I was 22, just out of college, and by all indications in pretty good shape when I stopped by my doctor’s office for a routine physical. Everything was fine—except I learned I had high cholesterol. The test results couldn’t be right, I told myself. I couldn’t have high cholesterol—or could I?

Like me, American men of all ages are starting to realize they might be at greater risk for high cholesterol and heart disease than they once believed. Some men continue to think that because they aren’t overweight, their cholesterol must be fine. Others feel confident that because they’re eating mostly low-cholesterol foods, or because their test results don’t show high cholesterol, they won’t develop heart disease.

Women have misconceptions about their risks, as well. Although men are generally assumed to be at greater risk for high cholesterol, this is only true early in life. From age 45 on, women are more likely than men to have high levels.

Everyone, then, can benefit from learning more. Although much maligned, cholesterol is actually a vital building block of the human body, a soft, waxy substance in cells and the bloodstream that is used to create membranes and hormones. The problem occurs when too much cholesterol collects in the bloodstream. Called hypercholesterolemia, it leads to increased risk of coronary heart disease, which in turn can lead to a heart attack.

We should all take steps to regularly monitor our cholesterol levels and keep them within healthy limits, starting early in life. Here are a few real-world tips geared toward busy men—maybe the busy man in your life—to help protect that most important muscle, the heart.

Monitoring cholesterol
Step 1: Get to the doctor’s office—regularly!
Although this might seem like a no-brainer, it’s not always easy to get men to the doctor’s office for regular checkups. A 2000 study by the Commonwealth Fund found that men were three times more likely than women not to have visited a doctor in the previous year. “Men are terrible at that,” says Richard Stein, MD, associate chair of medicine at Beth Israel Medical Center in New York and spokesman for the American Heart Association (AHA). “We tend to go to a doctor only when we get sick. But if you wait till you get sick with heart disease, you’ve clearly missed the boat in a lot of what we can offer you.”

Men should start having their cholesterol checked every five years during their 20s and annually by the time they reach middle age. Cholesterol tests are usually part of a routine physical, but it doesn’t hurt to request it when talking to your doctor. An easy way for busy men to remember to get tested annually is to schedule an appointment on an anniversary.

Step 2: Decipher the test results
Doctors will usually check total blood cholesterol levels. Overweight people are more likely to have higher cholesterol, but thin people can also be at risk. Total cholesterol under 200 mg/Dl is optimal; levels above 240 mg/Dl indicate high risk for coronary heart disease.

Total cholesterol is composed of two types of cholesterol. There’s low-density lipoprotein, also known as LDL, or “bad” cholesterol, which clogs arteries. The other type is high-density lipoprotein, known as HDL, or “good” cholesterol, which actually helps remove “bad” cholesterol from the bloodstream. A healthy man’s LDL level would be less than 100 mg/Dl and his HDL level greater than 40 mg/Dl.

Step 3: Check for other warning signs
Total blood cholesterol tests are just one piece of the coronary heart disease puzzle. Doctors generally compare each patient’s cholesterol levels with a handful of other factors associated with heart disease, including elevated blood levels of a fat called triglyceride, as well as elevated levels of homocysteine and C-reactive protein. It’s smart to ask your physician to test for these when they check your cholesterol levels.

Even if cholesterol levels come back as normal, that doesn’t mean a man is not at risk. While at the doctor’s office, ask to discuss any other relevant factors associated with heart disease, including family medical history, high blood pressure, smoking, stress, obesity, and diabetes.

Recent public attention has focused largely on these “other” heart disease risk factors. It’s not that high cholesterol is less dangerous than previously believed; it just turns out that coronary heart disease is more complicated. “As our knowledge and understanding of coronary heart disease increases, we realize that there’s a lot more to this story than just cholesterol,” says Riska Platt, MS, RD, a registered dietitian and AHA spokesperson.

Lowering cholesterol
Step 1: Steer clear of hydrogenated fats and trans-fatty acids
The AHA traditionally has regarded saturated fats as the major cause of high cholesterol and heart disease from atherosclerosis (hardening of the arteries). These fats are found in meat, whole-milk dairy products, and tropical oils such as coconut oil and cocoa butter.

However, an emerging body of research indicates that saturated fats are not always the serious offenders they were once thought to be (Journal of Clinical Epidemiology, 1998, vol. 51, no. 6). One recent study found no association between saturated fat intake and stroke (British Medical Journal, 2003, vol. 327, no. 7418). Another conducted in postmenopausal women found that carbohydrate intake was associated with a much greater progression of atherosclerosis than saturated fat intake (American Journal of Clinical Nutrition, 2004, vol. 80, no. 5).

Not all saturated fats are the same; some have neutral or even mildly beneficial effects on cholesterol. Studies have shown that stearic acid, a saturated fat found in meat and dairy products, can lower LDL cholesterol in some individuals. Lauric acid, another saturated fat found in tropical oils, dairy products, and human breast milk, has even been shown to raise HDL cholesterol. Certain populations with diets rich in coconut oil, in fact, have shown very low incidences of heart disease.

