Dear Alice,

I am a 60 year old man who exercises daily — runs and walks over 30 miles a week. My "bad" cholesterol was 124 and my "good" cholesterol was 39. I know the 124 is OK, but I am worried about the 39. Do you think I have a problem? I have a sweet tooth and eat a lot of candy. Can this be a problem? I follow a rather low fat diet and eat little red meat.

Dear Reader,

A heart-y congratulations is in order for your commitment to regular physical activity. It's also great that you're keen to get to the bottom of your blood test results. All the talk about "good" and "bad" cholesterol, can make figuring out your cholesterol numbers a little confusing. First, the basics — cholesterol is made up of low-density lipoproteins (LDL) and high-density lipoproteins (HDL). You're correct in your knowledge about the difference between HDL and LDL — HDL is the type of cholesterol that is beneficial for the body because it carts away cholesterol to the liver, which then removes it from the body. Generally speaking, a higher HDL level is recommended and an HDL level between 40 to 50 milligrams per deciliter (mg/dL) is good (while a level higher than 60 mg/dL is even better). So, when it comes to the “good” stuff, you’re almost there! On the flipside, a lower level of LDL is advised, but you’re right on track because an LDL level of 124 mg/dL falls into the nearly optimal range.  And, while your sweet tooth may play a role in cholesterol levels, so do a number of other lifestyle and genetic factors. Read on for the full scoop on everything else you may be wondering about cholesterol.

Blood cholesterol can be used to estimate an individual’s risk for heart disease, which involves looking at the ratio of total cholesterol level to the level of HDL. Total cholesterol includes not only LDL and HDL levels, but also accounts for levels of another kind of fat in the blood stream, called triglycerides. An easy way to determine your heart health risk is to consider your cholesterol ratio. To calculate this, take your total cholesterol level and divide it by your HDL level. An optimal result is less than or equal to 3.5 to 1, but if the resulting ratio is greater than that, it’s worth your while to consider incorporating additional lifestyle changes to improve the cholesterol ratio and reduce the risk for cardiovascular disease. There are prescription medications available to raise HDL levels, but research has yet to demonstrate that they're as effective as lifestyle changes when it comes to reducing the risk of cardiovascular disease. In addition to using blood cholesterol levels as a risk indicator, there’s also ongoing research that focuses on quantifying the number of HDL particles as opposed to cholesterol levels in the blood to gauge heart disease risk. 

Regarding your sweet tooth, here's some food for thought: diets high in refined sugars and simple carbohydrates, such as the ones found in candies, are associated with elevated levels of blood triglycerides. High levels of triglycerides are included in high total cholesterol numbers, which is associated with low HDL levels, and increased risk for heart disease. To protect your heart and satisfy your sweet tooth, you may consider trying some naturally sweetened options instead. Above and beyond your sweet treats, you may take a look at your food choices as a whole. There are a number of foods that may help lower LDL levels or raise HDL levels that you may want to swap in or add to your favorite meals and snacks.

Reader, it's also worth noting that cholesterol levels are only one risk factor for heart disease. Family history, body mass index (weight to height ratio), smoking status, and high blood pressure also need to be considered. If you want an overall sense of your heart health that incorporates your test results and medical history, your health care provider can advise you further and help you increase your heart smarts moving forward.

Alice!

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