Dr. Agatston also suggests that all women request more detailed blood tests that measure not only the level of cholesterol but its type and size—factors that he says affect the heart in ways that scientists are only now beginning to understand. Talk to your doctor about a standard lipid profile. A blood test can also detect the presence of C-reactive protein in the bloodstream, which may contribute to plaque formation.
More prevalent in people who are overweight, sedentary, hypertensive, or smokers, C-reactive protein's presence accurately predicts the likelihood of heart attacks in women with relatively low cholesterol, and researchers speculate that it could signal heart disease before symptoms develop. Ask your doctor to check your numbers next time you get blood work done.
Step 2: Sorry, you're gonna have to do a little math.
The connection between cholesterol—a waxy substance made in your liver and found in blood cells—and heart disease has been known for decades, but your total cholesterol number is only part of the equation. The real key is how much of it is low-density lipoprotein (LDL), the so-called "bad cholesterol," and how much is high-density lipoprotein (HDL), the "good" kind.
LDL cholesterol can build up in your arterial walls, causing plaque, which can rupture in the arteries and result in blood clots and possibly heart attacks. A recent study from the University of Texas Southwestern Medical Center indicates that keeping LDL levels low (the longer the better) can protect even people with other risk factors like smoking. Meanwhile, HDL plays the role of crime-fighting superhero to LDL's nasty villain, transporting the bad stuff through the blood to the liver, where it's metabolized and then eliminated.
A Mayo Clinic newsletter article last August indicated that increasing HDL by even 1 milligram per deciliter (mg/dL) can reduce heart attack risk by 3 percent. "Basically, you want more of the good stuff, less of the bad stuff," says WH advisor Sharonne Hayes, M.D., director of the Mayo Clinic Women's Heart Clinic.
For most women, total cholesterol should be under 200, with LDL levels no higher than 100 and HDL no lower than 50. If your numbers are in line, doctors recommend retesting your blood every 5 years in your 20s and 30s.
Step 3: Don't be afraid to do drugs.
If blood tests show your cholesterol is high, a change in diet and exercise might help (see Step 5 for some suggestions). But in many cases, it's too late or your numbers are too high for these basic steps to help. That's when your doctor may give you a cholesterol-lowering medication, known as a statin, which keeps the liver from producing too much cholesterol. Some doctors have questioned the wisdom of prescribing these drugs, especially for patients who might lower their cholesterol through lifestyle changes.
But recent studies show that statins can diminish LDL by as much as 40 percent, slightly raise the level of HDL, and reduce the risk of heart attacks by about 35 percent. This is why many experts say these medications are actually under-prescribed. "Statins are incredible tools in lowering cholesterol and can keep many people from suffering heart attacks," Dr. Agatston says. "But there's no question: They're meant to work together with proper diet and exercise." Women taking statins may experience muscle fatigue as a side effect, though, and should get regular blood tests to check liver function.
Step 4: Ask yourself, "What kind of fruit am I?"
Carrying extra weight around isn't just a drag during swimsuit season. It can also be dangerous, especially if those excess pounds find their way to your belly and not, say, your hips. Recent studies indicate that abdominal fat is metabolically different from the other fat in your body: As you gain padding around your middle, the individual cells swell, and their size is linked to higher triglyceride levels and lower good cholesterol.
The best treatment for belly fat? Signing up for Weight Watchers isn't enough; you're going to have to pry yourself off the couch too. New research from Wake Forest University Baptist Medical Center shows that diet and exercise together reduce the size of abdominal fat cells, which doesn't happen if you lose weight through dieting alone. Working out regularly also has a ripple effect on the body: Not only do dangerous pounds come off, but your muscles become more efficient at using blood; your heart gets stronger; and your blood vessels become more limber, so blood flows more easily. "A lot of things don't make you feel better in the short term," Dr. Hayes says. "Exercise is the one thing that does."
And you don't have to run a marathon every week to get these benefits. Cardiologists recommend an average of 30 minutes of moderate aerobic exercise a day, which has been shown to increase life expectancy by 3 ? years. Whether walking, running, or swimming, you should aim to work your heart to about 50 to 70 percent of its maximum rate. Even this amount of exercise is powerful enough to combat other high-risk factors: A study out of the Cooper Institute in Dallas found that even moderately fit people had half the death rates of those who were sedentary.