Know Your Numbers: Why “Cholesterol” Isn’t Just a Buzzword, and Testing Is the First Step to Avoiding Cardiovascular Disease

“Cholesterol.”

You heard it in every high school health class you were forced to attend, and now, as an adult, you hear it again at the mandatory yearly checkup at the doctor’s office. You know you’re supposed to lower it somehow, but you don’t exactly know what it is or why your teachers or primary care provider push checking it so much.

Cholesterol is a waxy, fat-like substance found in every single cell in your body. It helps build cells, produce vital hormones such as testosterone and estrogen, and make vitamin D. In other words, it’s a good thing to have. Your body needs some to function properly.

However, too much cholesterol can increase your risk of heart disease as well as the risk of heart attacks or stroke.

Heart disease prevention is changing. While doctors used to focus on treating people who had already developed heart problems, new guidelines have emerged, encouraging risk assessments to begin around age 30.

I spoke with Michael Shapiro, D.O., a cardiologist with a specialization in preventive medicine, about the updated approach to cholesterol management. He shared that doctors can now look at both short-term risk (your chances of heart problems in the next 10 years) and long-term risk (your chances over your lifetime).

It all starts with what Shapiro calls “knowing your numbers.”

Cholesterol Numbers Are Not the Only Numbers

Doctors are paying attention to other signs that contribute to your quantitative risk score (QRS), a numerical tool used by doctors to calculate the probability of a patient developing a disease.

Two elements are crucial to get tested for:

1. Lipoprotein(a), or Lp(a): a type of cholesterol mostly controlled by genetics. Some people inherit high levels, which can increase their risk of heart disease. Testing can help identify people who may need closer monitoring. This factor is solely based on genetics.
2. High-sensitivity C-reactive protein (hs-CRP): a blood test that measures inflammation in the body. Higher inflammation levels may be linked to a higher risk of heart disease. Unlike Lp(a), this hs-CRP is entirely linked to lifestyle.

Heart Disease Prevention: Genetics vs. Lifestyle

Your family history matters. If heart disease runs in your family, doctors may want to look at your risk earlier. Some people may benefit from taking steps to lower risks before problems occur.

These lifestyle choices are still among the most effective tools for prevention. “The basics” you learned about back in your high school health classes will make a major difference today.

To start, nutrition and exercise are still the framework for a healthy lifestyle. Inflammation levels in the body directly respond to how the body is treated — it's the output to the body’s input.

Shapiro recommends weight loss as the best solution to lower hs-CRP, especially in those who are overweight or obese.

With the rise of GLP-1s, often called a miracle drug, Shapiro acknowledges the benefits of use, including how they lower cardiovascular disease risk, promote weight loss and are anti-inflammatory. In fact, hs-CRP will go down with use before the numbers on the scale even begin to drop.

However, other methods can help lower your risk.

What You Can Do

• Diet is the first step toward heart health. It is more about what is consumed than the time of day, so there’s not enough evidence that intermittent fasting lowers cholesterol. Instead, Shapiro recommends a Mediterranean-style or plant-forward diet (not strictly vegetarian, just get those plants in!). Portion control also makes a vast difference, as does making sure the majority of the food you consume includes whole foods rather than processed ones.
• Physical activity is the best way to lower cholesterol and prevent heart disease. Daily physical activity helps lower blood pressure, improves cholesterol levels, reduces blood sugar and metabolic symptoms, improves sleep, and promotes mental wellness. An easy way to get more activity in is by walking. Set a solid step-count goal (such as 7,000 steps a day) and use a health tracker app on your phone to keep track.
• If you smoke, make a plan to quit. Smoking contributes to plaque buildup, lowers protective HDL cholesterol and increases the risk of heart attack and stroke. The good news is that your body begins to recover soon after you stop smoking, and support from your health care team, nicotine replacement products, medications or quit programs can make the process more manageable.
• Don't wait for symptoms to get screened. Cholesterol testing early in life can help detect inherited conditions such as familial hypercholesterolemia, which affects about 1 in 250 people. Experts recommend screening children between ages 9 and 11, retesting between ages 18 and 20, and checking cholesterol every 5 years as an adult. Starting around age 30, tools such as the American Heart Association's PREVENT equation can help estimate your risk of cardiovascular disease years in advance, giving you and your health care team more time to take steps to protect your heart.