Did you know that as many as 99.5 million American adults have high cholesterol numbers? Drug therapy combined with lifestyle changes helps people with very high cholesterol reduce heart attacks by 34 percent and cardiac deaths by more than 40 percent. The following information can help you lower your numbers.

Checklist for making lifestyle changes

• Ask your physician or healthcare professional to help you with nutrition and physical activity advice.
• Learn to read food labels so you'll be able to tell how much fat, sodium and other ingredients are in your diet.
• Keep a diary of all your nutrition and physical activity efforts. When you get to see your successes written down, it will encourage you to continue with your good habits.
• If you don't feel like you are making progress, talk to your physician and ask why your progress is slow.
• If you are having trouble giving up smoking, ask your physician if you would be able to take a smoking cessation drug to help.
• Become an active participant in making treatment decisions and solving problems that keep you from following the doctor's orders.

Checklist for eating to lower your cholesterol

It's fairly easy to lower your blood cholesterol. Just eat more foods low in saturated fat and cholesterol and cut down on high-fat ones, especially those high in saturated fats. Here are some simple daily guidelines:

• Watch your caloric intake by eating a wide variety of foods low in saturated fat and cholesterol.
• Eat at least five servings of fruits and vegetables every day.
• Eat six or more servings of cereals, breads, pasta and other whole-grain products.
• Eat fish, poultry without skin and leaner cuts of meat instead of fatty ones.
• Eat nonfat or 1% milk dairy products rather than whole-milk dairy products.
• Enjoy 30–60 minutes of vigorous activities at least 3–4 days each week.
• Maintain a healthy weight.

Tips for Eating Out

You can eat out and eat healthy, too. Many restaurants offer delicious low-fat, low-cholesterol meals. Eating less fat (especially saturated fat) and cholesterol is important for your health. That's because a diet high in saturated fat raises blood cholesterol. High blood cholesterol is a major risk factor for heart attack and stroke.

A guide to choosing healthy meals away from home

• Fried, basted, braised, au gratin, crispy, escalloped, pan-fried, sautéed, stewed or stuffed foods are high in fat. Instead, look for steamed, broiled, baked, grilled, poached or roasted foods. If you’re not sure about a certain dish, ask your server how it’s prepared.
• Even if dishes low in saturated fat and cholesterol aren't on the menu, you may still be able to get a low-fat meal, because many restaurants will prepare foods to order. If you’re not sure about a particular restaurant, phone before you go.
• High-sodium foods include those that are pickled, in cocktail sauce, smoked, in broth or au jus, in a tomato base, or in soy or teriyaki sauce. Steer clear of these.

Cook's Tip

Cook's Tip on Leftover Fresh Herbs: Small amounts of fresh herbs, such as basil, oregano, cilantro, or a mixture, are the basis of easy herb cream cheese or herb margarine spread. Mix 2 tablespoons of chopped fresh herbs with 1 minced clove of garlic or 1/2 teaspoon bottled minced garlic and 8 ounces of nonfat or low-fat cream cheese or light margarine. Try a little herb cream cheese on a bagel or a dollop of herb margarine on a baked potato. You'll find lots of uses for these treats.

Nutrient Analysis
Calories: 126
Protein: 6 g
Carbohydrates: 20 g
Total fat: 2 g
Saturated: 1 g
Polyunsaturated: 0 g
Monounsaturated: 1 g
Cholesterol: 7 mg
Sodium: 220 mg

Checklist for taking medication

It's important when taking medications to follow your healthcare professional's recommendations carefully. When you don't take medicine exactly as prescribed, it can be harmful to you. Without knowing it, you could counteract one medicine by taking it with another. Not taken properly, medicine can make you feel sick or dizzy. Here are some checklists to help you take your medicines properly.

How can I remember to take my medicine?

• Take it at the same time every day.
• Take it along with meals or other daily events, like brushing your teeth.
• Use special pillboxes that help you keep track, like the day-of-the-week divided ones you find at any drugstore.
• Ask people who are close to you to help remind you.
• Keep a "medicine calendar" near your medicine and make a note every time you take your dose.
• Put a sticker or reminder note on your medicine cabinet or refrigerator. You can buy a small, magnetized white board with dry-erase markers and keep a list of your pills on the board. Each day, mark the board when you take your medication. It's an easy way to keep track, and at the end of the day, just erase the board and start over again in the morning.

