Cholesterol, blood pressure,
and heart disease
By Melissa Bess
Nutrition and Health Education
Specialist
University of Missouri Extension
FNEP STAFF TRAINING ONLY, DO NOT USE
WITH FNEP PARTICIPANTS
06/2007
Introduction
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About cholesterol
LDL vs. HDL
Triglycerides
Healthy levels
Common misconceptions
What affects cholesterol?
Why does it matter?
Prevention of high cholesterol
Introduction (continued)
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About blood pressure
Common misconceptions
Controlling high blood pressure
Heart disease risk factors
About cholesterol
• Soft, fat-like, waxy substance
• Bloodstream and cells
• Needed for cell membranes and
hormones and to make vitamin D
• Comes from 2 sources
– Body produces it (mostly genetic) in liver
(1000 mg day)
– Food sources (animal products – meats,
poultry, fish, eggs, butter, whole milk, and
cheese, not from plant sources) (100 – 500
mg day)
– Foods with trans fats or saturated fats may
cause the body to produce more
cholesterol
About cholesterol
• Must be transported through
blood
• Carriers are called lipoproteins
– Low-density lipoprotein (LDL)
– High-density lipoprotein (HDL)
• Lipoprotein = protein + fat
– LDL, more fat, less protein
– HDL, more protein, less fat
LDL vs. HDL
• LDL = “bad”
• Too much can clog arteries by
forming plaque
• Atherosclerosis can cause heart
attack or stroke
LDL vs. HDL
• HDL = “good”
• Tends to carry cholesterol away
from arteries and back to liver
• May also remove excess
cholesterol from plaque in
arteries, slows buildup
Triglycerides
• Form of fat
• Also made in body (body fat
stored as triglyceride) and from
food
• Help transport dietary fat,
metabolism
• Trigger liver to make more
cholesterol, rising LDL and total
cholesterol
Healthy Levels
• Total cholesterol
– Optimal – under 200 mg/dL
– Borderline high risk – 200-239 mg/dL
– High risk – 240 mg/dL and up
• LDL
– Optimal – less than 100 mg/dL
– Near/Above optimal – 100-129 mg/dL
– Borderline high – 130- 159 mg/dL
– High – 160 – 189 mg/dL
– Very high – 190 mg/dL
Source: National Cholesterol Education Program, National Heart,
Lung, and Blood Institute
Healthy Levels
• HDL
– Low - less than 40 mg/dL
– High – above 60 mg/dL (may lower
risk for heart disease)
– Women tend to have higher HDL due
to estrogen (needs to be over 50
mg/dL)
• Triglycerides
– Normal – less than 150 mg/dL
– Borderline high – 150 – 199 mg/dL
– High – above 200 mg/dL
Source: National Cholesterol Education Program, National Heart, Lung, and Blood
Institute
Common misconceptions
• Using margarine instead of butter
will help lower my cholesterol
• Thin people don’t have to worry
about high cholesterol
• If a label lists no cholesterol, it’s a
“heart-healthy” choice
• Eggs – good or bad?
• Women don’t need to worry about
cholesterol
• Only middle-aged people should
have their cholesterol checked
What affects cholesterol?
• Diet
– Poly and monounsaturated fats may help
lower cholesterol when used in place of
saturated fats, but still limit
– High carbs, excessive alcohol may
increase triglycerides
– Soluble fiber may lower LDL, not HDL
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Weight
Physical activity
Age
Gender
Heredity
Why does it matter?
• Coronary heart disease is caused
by atherosclerosis
• Single leading cause of death
• The higher LDL you have plus risk
factors increases risk for heart
attack
– Smoking
– High Blood pressure
– Low HDL
– Family history of early heart disease
– Age
Prevention of high cholesterol
• Get it checked
• Watch fats, eat healthy
• Consume less than 300 mg of
cholesterol a day
• Be active
• Quit smoking
• Some may need medication
– Lipitor, Crestor, Zocor
– Vytorin
– Zetia
Blood pressure
• 1 in 3 adults has hypertension
• No symptoms, nearly 1/3 of those
people don’t know they have it
• No known cause
• 2 forces
– Blood pumps to arteries and through
circulatory system
– Arteries resist blood flow
• Arteries elastic, stretchy
• Heart beats 60-80 times a minute
Blood pressure
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Systolic (top) – heart is beating
Diastolic (bottom) – heart resting
Normal – 120/80 mm Hg
Pre-hypertensive – 120-139/80-89 mm
Hg
Hypertensive – 140/90 mm Hg
May take several readings
“White coat hypertension”
Hypertension increases risk for heart
disease and stroke
Number 1 controllable risk factor for
stroke
Blood pressure
• Sodium/salt
– Holds excess fluid in body, heart has
to work harder
• Potassium
– Blunts effects of salt on blood
pressure
Common misconceptions
• Symptoms of high blood pressure
include nervousness, sweating,
and difficulty sleeping
• High cholesterol = high blood
pressure
• Everyone has high blood
pressure, I don’t need to worry
• Women don’t need to worry about
high blood pressure
Controlling hypertension
• Reduce fat (particularly saturated
fat)
• Stop smoking
• Cut back on alcohol
• Be active
• May need medication
• Stress management
Heart disease risk factors
• Uncontrollable
– Age
– Male gender
– Heredity (including race) – African
Americans = higher blood pressure.
Also higher among other races
• Controllable
– Smoking (2-4x higher than nonsmokers)
– High cholesterol (high HDL can be
positive risk factor)
– High blood pressure
Heart disease risk factors
• Controllable
– Physical inactivity
– Obesity/overweight (especially in
abdominal area)
– Diabetes
• Other factors
– Stress
– Too much alcohol
• Moderate drinkers = less risk than nondrinkers (may increase HDL cholesterol)
Phytonutrients
• Soy protein may reduce risk of heart
disease
– Especially when replacing foods high in
saturated fat
• Plant sterols/stanols
– Found naturally in fruits/veggies, plant oils
may lower LDL
• Omega-3 fatty acids
– Two weekly servings of fish may be heart
healthy
• Folic Acid
– May lower homocysteine levels
• Antioxidants
• Questions??
• Activity time!