What is cholesterol?
Cholesterol is a waxy, fat-like substance that is found in all cells of the body. Your body needs some cholesterol to make hormones, vitamin D, and substances that help you digest foods. There are two types of cholesterol:
- LDL cholesterol: Also called “bad” cholesterol, high levels of LDL cholesterol can increase your risk for heart disease and stroke.
- HDL cholesterol: Also called “good” cholesterol, high levels of HDL cholesterol can lower your risk for heart disease and stroke.
As you get older, your cholesterol levels may start to rise. Elevated cholesterol is a risk factor for developing heart disease and stroke. This article will discuss ways older adults can improve cholesterol levels.
Why do cholesterol levels rise with age?
There are several reasons why cholesterol levels tend to increase as you get older:
- Your liver becomes less efficient at removing LDL cholesterol from the bloodstream.
- HDL cholesterol levels decrease with age.
- Weight gain and decreased physical activity lead to higher LDL and lower HDL cholesterol levels.
- Genetics and family history can play a role.
Some older adults may have familial hypercholesterolemia, an inherited form of high cholesterol. For these individuals, elevated cholesterol is present from birth and worsens with age.
When are high cholesterol levels a concern?
The National Heart, Lung, and Blood Institute provides the following cholesterol level guidelines for adults:
| Category | LDL Cholesterol Level |
|---|---|
| Normal | Less than 100 mg/dL |
| Borderline high | 130-159 mg/dL |
| High | 160-189 mg/dL |
| Very high | 190 mg/dL and above |
For HDL (“good”) cholesterol, levels of 60 mg/dL and above are considered beneficial. HDL levels below 40 mg/dL for men and 50 mg/dL for women are considered risky.
If your total cholesterol level is above 200 mg/dL or your LDL level is above 100 mg/dL, your doctor will likely recommend lifestyle changes and possibly cholesterol-lowering medications. Reducing high cholesterol can significantly lower your risk for heart disease and stroke.
How often should older adults get cholesterol levels checked?
The National Committee for Quality Assurance recommends the following cholesterol screening schedule:
- Men aged 35 and older should get screened every 5 years.
- Women aged 45 and older should get screened every 5 years.
- Screening should begin at age 20 for those with increased risk for coronary heart disease.
Some medical groups, like the American Heart Association, recommend more frequent lipid panel screening in older adults, such as annually. Those with high cholesterol, obesity, diabetes, or high blood pressure may need cholesterol testing two to four times per year. Talk to your doctor about the right cholesterol screening schedule for you.
What lifestyle changes can help lower cholesterol in older adults?
Follow a heart-healthy diet
Changing your diet is one of the most effective ways to lower high LDL cholesterol. Try to limit foods that are high in saturated fats, trans fats, and cholesterol. Here are some tips:
- Choose lean protein sources like fish, skinless poultry, beans, and lentils.
- Swap animal-based fats for plant-based fats like olive oil, avocados, and nuts.
- Increase fiber intake by eating plenty of vegetables, fruits, and whole grains.
- Limit processed meats, full-fat dairy, fried foods, pastries, and other sources of saturated fat.
If adopting a vegan or Mediterranean-style diet does not lower cholesterol sufficiently, reducing dietary cholesterol may also help. Limit egg yolks to two per week and minimize organ meats, shrimp, and fatty meats.
Increase physical activity
Regular physical activity can help raise HDL cholesterol while lowering LDL levels. Aim for 150 minutes of moderate exercise per week, which equals 30 minutes a day for 5 days. Brisk walking, swimming, cycling, aerobics, and gardening are great cholesterol-lowering options.
Start slowly if you have not exercised in a long time. Even light activities like taking the stairs instead of the elevator can make a difference. But check with your doctor before significantly increasing your activity levels.
Lose excess weight
Carrying extra weight, especially around the abdomen, increases the risk for high cholesterol. Losing even 10-20 pounds can help improve cholesterol numbers. Work diet and exercise into your daily routine to shed excess weight in a healthy manner.
Quit smoking
Smoking damages blood vessels while also decreasing HDL cholesterol. Kicking the habit can quickly boost HDL levels and support heart health. Seek support from your doctor, family, and friends to quit smoking.
Limit alcohol
Drinking too much alcohol can increase blood pressure and triglycerides, a type of fat found in the blood. Men should limit alcohol to one or two drinks per day, while women should stick to one drink a day to avoid elevating cholesterol levels.
When are cholesterol medications appropriate for older adults?
If lifestyle changes do not lower cholesterol sufficiently after about 3-6 months, cholesterol-lowering medications may be needed. Statins are the first-line medications prescribed to reduce LDL cholesterol.
Statins that may be used include atorvastatin (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor). These drugs decrease cholesterol synthesis in the liver. Statins have been shown to significantly reduce the risk of heart attack and stroke.
Some older individuals are unable to tolerate high-intensity statin therapy due to side effects like muscle pain. In these cases, lower-intensity statin therapy may be prescribed instead.
Other cholesterol drugs like bile acid sequestrants, cholesterol absorption inhibitors, fibrates, and niacin may be added if statins are not enough. But these can also cause side effects in older adults.
Doctors will carefully weigh the risks and benefits before prescribing cholesterol medications, especially in older patients. Always talk to your doctor about medication options and make sure to take cholesterol drugs exactly as instructed.
Are natural remedies effective for lowering cholesterol in older adults?
Some natural supplements may help improve cholesterol levels, usually in conjunction with other lifestyle measures:
- Soluble fiber – 10-25 grams per day of soluble fiber from foods like oats, barley, and psyllium may reduce LDL cholesterol.
- Plant stanols/sterols – Consuming 2 grams per day of these compounds found in some margarines, orange juice, and supplements can decrease LDL cholesterol by 10-15%.
- Garlic – 900-1,200 mg per day of garlic supplements may lightly reduce LDL cholesterol while raising HDL cholesterol.
- Soy protein – 25 grams per day of soy protein from foods like edamame, tofu, and soy milk may help lower LDL cholesterol.
Clinical evidence is still limited on the efficacy of popular supplements like red yeast rice, niacin, and fish oil. Consult your doctor before trying natural products to ensure safety and efficacy.
How else can older adults reduce the risk of heart disease and stroke?
In addition to lowering cholesterol, older adults should take the following preventive measures:
- Control blood pressure – Keep levels below 130/80 mm Hg, or below 140/90 mm Hg for those over age 60.
- Prevent or manage diabetes – Maintain hemoglobin A1c levels below 7%.
- Take a daily low-dose aspirin if recommended by your doctor.
- Reduce stress through meditation, yoga, or other relaxation techniques.
- Get 7-8 hours of quality sleep per night.
- Stay socially engaged and maintain a positive outlook.
Making heart-healthy lifestyle choices and managing medical conditions are the best ways to prevent heart disease and stroke as you get older. Work closely with your healthcare provider to reduce your personal risk factors.
Conclusion
Cholesterol levels tend to rise with age, increasing the risk for cardiovascular disease. However, there are many effective ways older adults can improve their cholesterol profile. Eating a healthy diet, exercising regularly, maintaining a healthy weight, not smoking, and limiting alcohol are all cholester0l-lowering lifestyle measures. If levels remain high, cholesterol-lowering medications like statins may be prescribed. Natural supplements can also help in some cases. Along with controlling other risk factors, lowering cholesterol can help promote heart health in the senior population. Work with your doctor to develop the most effective cholesterol management plan for you.