Using medications properly

• Understand your medication. Know what it's for, and how and when you are supposed to take it.
• Make an instruction sheet for yourself by taping a sample of each pill you have to take on a sheet of paper and writing down all the information about that pill to remind you.
• Get some colored labels and stick them on your medicine bottles to simplify your routine. For example, blue can be for morning, red for afternoon and yellow for bedtime.
• Ask your pharmacist to help you come up with a coding system for your medications that makes them easier to take.
• Timer caps can be purchased for pill bottles that remind you of the proper time to take medication.
• Many types of pill containers can be purchased – there are even some that beep when it's time for you to take medication. Ask your pharmacist about these aids. If your medication routine is too complicated, ask your physician or pharmacist to help you simplify the process.
• If your medications are too expensive, ask your physician or pharmacist about finding financial assistance.
• If you are away from home a lot, make sure you carry enough of your medication with you to take the prescribed doses while you're out. Some pharmacists will prepare blister paks for daily or weekly medications.
• If you are using one of the commercial pill dispensers, set a regular time each week to refill it – for example every Friday night after you eat.
• If you have trouble understanding your physician or pharmacist, ask a friend or loved one to go with you and help you.
• If you don't feel like your medication is making a difference, talk to your physician and ask why.

Checklist for getting started on an exercise program

Less active, less fit people have a 30-50% greater risk for developing high blood pressure. Here are tips to help you get active!

• Wear comfortable clothes and sneakers or flat shoes with laces.
• Start slowly. Gradually build up to 30 minutes of activity, three to four times per week (or whatever your doctor recommends). If you don't have a full 30 minutes, try two 15-minute sessions to meet your goal.
• Exercise at the same time of day so it becomes a regular part of your lifestyle. For example, you might walk every Monday, Wednesday and Friday from noon to 12:30 p.m.
• Drink a cup of water before, during and after exercising (but check with the doctor, because some people need to limit their fluid intake).
• Ask family and friends to join you. You'll be more likely to stick with it.
• Note your activities on a calendar or in a logbook. Write down the distance or length of time of your activity and how you feel after each session. If you miss a day, plan a make-up day or add 10-15 minutes to your next session.
• Use variety to keep your interest up. Walk one day, swim the next time, and then go for a bike ride on the weekend.
• Join an exercise group, health club or YMCA. Many churches and senior centers offer exercise programs, too (Get your doctor's permission first).
• Look for chances to be more active during the day. Walk the mall before shopping, choose a flight of stairs over an escalator, or take 10–15 minute walking breaks while watching TV or sitting for some other activity.
• Don't get discouraged if you stop for a while. Get started again gradually and work up to your old pace.
• Don't engage in any activity that causes chest pain, shortness of breath, dizziness or light-headedness. If these happen, stop what you're doing right away.
• Don't exercise right after meals, when it's very hot or humid, or when you just don't feel up to it.

An Eating Plan for Healthy Americans

This eating plan from the American Heart Association is based on the latest advice of medical and nutrition experts. The best way to help lower your blood cholesterol level is to eat less saturated fat and cholesterol, control your weight and walk or do another physical activity for at least 30 minutes each day. Our plan is based on these dietary guidelines:

• Total calories should be adjusted to reach and maintain a healthy weight.
• Saturated fat intake should be 7 to 10 percent of calories (or even less).
• Polyunsaturated fat intake should be up to 10 percent of calories.
• Monounsaturated fat can make up to 15 percent of total calories.
• Total fat intake should be 30 percent or less of total calories.
• Cholesterol intake should be less than 300 milligrams per day.
• Sodium intake should be less than 2,400 milligrams per day, which is about 1-1/4 teaspoons of sodium chloride (salt).

This is an easy-to-follow guide to delicious eating. You don't have to calculate anything -- and you don't have to give up your favorite foods.

Know your fats

Knowing which fats raise LDL cholesterol and which ones don’t is the first step in lowering your risk of heart disease. Saturated fat, trans fatty acids and dietary cholesterol raise blood cholesterol. Monounsaturated fats and polyunsaturated fats don't. Some studies suggest they might even help lower LDL cholesterol slightly when eaten as part of a low-saturated-fat diet.

Saturated fats

Saturated fat is the main dietary cause of high blood cholesterol. The American Heart Association recommends that you limit your saturated fat intake to 7-10 percent of total calories (or less) each day. If you have coronary heart disease or an LDL cholesterol leve of 100mg/dL or greater, your doctor may recommend the Therapuetic Lifestyle Change Diet (TLC). It recommends 25-35 percent of calories from fat, with less than 7 percent coming from saturated fat. Cholesterol is limited to less than 200 milligrams a day. Saturated fat is found mostly in foods from animals and some plants.

