According to the American Heart Association, more than 100 million Americans suffer from borderline high to high cholesterol. Heart disease is the number one killer of men and women each year, accounting for 500,000 deaths annually.

With an aim toward prevention, we recently sat down with cardiologist Mason Weiss, M.D., F.A.C.C., to help Wellness Advisor readers fully understand what cholesterol is, tips on lowering high cholesterol, as well as how to better communicate with your doctor to get the most out of your medical appointments.

Dr. Weiss is a triple-boarded physician with certification in internal medicine, general cardiology, and interventional cardiology. He has practiced medicine for 23 years and is a physician partner with the highly regarded Apex Cardiology team of physicians in Los Angeles, California.

Wellness Advisor: Everyone talks about high cholesterol being bad. Can you please explain to readers what cholesterol is and why having high cholesterol is so bad?

Dr. Weiss: I like the way the American Heart Association describes it best - cholesterol is a soft, waxy substance found among the lipids (fats) in the bloodstream.

Our bodies use cholesterol to form cell membranes, some hormones and other tissues. Cholesterol is made in the liver. Actually, the liver produces all of the cholesterol we need to survive. The additional cholesterol we get is from our diet when we eat animal foods like meats, whole milk dairy foods, egg yolks, poultry, and fish. Plants don’t produce cholesterol.

Too much cholesterol is bad because it can cause damage to the inner linings of arteries when too much builds up. This is especially dangerous if there are other negative forces at work such as smoking and diabetes. These (smoking and diabetes) can cause a domino effect exacerbating trauma to the arterial wall. Once that happens, it can lead to further accumulation of cholesterol and plaque build-up and narrowing inside of the arteries, which may lead to a heart attack.

WA: What’s the difference between HDL and LDL cholesterol?

Dr. Weiss: Cholesterol can’t dissolve in the bloodstream so it depends on two things to carry it to where it needs to go. High-Density Lipoproteins (HDL) or the so-called ’good’ cholesterol, act as scavengers removing cholesterol from the body.

Low Density Lipoproteins (LDL) or ’bad’ cholesterol carries cholesterol throughout the body. Too much LDL in the blood causes cholesterol to build along arterial walls forming plaque that can block arteries.

When you have your cholesterol checked at the doctor’s office, they are looking at these (HDL and LDL) levels as well as your triglyceride levels. Triglycerides are a type of fat found in food and our bodies produce it naturally. People with high triglycerides tend to have high cholesterol levels.

WA: Do you think dietary supplements that contain plant sterols and stanols can help lower cholesterol?

Dr. Weiss: Yes. We have patients who have concerns about taking prescription medications to lower cholesterol because of side effects, and some patients who aren’t candidates for those medications but suffer from borderline high to high cholesterol and need help. For those who fit into these categories, dietary supplements that contain plant sterols and stanols coupled with a healthy diet can help lower cholesterol levels.

For high risk populations – those with high cholesterol, those who have a hereditary condition causing high cholesterol, those who have suffered heart attacks or had by-pass surgery - these individuals need more aggressive approaches such as prescription medications to lower cholesterol and various other therapies to treat their disease.

The most important thing to remember is not to self-medicate. Be sure to talk to your doctor even before taking a supplement containing plant sterols and stanols to make sure it is right for your cholesterol lowering needs.

WA: How do plant sterols and stanols work to lower cholesterol?

Dr. Weiss: Plant sterols and stanols (they are also called phytosterols and phytostanols) are lipid (fat)-like compounds found in some plants, fruits, and vegetables that have been studied since the ‘50s and proven for their cholesterol lowering benefits.

Plant sterols and stanols look like cholesterol. So, they work by connecting to cholesterol in the intestines and prevent it from being absorbed. This results in lowering the LDL ’bad’ cholesterol.

Unfortunately, we simply don’t get enough plant sterols and stanols in our daily diets to make an impact on our cholesterol levels - studies have shown that we would have to eat 1-2 grams of plant sterols and stanols a day – that is a lot. That’s why a supplement containing plant sterols and stanols is so terrific.

WA: Beyond supplements containing plant sterols and stanols, are there other supplements do you think may support heart health?

Dr. Weiss: Since diet plays a major role in heart health, it’s important to eat foods rich in antioxidants and folic acid, such as dark green leafy vegetables and whole grains. But it isn’t always easy to eat the recommended servings of these heart-healthy foods on a daily basis. You may want to consider supplementing your diet with certain vitamins. Many studies have been performed on supplements such as Vitamin E and B-complex vitamins demonstrating their benefit in helping support heart health. Many people also believe garlic can play an important role in lowering cholesterol. I think it is important to discuss your options in terms of supplementation and lifestyle changes with a physician who understands these benefits to determine what is right for you.

WA: How do we make the most of our visit with our doctor? Do you have any tips for readers?

Dr. Weiss: Remember that we are here to provide a service to you so it is important that you feel comfortable and can communicate honestly and openly with your doctor.

To that end, patients should take some time to think about the types of questions they want to ask their doctor before they come in for an appointment. Write those questions down and bring them with you – otherwise chances are you will forget something during the visit.

Also, bring a pad and pen with you to take notes and write down any additional questions you might have. Knowing your family history with regard to heart disease and any other disease factors is very important to share with your doctor. In addition, be sure to share what’s happening in your life - any stress or changes at work and home – these factors can influence your health and it is important for us to have a full picture.

It is also very important to make us aware of all medications and supplements you are taking – there may be a side effect you were unaware of some additional information that may be of benefit to you that we can provide.

For a patient concerned specifically about heart health, having a basic understanding of cholesterol – LDL, HDL, and triglycerides - will allow them to have a better grasp of what their test results mean so we can have a comprehensive discussion. There are a number of good resources online for this type of information including this site - www.naturemade.com, and the American Heart Association’s web site at www.americanheart.org.