Coronary artery disease symptoms include shortness of breath, chest pain, activity intolerance, nausea, dizziness, and loss of energy. But over time, you may have a heart attack due to blockage of blood flow in a coronary artery. Your heart tissue can become damaged, weaken, and stiffen. This process can result in heart failure. It also leads to an increased risk for developing abnormally fast electrical rhythms from the upper and lower heart chambers. In some cases, coronary artery disease treatment includes cardiac stents, or, when the disease is very severe, coronary artery bypass surgery.
What if this could be prevented?
Our Enormous High Cholesterol Problem
Coronary artery disease is often the consequence of many other diseases, problems, or lifestyles termed risk factors:
- High cholesterol
- Diabetes
- High blood pressure
- High levels of body inflammation
- Obesity
- Physical inactivity
- Smoking
Most of these are preventable.
If you have a genetic tendency towards coronary artery disease, with parents or siblings who developed it early in life, the disease can occur without many risk factors. But even in these cases, it accelerates quickly in the presence of risk factors.
Of all the coronary artery disease risk factors, high cholesterol is a particularly big problem in the United States. The Center for Disease Control and Prevention (CDC) estimates that 71 million U.S. adults have high cholesterol. That’s one third of our adult population.
Yet less than half of people with high cholesterol seek treatment for it, the CDC notes. What’s more, when treatment is pursued, only one in three adults have their cholesterol adequately treated.
High Cholesterol Treatment
The most common treatment for high cholesterol, particularly after heart disease has developed, is a statin. This type of drug comes with benefits and risks. Statins inhibit HMG-CoA reductase, an enzyme in our bodies that is used to make cholesterol. Some examples of statin drugs areZocor (simvastatin), Lipitor (atorvastatin), Crestor (rosuvastatin), and Pravachol (pravastatin). These drugs have side effects that include muscle pain, joint pain, headache, and nausea. You can also have rare severe sides effects such as inflammation and injury of the liver and muscles.
Most of the time, when I see patients in clinic, joint and muscle pain leads them to stop their statin medication and try to lower their cholesterol by other means. Some of the most common questions I hear are:
“What will happen to my cholesterol if I change my diet?”
“Can I work on my lifestyle, exercise more and eat better, and recheck my cholesterol in 6 months?”
“I gained weight this year. If I lose weight and eat better will I still need my statin?”
If you have high cholesterol or have needed a statin drug you may have asked these same questions to yourself or your physician. A new study tells us just how much of a benefit we can expect when our diets are greatly improved.
Cholesterol Benefits of Vegetarian Diets
An October 2015 analysis in the Journal of the American Heart Association examined how a strict vegetarian diet affects cholesterol levels in people with heart disease or risk factors of heart disease. This report summarized 11 prior studies in what is called a meta-analysis. The studies included were from the United States, Finland, Sweden, Czech Republic, and Australia. In all the studies, people were randomized to receive a vegetarian diet versus a diet that included meat. The average age of the people in these studies ranged from 28 to 54. In three studies, people had already tried a medication to lower their cholesterol.
The most commonly studied vegetarian diet was a vegan diet in which both meat and diary products are avoided. The second most common diet studied was a lacto-ovo vegetarian diet that primarily avoids meats (but can include dairy products). In all studies these diets were compared to an omnivorous diet of plant and animal products. The cholesterol levels in these patients were studied up to 74 months.
Here is a summary of what the researchers found about people’s cholesterol on a vegetarian diet:
- Total cholesterol was reduced by 13.9 mg/dL
- LDL (bad cholesterol) was reduced by 13.1 mg/dL
- HDL (good cholesterol) was reduced by 3.9 mg/dL
- Triglycerides levels were similar in nearly all studies regardless of diet
In addition, people on a vegetarian diet were more likely to lose weight by an average of 2.9 kg (about 6.35 pounds).
What Else Can Help Control High Cholesterol?
Looking at the vegetarian diet analysis you may be thinking the cholesterol levels did not lower all that much. If you consider most people in these studies started with a total cholesterol over 200 mg/dL, the dietary changes only reduced cholesterol by 5 to 10 percent. Unfortunately, good cholesterol levels did not improve but actually slightly declined with a vegetarian diet. Raising good cholesterol levels can be hard. In fact, good cholesterol levels also don’t improve with statin drugs.
Fortunately, if you are serious about lowering your cholesterol without medications, you can do more.
First, remember that certain food types can actually lower cholesterol more significantly when added to an already heart-healthy diet:
- Nuts
- Avocados
- Healthy oils
Second, to tackle high cholesterol you have to take on all the different lifestyle choices that raise it, in particular sedentary lifestyles, obesity, and lack of exercise.
Exercise Lowers Bad Cholesterol and Raises Good Cholesterol
A 2002 study in the New England Journal of Medicine from researchers at Duke University examined the value of exercise to lower cholesterol. Here, 111 patients were randomized to three exercise programs, one was exercise equivalent to jogging 20 miles per week, another to jogging 12 miles per week, and the final group to walking 12 miles per week.
Here is a summary of the impact of exercise on people’s cholesterol levels:
- LDL (bad cholesterol) was reduced by 1 mg/dL in the walking group and down 3 mg/dL in the jogging 20 miles per week group
- HDL (good cholesterol) was increased by 1 mg/dL in the walking group and up to 4 mg/dL in the jogging 20 miles per week group
If exercise is a good thing, how much should be done? I get this question almost every time I see patients in clinic.
First, exercise should be moderate in intensity for most people. For most people this is jogging, walking quickly, swimming, or using an exercise machine at a low to a low-medium level. If you exercise to a level that makes you breathless this is beyond moderate intensity. Find a moderate exercise level that will allow you to do it continuously for at least 10 minutes and up to 20 to 30 minutes.
Second, the American Heart Association recommends that you exercise from 30 to 60 minutes per day. Sixty minutes should be targeted if you want to lose weight. This exercise quantity can be done at once, or by breaking things up in 10-minute intervals.
Third, I am often asked what the best exercise is. The truthful answer is that I don’t know. What I do know is that you should find an exercise that you can enjoy doing on a daily basis. This exercise should over time allow your body and mind to heal. For me, this exercise is jogging. For many of my patients it’s aerobics or yoga classes. For others, it’s cycling, weight lifting, interval training, or swimming.
What Are Healthy Cholesterol Levels?
If you are an adult, you should get your cholesterol checked through a simple fasting blood test at minimum every 5 years, to see if it’s healthy. If you have not developed heart disease or you have risk factors associated with coronary artery disease, the following cholesterol levels are consider ideal:
- Total cholesterol less than 200 milligrams (mg) per deciliter (dL)
- LDL (bad cholesterol) less than 100 mg/dL
- HDL (good cholesterol) more than 60 mg/dL
- Triglycerides less than 150 mg/dL
If heart disease has developed, your doctor will try to more aggressively reduce your cholesterol to minimize plaque build up in your coronary arteries, and your target numbers will be different. For example, the ideal goal LDL in people who have had a heart attack or received a heart stent or bypass surgery is less than 70 mg/dL.
Time to Get Serious About High Cholesterol
Diet and exercise can significantly improve cholesterol in as little as a few months. The benefits of diet and exercise extend beyond the cholesterol levels themselves to improving the type and function of the cholesterol particles. Some people still need medication despite all they do, but most people can achieve their cholesterol level goals if they adopt healthy lifestyle changes early.
