CHOL ESTEROL Cholesterol-Savvy Moves to Help Protect Your Heart When it comes to heart health, keeping an eye on your cholesterol levels is key. Unfortunately, many people remain confused about what’s bad, what’s good and what heart-protective actions to take. Erin Imler, MD, a UCLA family physician in Pacific Palisades, cuts through the cholesterol confusion. Know your risk. Consider medication. One of the biggest changes in current cholesterol management is a greater focus on collective heart-disease risk factors and not just good (high-density lipoprotein, or HDL) and bad (low-density lipoprotein, or LDL) cholesterol numbers. “We no longer prescribe cholesterol-lowering medications, called statins, based solely on your cholesterol numbers,” Dr. Imler says. The risk estimator developed by the American College of Cardiology and the American Heart Association assesses the 10-year and lifetime risk of atherosclerotic cardiovascular disease (ASCVD), or heart attacks and strokes. In addition to cholesterol numbers, the calculator also considers age, gender, race and health history, such as tobacco use, diabetes and blood pressure. The score helps doctors identify those most at risk for potentially life-threatening heart events. You can assess your risk online or via the ASCVD Risk Estimator app. If results indicate that you are at high risk for heart problems, your doctor may recommend statins. Studies show that these medications are highly effective at lowering LDL, and they may reduce heart-attack risk by as much as 36 percent. Still, some people shy away from statins due to concerns about possible side effects. “Often, symptoms can be alleviated by reducing the medication dose or frequency, and by adding an antioxidant supplement called Coenzyme Q10 (CoQ10) to relieve muscle aches,” Dr. Imler says. Move more. Exercise is the best way to raise HDL, which clears the arteries of bad cholesterol. Aim for at least 30 minutes of physical activity five days a week, Dr. Imler says. In addition to boosting good cholesterol, exercise also helps you lose weight. Excess weight, especially a waist circumference of more than 40 inches for men or more than 35 inches for women, increases your likelihood of diabetes, another major heart disease risk factor. Switch up your diet. The foods you eat play a big role in your cholesterol numbers. “It’s more important to eat the right kinds of fat than to restrict fats,” Dr. Imler says. She suggests cutting back on saturated fats, found in red meats and full-fat dairy products, and trans and saturated fats, found in fried foods, chips and crackers. Instead, eat more fish, soybeans, nuts and olive-oil products, which are high in heart-healthy polyunsaturated and monounsaturated fats. Talk to your doctor. “Too often, people choose to forego medication in favor of lifestyle changes, but you jeopardize your health if those changes don’t happen,” says Cody Dashiell-Earp, MD, associate medical director of quality for the UCLA Department of Medicine. To help you succeed in making changes, or to determine your next steps, UCLA Health’s new Healthy U preventive initiative reaches out to patients at high risk for heart problems. “You might get a phone call or a message via my.UCLAhealth.org if a Healthy U staff member thinks you could benefit from a heart health discussion with your primary- care doctor,” Dr. Dashiell-Earp says. To find a UCLA clinic near you, visit: uclahealth.org Erin Imler, MD LAW Cody Dashiell-Earp, MD Vital Signs Summer 2017 Vol. 75 3