Foods from animals -- These include beef, beef fat, veal, lamb, pork, lard, poultry fat, butter, cream, milk, cheeses and other dairy products made from whole milk. These foods also contain dietary cholesterol.

Foods from plants -- These include coconut oil, palm oil and palm kernel oil (often called tropical oils), and cocoa butter.

Hydrogenated fats

During food processing, fats may undergo a chemical process called hydrogenation. This is common in margarine and shortening. Recent studies suggest that these fats may raise blood cholesterol. Use hydrogenated fats only if they contain no more than two grams of saturated fat per tablespoon. The saturated fat content of most margarines and spreads is printed on the package or Nutrition Facts label.

Polyunsaturated and monounsaturated fats

Polyunsaturated and monounsaturated fats are the two unsaturated fats. They're often found in oils from plants.

Polyunsaturated fats -- These include safflower, sesame and sunflower seeds, corn and soybeans, many nuts and seeds, and their oils.

Monounsaturated fats -- These include canola, olive and peanut oils, and avocados.

Both polyunsaturated and monounsaturated fats may help lower your blood cholesterol level when you use them in place of saturated fats in your diet. But a moderate intake of all types of fat is best. Use polyunsaturated or monounsaturated oils -- and margarines and spreads made from them -- in limited amounts. This is better than using fats with a high saturated fat content, such as butter, lard or hydrogenated shortenings.

Trans fatty acids

Unsaturated fatty acids can be in one of two shapes-"cis" and "trans." These terms refer to the physical positioning of hydrogen atoms around the carbon chain. The cis form is more common than the trans form. Trans fatty acids (TFA) are found in small amounts in various animal products such as beef, pork, lamb and the butterfat present in butter and milk. TFA are also formed during the process of hydrogenation, making margarine, shortening, cooking oils and the foods made from them a major source of TFA in the American diet. Partially hydrogenated vegetable oils provide about three-fourths of the TFA in the U.S. diet.

To make foods that will stay fresh on the shelf or to get a solid fat product, such as margarine, food manufacturers hydrogenate polyunsaturated oils. Hydrogenate means to add hydrogen. When unsaturated fatty acids are hydrogenated, some of the hydrogen atoms are added on opposite sides of the molecule to the already attached hydrogen. Cis double bonds convert to trans double bonds, and the fatty acids become saturated.

How are trans fatty acids harmful?

In clinical studies, TFA or hydrogenated fats tend to raise total blood cholesterol levels but not as much as more saturated fatty acids. TFA also tend to raise LDL ("bad") cholesterol and lower HDL ("good") cholesterol when used instead of cis fatty acids or natural oils. These changes may increase the risk of heart disease.

Because there are no standard methods, it's difficult to estimate the TFA content of food items. It's also difficult to estimate intake, especially long-term intake. The four most important sources of TFA in one large group of women studied included margarine; beef, pork or lamb as the main dish; cookies (biscuits); and white bread.

Current U.S. regulations provide an incentive to manufacturers to produce foods high in TFA because food labels are not required to include the amount of TFA. Many scientists agree that the amount of TFA should be stated on food labels. Although changes in labeling are important, they are not enough. Many fast foods contain high levels of TFA. There are no labeling regulations for fast food and it can even be advertised as cholesterol-free and cooked in vegetable oil. When you take into account that eating one doughnut at breakfast (3.2 g of TFA) and a large order of french fries at lunch (6.8 g of TFA) add 10 g of TFA to one's diet, the lack of regulations for labeling these foods can be dangerous to your health.

Is butter better than margarine?

Recent studies on the potential cholesterol-raising effects of TFA have raised public concern about the use of margarine and whether other options, including butter, might be a better choice. Some stick margarines contribute more TFA than unhydrogenated oils or other fats.

Because butter is rich in both saturated fat and cholesterol, it's potentially a highly atherogenic food (a food that causes the arteries to be blocked). Most margarine is made from vegetable fat and provides no dietary cholesterol. The more liquid the margarine, i.e., tub or liquid forms, the less hydrogenated it is and the less TFA it contains.

What can I do to regulate my intake of trans fatty acids?

The American Heart Association's Nutrition Committee strongly advises that healthy Americans over age 2 limit their intake of saturated fat to 7-10 percent of total calories and their total fat intake to no more than 30 percent of total calories. If people limit their daily intake of fats and oils to about 5-8 teaspoons, they aren't likely to get an excess of TFA.