well as other risk factors, can lead to problems in the future.

Your Blood Cholesterol Tests
Blood cholesterol levels are measured in a small blood sample taken from your finger or your arm. The blood is tested for total cholesterol and, if accurate results can be obtained, HDL- cholesterol levels. You do not have to fast or do anything special before having this blood test. Depending on the results, you may also need a second blood test, a lipoprotein profile, to determine your LDL-cholesterol level; you do have to fast for this test. An LDL-cholesterol level gives the doctor more information about your risk of heart disease and helps to guide any necessary treatment.

Check Your Level
After the test, compare your results with the levels listed in the chart below. Refer to Chart 2 to see what your next steps should be.

Chart 1
Classification: Total and HDL-Cholesterol*

Total Cholesterol

Desirable Blood Cholesterol Borderline-High Blood Cholesterol High Blood Cholesterol

less than 220 mg/dL 200-239 mg/dL 240 mg/dL and above

HDL-Cholesterol

Low HDL-Cholesterol

Less than 35 mg/dL

*For anyone 20 years of age or older

Chart 2
Classification: Total and HDL-Cholesterol*

Your Next Steps If you Do Not Have Heart Disease

If Your Total and HDL Levels are... Then...

Total Cholesterol HDL-Cholesterol

less than 200 mg/dL 35 mg/dL or greater You are doing well and should have your total and HDL- cholesterol levels checked again in about 5 years. In the meantime, take steps to keep your total cholesterol level down: eat foods low in saturated fat and cholesterol, maintain a healthy weight, and be physically active. The last two steps, along with not smoking, will also help keep your HDL level up.

less than 200 mg/dL,200-239 mg/dL less than 35 mg/dL You will need lipoprotein profile to find out your LDL- cholesterol level. For this test you need to fast for 9-12 hours before the test. have nothing but water, or coffee or tea with no cream or sugar.

200-239 mg/dL 35 mg/dL or greater Your doctor will see if you have other risk factors for heart disease and determine whether more tests (including a lipoprotein profile to find out your LDL-cholesterol) need to be done. No matter what your risk is, it is important to eat foods low in saturated fat and cholesterol, to maintain a healthy diet.

240 mg/dL and above any level You will need a lipoprotein profile to find out your LDL- cholesterol level. Again, you need to fast for 9-12 hours before the test, having nothing but water, or coffee or tea with no cream or sugar.

What Your LDL-Cholesterol Levels Mean

A high LDL-cholesterol level increases your risk for heart disease. Use Chart 3 below to find out about your risks and your next steps.

Chart 3
Classification: LDL-Cholesterol

Desirable Borderline-High Risk High Risk

less than 130 mg/dL 130-159 mg/dL 160 mg/dL and above

Your Next Steps If you Do Not Have Heart Disease

If Your LDL Level is... Then...

less than 130 mg/dL You have a desirable LDL-cholesterol level. You will need to have your total and HDL-cholesterol levels tested again in 5 years. You should follow an eating plan low in saturated fat and cholesterol, maintain a healthy weight, be physically active, and not smoke.

130 mg/dL or above Your doctor will look at your other heart disease risk factors and decide what you need to do to lower your LDL-cholesterol level. The higher your level and the more other risk factors you have, the more you need to follow a diet low in saturated fat and cholesterol. For example, if your LDL is 160 mg/dL or greater and you have fewer than two other risk factors, your LDL goal is a level below 160 mg/dL. If your LDL is 130 mg/dL or greater and you have two or more other risk factors, your goal is to reduce your LDL level to below 130 mg/dL. It is also important to lose weight if you are overweight, to be physically active, and to not smoke. discuss your treatment plan with your doctor.

Profile - Jack Williams Story

Risk Factors
Jack is 35 years old, and his father died from a heart attack at the age of 50. Jack smokes about half a pack of cigarettes a day. His diet is high in saturated fat, cholesterol and calories. He is not physically active. His doctor ordered a lipoprotein analysis, and the results are shown below:

Lab Report

Total cholesterol 260 mg/dL

HDL-cholesterol 40 mg/dL

LDL 190 mg/dL

Evaluation
Jack is at a high risk for heart disease. Here's why:

He has a family history of early death from heart disease.
He smokes.
His total cholesterol and LDL-cholesterol levels are high.
He is physically inactive.

Reducing Risk
The doctor identified Jack as being at a high risk for heart disease. She advised him to stop smoking. Jack had tried to stop on his own, but never quit for more than a few weeks. This time, he enrolled in a program at work that charges him for each class. But if he stops smoking, he will get his money back. His health insurance premium also will go down.

The doctor wanted Jack to focus on giving up smoking. She said that changes in his eating and activity could wait. However, she told him to eat fewer fried foods and more breads, fruits, and vegetables. She said he should get at least some physical activity and suggested that he part further away when shopping at the store, work in his garden, and use the stairs more often.

Two months later, Jack had quit smoking. But he still attended the smoking classes so that he wouldn't start again. The doctor said he was ready to start a Step I diet to improve his blood cholesterol levels, and she told him how to follow it. If Jack had high blood pressure, he would have been advised to follow a low-sodium Step I diet. The doctor also suggested he try to walk about 5-10 minutes in the evening after work, a few days a week.

3 months later his blood cholesterol levels were:

Lab Report 3 months ago Today

Total cholesterol 260 mg/dL 224 mg/dL

HDL-cholesterol 40 mg/dL 45 mg/dL

LDL 190 mg/dL 149 mg/dL

Jack's progress pleased his doctor, but his levels were still not low enough. The doctor told him to walk briskly for 10-15 minutes three times a week and to add more time each week until he reached a 30 minute walk. She also put him on a Step II diet and referred him to a registered dietitian (R.D.) to help him follow it. After 1 month on the diet, he could follow it at home but not when eating out. He went back to the dietitian to get more tips to help him follow the diet when eating out.

After 3 months on the diet, Jack's blood cholesterol levels had fallen to the desirable range. His wife also liked the diet and has modified family recipes, as well as tried new ones for the whole family to enjoy. Now when Jack eats out, he asks about how a food is cooked to be sure it fits into the diet. His new food habits have become a part of his way of eating and his family's.

Jack also walks 30 minutes, three or four times a week. He hasn't smoked a cigarette since joining the class at work, and he still attends the class once a month. He feels great and has lots of energy. He plans to stick to his new habits and keep his cholesterol levels down and reduce his risk of heart disease.

September 2001
Posted February 2002