Cholesterol isn’t a sexy dinner topic, but in the midst of what-to-order dilemmas–shrimp scampi drowning in butter or grilled wild salmon?—it can pop up. Would one little splurge hurt? And what about that study, published a few years ago but still getting traction, finding people over 60 with high “bad” (LDL) cholesterol live as long as those with low LDL cholesterol?

That study has been loudly and roundly debunked, including this British Heart Foundation report citing overwhelming evidence that lowering LDL cholesterol reduces death from heart attacks and strokes and other causes.  Since then, however, some other research has found, for instance, that higher LDL levels weren’t linked with heart disease, but only in a group of people 75 and over who were entirely free of heart disease before the 5-year follow up. Independent experts, taking note of the research, call for more research.

What now?

Paying attention to your blood cholesterol levels is definitely important for older adults, says Seth Martin, MD MHS, a professor of medicine, cardiologist and lipid specialist at John Hopkins School of Medicine, Baltimore, who talked with us about all things cholesterol.

Cholesterol Facts

Here is what he and other experts say to know and do:

• Know your numbers. If you don’t, it’s time for a blood test to evaluate your cholesterol levels. How often? According to the CDC, most healthy adults should get their cholesterol checked every 4 to 6 years, but a history of heart disease or family history of high cholesterol or other factors could narrow that interval greatly. Best answer to how often? Ask your doctor. To fast or not? Ask your doctor.
• Know there is no one-size-fits-all approach for managing cholesterol in older adults. In general, total cholesterol under 200 mg/dl is viewed as heart healthy, as well as an LDL (bad cholesterol) under 100 and an HDL (good cholesterol) of 60 or higher. However, your doctor may suggest much lower LDL and total levels, especially if you have diabetes or if you have had a heart attack. It’s spelled out in the guidelines from the American Heart Association and other organizations.
• Big picture: Beyond the recommended levels, Martin says, “it’s important to put the numbers in the context of your overall health.” That means looking at whether a person has diabetes, pre-diabetes, a family or personal history of heart disease or stroke, or a higher risk due to ethnicity. Your doctor will calculate your so-called risk profile-what are your chances of a heart attack in the coming years?
• Other tests: Depending on how your cholesterol numbers turn out, Martin says, your doctor may also evaluate lipoprotein A, a type of LDL, or measure calcification in your coronary arteries.

Finally, your doctor will consider all the information in context and tailor a treatment plan for you. Paying attention to your cholesterol levels and getting it within recommended bounds ‘’could end up being a really important factor for your overall quality of life, how long you live and how long you live a healthy life free of cardiovascular disease,” Martin says.

He encourages patients by saying that getting control of cholesterol is within their power, with effort. He sometimes explains why it’s important this way: There is a relation between high cholesterol levels and inflammation. “When an LDL particle enters into the arterial wall, that triggers a cascade of inflammation,” and ultimately that results in plaque buildup and disease.

Lowering Cholesterol

Improving your diet may lower cholesterol, and a step many patients ask to take in an effort to avoid statins. Here, what the American Heart Association says about cholesterol from your diet and heart disease risk. However, a dedicated effort on cleaning up the diet is usually needed. Martin encourages improvement of the diet, but warns patients that it may not be enough to lower cholesterol enough. Genetics play a role in cholesterol, he says, so he tells patients not to feel like a failure if diet changes don’t solve the problem entirely. For those who want to focus on diet first, Martin recommends a plan known as the DASH diet or a similar program. He tells patients to reduce saturated fat; instead, choose fats like olive oil, which may result in better cholesterol levels.

If diet and other lifestyle aren’t enough, statins can lower cholesterol. If you start a statin, your doctor needs to consider what other medications you are on, as many can interact with statins. That caveat is especially true for patients over age 75, Martin says.  The Mayo Clinic has a partial list of which drugs to watch out for, plus a rundown of side effects that might be due to the statins.

Need more cholesterol-lowering motivation?  Mayo Clinic has the top 5 lifestyle changes to improve cholesterol. A one-hour consult with a dietitian could help, too, Martin says.  The Academy of Nutrition and Dietetics has a nationwide directory, or you could ask your primary care doctor or cardiologist to refer you.

Your turn

Do you pay more or less attention now to cholesterol than in your younger years, and why? Did you get your LDL to plummet  with genius diet tweaks? Let us know in the comments!

Kathleen Doheny is a Los Angeles-based independent journalist, specializing in health, behavior, fitness and lifestyle stories. Besides writing for Senior Planet, she reports for WebMD, Medscape, Psycom.net,  Practical Pain Management, and other sites.  She is a mom, mother-in-law and proud and happy Mimi who likes to hike, jog and shop.

Doheny photo: Shaun Newton

This article offered by Senior Planet and Older Adults Technology Services is for informational purposes only and is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding any medical condition. If you think you may have a medical emergency call 911 immediately.