In contrast, many studies point to the hydrogenated fats and trans-fatty acids (found in margarine, shortening, and prepared foods like baked goods) as the real culprits behind unhealthy cholesterol elevations, cardiovascular disease, and stroke. Often these foods are labeled “no cholesterol,” meaning they contain no dietary cholesterol. But don’t be fooled—some of the fats they do contain are worse for you than foods containing cholesterol.

Thankfully, it’s now easy to find alternatives to fatty foods, such as low-fat and skim dairy products, soy products, and olive oil. Small amounts of fatty foods are fine, but most Americans eat way too much, says Platt. “The AHA suggests that you have only 5 to 7 ounces of animal protein a day—the equivalent [in size] of two decks of cards. That’s really shocking to a lot of people,” she says.

Drinking 1 cup of antioxidant-rich cranberry juice a day can help raise good cholesterol levels, according to recent studies.

Step 2: Focus on veggies, fruit, and fish
Instead of thinking about what you can’t eat, it’s generally more successful to focus on what you can eat—delicious foods that will also help lower cholesterol. These include at least five servings of fruits and vegetables and six or more servings of whole-grain cereals, breads, and pastas. These foods not only lack saturated fat; they have fiber, which helps lower cholesterol. According to the AHA, some kinds of soluble fiber, such as pectin and oat bran, may reduce LDL cholesterol levels. Drinking at least 1 cup of antioxidant-rich cranberry juice a day can help raise good cholesterol levels, according to recent studies. Plants also contain sterols and stanols, which help block the body’s absorption of cholesterol.

Tuna, salmon, sardines, and other fish also are good choices because they are rich in omega-3 fatty acids. Research has shown that omega-3 fatty acids decrease both triglyceride levels and the risk of heart arrhythmias and reduce cholesterol buildup. An easy way to increase intake of both fiber and omega-3 fatty acids is to sprinkle ground flaxseed on foods such as cereal and salads.

Step 3: Say no to (most) take-out
It’s hard to eat low-cholesterol meals when someone else is cooking. “You can make pizza at home with fat-free or low-fat cheese, but when you go to the pizza parlor, it’s gonna be the full-fat deal,” says Platt. It’s best to avoid eating out and consuming preprepared meals as much as possible. This might sound difficult for time-strapped men, but the AHA website lists numerous easy, heart-healthy recipes (see “Heart-Smart Resource”).

When you do go out to eat, don’t be afraid to ask your server for heart-healthy menu suggestions. Chefs are often willing to prepare cooked-to-order specialties with low-cholesterol alternatives, such as olive oil and fat-free dairy products.

Step 4: Stock up on supplements
Along with eating a variety of healthier foods, many experts also recommend taking dietary supplements. Several supplements are associated with lowering cholesterol levels or reducing heart disease risk, including vitamin E, fish oil, red yeast rice, policosanol, beta-sitosterol, and niacin (see “Heart-Healthy Supplements”).

If you take cholesterol-lowering prescription medications, it’s sometimes wise to take supplements, too. For example, statin drugs are used to reduce cholesterol, but they also reduce the body’s production of an important substance called coenzyme Q10, and so many people replenish it with supplements.

Heart-smart resource
American Heart Association
www.americanheart.org
A veritable one-stop shop for issues relating to cholesterol and coronary heart disease, the AHA’s comprehensive website includes detailed information about cholesterol, cholesterol-lowering tips for busy professionals, exercise routines, and heart-healthy, quick recipes.

Step 5: Get active!
Not only does regular exercise keep your heart in shape, it’s been shown to help lower the level of harmful cholesterol in your blood. “Increasing your heart rate to higher than 120 beats per minute for 15 minutes at least three times a week has been shown to increase HDL levels,” says Joshua Levitt, ND, vice president of Natural Health Associates in Hamden, Connecticut. Although it’s best to regularly work out at the gym or participate in a favorite sport, even a small amount of regular physical activity can really make a difference. “Exercise is not something that needs to be expensive; it’s not something that needs to be time-consuming. In fact, it can be something that can just be a part of a person’s normal daily life, especially if they rely on their feet to get somewhere,” says Levitt.

Simple exercise solutions abound. Take ten-minute walks at lunch or after work. Always choose the most remote spot when parking in a lot. Instead of riding the elevator, climb the stairs. Lift weights or march in place while you watch television. “Get a pedometer to count your steps, and see if you can increase that number,” says Platt. “Every little bit really adds up.”

My own experience has shown that making dietary and lifestyle changes can help prevent coronary heart disease. By watching my diet and exercising regularly, I have been able to get my cholesterol levels back in check. Now that’s what I call a heart-warming ending.

Joel Warner is an editor and freelance writer living in Boulder, Colorado. Despite living in a land-locked state, he tries to eat as much omega-3 fatty acid–rich fish as possible.