If you’ve been diagnosed with high cholesterol, you may have taken steps to retool your daily routines to make them healthier, by eating a healthy diet, exercising, and, if your doctor prescribed cholesterol-lowering medications, taking them consistently.
But could there be something you’ve missed that could be sabotaging your success as you work to reduce your risk of cardiovascular disease? Here are 8 things that may be working against your efforts to reduce cholesterol and some ideas for smart steps to get you back on track.
Mistake 1: You’re not paying attention to the sugar and alcohol in your diet.
When you get a high-cholesterol diagnosis, it’s understandable — and correct — that you’d focus on limiting the saturated and trans fats in your diet. But it’s also important to look at the amount of sugar and alcohol you’re consuming, which also contribute to high cholesterol, says Erin Donnelly Michos, MD, an associate professor of medicine at Johns Hopkins School of Medicine and director of women’s cardiovascular health at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, in Baltimore.
That’s because your body turns excess calories from sugar and alcohol into cholesterol and triglycerides, which can contribute to unhealthy cholesterol levels in your blood. “People don’t realize that this is why their numbers are not getting any better, even though they’re reducing fat and exercising,” says Dr. Michos.
To help improve your cholesterol levels, cut down on all sources of sugar, including sweetened drinks, alcohol, and refined carbohydrates, such as white bread and pasta, and opt for whole grains rich in cholesterol-lowering fiber.
Mistake 2: You’re only focusing on LDL cholesterol levels.
While it’s good to know what your so-called “bad” LDL (low-density lipoprotein) cholesterol number is, that doesn’t give you the complete picture, and numbers alone do not tell the story. Doctors order a blood test to look at your lipid panel, which consists of your high-density lipoprotein (HDL, or “good”) cholesterol, LDL cholesterol, triglycerides, and total blood (or serum) cholesterol (calculated by adding your HDL, LDL, and 20 percent of your triglycerides).
To evaluate your risk for cardiovascular disease, doctors will also consider other risk factors, such as your age, family history, and whether you have other health conditions related to heart disease, such as diabetes and high blood pressure, according to the American Heart Association (AHA).
Mistake 3: You forget to take your medication — or have stopped altogether.
Drugs to treat high cholesterol, including statins, have a proven impact on cholesterol levels and may prevent heart attack in people with coronary heart disease. But according to one article, not taking statins as prescribed was linked to a significantly higher risk of cardiovascular problems and even death.
The article cites reviews showing medication compliance problems worldwide:
- One Italian study examining the effectiveness of statins found that only 61 percent were still taking their meds as prescribed after 3 months.
- A Canadian study found that as many as 60 percent of patients who had experienced acute coronary syndrome, such as a heart attack, stopped taking their statin within 2 years of hospitalization.
- Discontinuing statins is estimated to add a staggering $44 billion to healthcare costs in the U.S.
According to the article, researchers theorize that noncompliance may be due to a combination of factors, including cost, infrequent visits with cardiologists, concerns about side effects, and forgetting to take the medication. They also note that statins may be discontinued at a higher rate than other medications because high cholesterol is a symptomless condition with infrequent tests compared with something like diabetes, which requires constant monitoring of blood sugar levels.
The article suggests some solutions that may increase adherence to statin therapy, such as better patient education and communication with physicians, improved access to healthcare, home visits, and smartphone app reminders that signal when it’s time to take medication.
Whatever your barrier is to taking statins as directed, it’s important to identify the problem and address it. Statins cannot work effectively if you don’t take them as prescribed, and stopping your medication without your doctor’s guidance can have serious health consequences, especially if you have a history of stroke. One study found that people who discontinued statin therapy between 3 and 6 months after an ischemic stroke were at higher risk of having another stroke within one year after stopping the medication.
If you’re experiencing any problems taking your statins, be sure to talk with your doctor so you can address the issue and continue therapy to manage your cholesterol.
Mistake 4: You think taking statins means you can eat anything you want.
Taking statins doesn’t mean you can eat what you want. Don’t ignore advice about a cholesterol-lowering diet, Michos stresses. Many people wrongly believe their medication will undo any cholesterol overload, regardless of what they eat.
Even if you’re taking medication to lower your cholesterol, you still need to watch your calorie intake and reduce the amount of saturated fats and carbohydrates, which could be contributing to unhealthy cholesterol levels. Instead, eat cholesterol-lowering foods, such as beans, fiber-rich fruits and vegetables, and whole grains.
Mistake 5: You’ve cut out all fat from your diet.
While it’s true that you should cut out trans fats and saturated fats — often found in baked goods, such as crackers and cookies — not all fats need to be avoided, says Michos. In fact, you should be eating heart-healthy monounsaturated and polyunsaturated fats — the kind found in olive oil, olives, and nuts — as well as foods rich in omega-3 fatty acids, such as salmon, tuna, and mackerel. But, she says, you should still watch the number of calories you eat, which can add up quickly, even with healthy fats.
Mistake 6: You’re not exercising enough.
“Diet alone is often not enough. It should be combined with exercise,” says Michos. When it comes to exercise, the equation is pretty simple: Being sedentary equals lower levels of HDL, according to the AHA. You can lower both cholesterol and high blood pressure by doing at least 150 minutes of moderate-intensity exercise, such as walking, bicycling, swimming, or even doing yard work, each week.
Even more good news: A study review found that both low- and moderate-intensity aerobic exercise led to a significant reduction in total cholesterol, including LDL.
Mistake 7: You engage in yo-yo dieting.
Do you diet hop, going from one diet promising to help you reduce cholesterol and lose weight to another? According to Michos, the diets that seem to work best for improving heart health and reducing cholesterol are not necessarily new.
She recommends a Mediterranean diet, the tried-and-true eating plan that emphasizes fruits, vegetables, whole grains, healthy fats, and fish. It’s high in omega-3 fatty acids, which are associated with a reduced risk of cardiovascular disease, and cuts way back on foods high in saturated fat, such as meat.
Mistake 8: You take statins with grapefruit juice.
Maybe you want to get a healthy start to your day and take your statins with breakfast. But if your breakfast includes grapefruit juice, you may want to check with your doctor first. According to Cleveland Clinic, grapefruit juice contains a chemical that can interfere with your body’s ability to break down certain statins.
Additional reporting by Katherine Lee.