Frequently Asked Questions About Heart Health

Experts from NYU Langone’s Center for the Prevention of Cardiovascular Disease answer common questions about heart health and preventing heart attacks.

What is the link between cholesterol and heart disease?

Many years of scientific studies have shown a close relationship between cardiovascular disease and cholesterol levels. Your doctor may request a lipid profile—a test that shows the levels of LDL (bad cholesterol), HDL (good cholesterol), and triglycerides in your blood—to assess your risk for developing heart disease. 

If my body makes its own cholesterol, why does my diet matter? 

When we measure cholesterol levels in your blood, what we see is a combination of what your body makes and what you eat. Because you cannot control how much cholesterol your body produces, other than with medications, restricting saturated fat in your diet can have a major impact on lowering your cholesterol. 

Should I focus on lowering my dietary cholesterol or saturated fat? 

Limiting saturated and trans fats in your diet has the biggest impact on lowering your cholesterol. Restricting fatty meats, choosing low-fat or nonfat dairy products, and avoiding butter and margarine play a major role in helping to maintain healthy cholesterol levels. 

In addition, a diet high in fiber, particularly soluble fiber, can lower cholesterol levels significantly. Weight loss can also be an important part of your overall strategy to lower your cholesterol, including triglycerides, which should stay low, too.

If my cholesterol is less than 200mg/dl, should I worry about heart disease? 

Even though you have low total cholesterol levels you can still be at an increased risk for heart disease, especially if you have a family history of vascular disease that begins at an early age. 

Your risk also increases if you have metabolic syndrome, which is defined by having three or more of the following:

  • abdominal obesity, meaning your waist is more than 40 inches for males or 34 inches for females
  • blood pressure over 130/85
  • triglycerides over 150
  • HDL less than 50 in a woman or less than 40 in a man
  • high blood sugar levels 

Can taking fish oil capsules lower my cholesterol? 

No. Fish oil has the ability to lower triglycerides, but not LDL cholesterol. However, there may be other potentially protective effects from fish oil, such as making your blood less likely to clot. 

After you have a heart attack, is it too late to benefit from cholesterol-lowering drugs? 

No, it's never too late to benefit from cholesterol-lowering drugs. After you’ve had a heart attack, using cholesterol-lowering drugs such as statins may significantly lower your chances of having another heart attack. If you have not had a heart attack, but show early evidence of plaque in your arteries, a cholesterol-lowering drug may help prevent a heart attack or stroke. 

If I don't smoke and my cholesterol is within normal limits, what impact does my family history of heart attack have on my risk? 

Having a family history of a first-degree relative—your mother, father, or sibling—with a heart attack before age 55 for a man or 65 for a woman is a major risk factor for developing coronary artery disease. 

Keep in mind that low cholesterol levels may not be what they seem—low HDL, the “protective” cholesterol, may keep your overall levels down, but that isn’t beneficial. Other factors such as diet, exercise, and smoking are also of heavy importance to those with a family history of heart disease. 

If I am on a statin, should I worry about a high-fat diet? 

Yes. While statins lower your cholesterol and reduce your risk of a heart attack, studies have shown that the amount of saturated fat you eat correlates with the progression of plaque buildup in your arteries, which can cause a heart attack or stroke. There is also evidence that high fat levels in your blood after eating a meal high in saturated fat can interfere with some of the protective function of the cells that line your arteries.

Should I worry about possible liver damage from taking statin medications? 

The frequency of liver problems with statin therapy is actually quite low: less than one percent of people have to stop taking statins because they develop liver problems. Long-term trials have confirmed the safety of statins—the latest guidelines do not suggest a need to monitor patients who have normal liver function. In addition, in some cases where there is evidence of fat deposits in the liver, statin therapy may actually improve liver function tests.