Fact or fiction: What do you really know about cholesterol?

If you’re confused about cholesterol, you’re not alone. New cholesterol guidelines from heart health experts have recently changed the way doctors manage cholesterol. Now’s a great time to catch up — and separate fact from fiction.

Myth #1: Your cholesterol level determines whether you should take cholesterol medication.

FACT: Your overall heart health risk determines whether you should take cholesterol medication.

If this myth sounds familiar, it’s because that was the old-school way of managing cholesterol. Before, if your cholesterol was high, your doctor would prescribe a medication to lower it and then check your blood regularly to make sure that your LDL (“bad”) cholesterol stayed under a certain target level.

What’s wrong with that? This approach led patients and health care providers alike to over-focus on cholesterol targets that were actually pretty arbitrary. We don’t really know how much different LDL-cholesterol levels change your risk of heart attack and stroke (i.e. your cardiovascular risk) — and after all, that’s what we really care about, not blood test results.

Your cholesterol is just one indicator of your risk among many. Other cardiovascular risk factors include:

• Smoking cigarettes

• Getting older

• High blood pressure

• Diabetes

• History of heart disease, heart attack, or stroke

• Family history of early heart attack or stroke

If you do start taking a statin, many doctors will no longer monitor your cholesterol level to make sure it's come down. Taking the medicine protects your heart no matter what it does to your blood test results.

Myth #2: Statin cholesterol medications lower the likelihood of heart attack, stroke and death for anyone who takes them.

FACT: The higher your cardiovascular risk, the more you’ll benefit from taking a statin. For people with good heart health, the side effects of statins usually outweigh the benefits.

Statin medications lower the likelihood of heart attack, stroke and death for people with high cardiovascular risk, regardless of their cholesterol levels.

Given the side effects of statins, such as muscle pain (more common) and a higher risk of diabetes and liver damage (less common), many doctors now recommend cholesterol-lowering medication only for people who benefit from it the most, for whom the benefits outweigh the harms.

If you’re someone who has low cardiovascular risk, statins won’t do you much good; they won’t significantly reduce your already-low risk of heart attack and stroke — even if they bring your “high” cholesterol level down to normal range. On the other hand, you might have “good numbers” when you get your cholesterol checked, but if you’re high risk for other reasons (see the list above), taking a statin could literally be a lifesaver. If you’re moderate risk, you should weigh the pros and cons of statin medications with your primary care provider and make a decision together about what’s right for you.

Myth #3: A heart-healthy diet means eating less fat.

FACT:  Eating healthy fat is better for your heart than eating less fat.

A heart-healthy diet means eating real food and less processed, packaged, and fast food.

What does “real” mean? It’s eating food that’s close to its original form, whether that’s spinach sautéed in olive oil or a green apple with natural peanut butter. A good rule of thumb is to shop the perimeter of the grocery store, where you find fresh fruits, veggies, dairy and meats. The inner aisles are more likely to have packaged, processed foods with fewer nutrients your body needs (like fiber), and more of what you don’t need (like added sugar). And when it comes to fat, it turns out that the kinds of fats in your diet are much more important than the amount.

Here’s how to eat a heart-healthy diet with real food:

• Fruits and vegetables should take up half of your plate at every single meal.

• Eat whole grains like brown rice and quinoa.

• Avoid added sugar. It’s bad for your heart, whether it’s called high fructose corn syrup, organic evaporated cane juice, or agave nectar.

• Eat healthy fats. Olive oil, fatty fish, nuts, and seeds are good for your heart. Grass-fed meats are good, too, because they're high in omega-3s. Avoid hydrogenated fat, which comes in most packaged and fast food.

To go along with your nutritious diet, make sure to get 20 to 30 minutes of moderate-to-intense aerobic exercise three times a week to keep your heart in good shape. If you smoke, quitting is one of the best things you can do for your heart. (Check out the Quit Guide from the Centers for Disease Control.)

Curious About Your Cardiovascular Risk?

Try out the new 10-year risk calculator for ASCVD (atherosclerotic cardiovascular disease). It tells you the percent likelihood that you’ll have a heart attack or stroke in the next 10 years. Play with the variables and see which lifestyle changes (like quitting smoking or lowering your blood pressure) could change your risk the most, and talk to your doctor at your next check-up.

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A version of this article was originally published on the One Medical Blog.