How to Manage Your Cholesterol

It’s one of the most important metrics for your long-term health, but high cholesterol often goes unnoticed until it’s too late. Unlike a cold or the flu, there are generally no obvious symptoms to let you know your cholesterol levels are off. Learn how to improve your wellness routine in this WFMY 2 Your Well-Being conversation with Dr. Kenneth Hilty, with Cone Health HeartCare and Medical Director of Cone Health Advanced Lipid Disorders & Cardiovascular Risk Reduction Clinic.

Know Your Numbers

While some people with extremely high cholesterol may notice physical symptoms like cholesterol deposits under their eyes, most people don’t feel anything at all. This is why testing is so critical. Early detection and treatment can dramatically lower your risk for serious conditions like heart attacks and strokes.

Dr. Hilty recommends that all adults get a baseline cholesterol screening, ideally starting in their 20's. If your levels are found to be high, your doctor may recommend more frequent testing, possibly two to four times a year, to monitor your progress.

Lifestyle v.s. Genetics

Managing cholesterol isn’t just about diet and exercise—your family history plays a huge role. Your body naturally produces cholesterol, and you also get it from food. However, some people have a genetic predisposition to high cholesterol. This means that even if you live a perfectly healthy lifestyle, your cholesterol levels could still be elevated.

"I encourage people to enroll in our no-cost GeneConnect program, which will tell you whether you have a genetic risk for high cholesterol, plus a lot of other helpful information," says Dr. Hilty. "Finding out if you have a genetic risk for high cholesterol will then help us manage that risk earlier and better." Visit conehealth.com/geneconnect to learn more.

The Role of Medications

If diet and exercise aren’t enough to get your cholesterol levels under control, your doctor may prescribe medication. Statins are the most common and have been used for more than 30 years with a strong safety record. These medications are effective at reducing your risk of heart disease and are available in inexpensive, generic forms.

Dr. Hilty emphasizes that statins are generally safe, and doctors work with patients to find a medication they can tolerate well. In some cases, other non-statin medications may be used if you can't tolerate statins.

When it comes to long-term use, the answer depends on why your cholesterol is high. If your levels improve due to lifestyle changes like weight loss or a new diet, your doctor may be able to take you off the medication. However, if you have a genetic condition or have already had a heart attack or stroke, you'll likely need to take the medication indefinitely to keep your risk low.

While you can’t change your genes, you can still take control of your lifestyle through:

Diet

• Focus on a Mediterranean-style diet rich in nuts, olive oil, and seeds. These "healthy fats" have been shown to help prevent cardiovascular disease and may even reduce the risk of conditions like Alzheimer's.
• Limit saturated fats found in fried foods, butter, and cheese.
• Consider reducing your red meat intake in favor of more plant-based options.

Exercise

• Prioritize regular physical activity, including both aerobic exercise and strength training. This helps your body use up cholesterol and related particles, like triglycerides, for energy.
• Aim for several sessions a week.

A Little-Known Risk: Lipoprotein(a)

You may have heard of a new health metric called Lipoprotein(a), or Lp(a). While it's been known about since the 1960's, a renewed interest in this specific blood test is growing. Lp(a) is a genetically determined type of cholesterol that is more likely to cause heart disease than "bad" LDL cholesterol alone.

Because it's not affected by diet, exercise, or most medications, Dr. Hilty recommends that anyone with a strong family history of heart disease ask their doctor for a specific Lp(a) blood test. While there are a few treatments available, new medications are also on the horizon to help lower this specific risk factor.

Next Steps

High cholesterol is often an invisible threat. That’s why it's so important to be proactive and get tested. Start by talking to your primary care provider, who can order a simple, fasting blood test. They can help you understand your risk and create a plan that works for you, whether it’s through lifestyle changes, medication, or a combination of both.

Remember, the sooner you identify your risk, the better your long-term outcome.