By Amy Harris 

Cholesterol screening is a quick and affordable way to get a helpful “snapshot” look at cardiovascular health and make changes to prevent heart disease. Unfortunately, too few Mainers, including immigrants and refugees, access this critical, life-saving health screening. Barriers such as cost, lack of health insurance, or a lack of knowledge about preventive health measures stand in their way. 

What is cholesterol and why should I think about it? 

Cholesterol is a waxy lipid substance made by the liver that builds cell membranes in a human body, produces vitamin D, manufactures hormones, and helps with digestion. Eating animal-based foods like red meat, poultry, and dairy (milk, butter, cheese) adds additional cholesterol to the body – sometimes too much. This can lead to a serious disease and result in a heart attack or stroke.  

Cholesterol accumulates in the body, mixing with other substances to form thick, hard deposits inside the arteries. These are called plaque. The plaque narrows the arteries and reduces flexibility (called atherosclerosis). If a narrowed artery then gets blocked, such as by a blood clot, blood will not get where it needs to go, and this could cause a heart attack or stroke.  

Cholesterol tests estimate a person’s risk of developing too much plaque on the artery walls. This is important because people do not experience symptoms of high cholesterol levels and can’t know on their own if plaque is building up. They only develop coronary artery disease or other diseases when it is already too late to take preventative measures. But there are ways to treat high cholesterol and reduce risk before it is too late.  

Regularly checking cholesterol is a relatively easy and inexpensive way to screen for heart disease and prevent strokes and heart attacks caused by plaque build-up. Healthy cholesterol levels vary by age and gender. The U.S. Centers for Disease Control and Prevention (CDC) recommends that healthy adults have their cholesterol checked every four to six years. People with a family history of high cholesterol or other health conditions such as heart disease or diabetes should have more frequent cholesterol checks. Children and adolescents should have cholesterol screenings at least once between the ages of 9 and 11 and then again between ages 17 and 21. 

You can lower your LDL cholesterol and protect your heart health 

  • Eat a lower-cholesterol, high-fiber diet 
  • Get more exercise 
  • Take medication if recommended by a healthcare provider. 

What is a screening like? 

A blood test called a complete cholesterol test, lipid panel, or lipid profile measures high-density lipoproteins (HDL) known as “good cholesterol,” low-density lipoproteins (LDL) known as “bad cholesterol,” triglycerides, and total blood (or serum) cholesterol. For adults, total cholesterol should be lower than 200 milligrams/deciliter of blood, LDL should be below 100, HDL should be above 60, and triglycerides should be less than 150, according to the American Heart Association. Too much LDL cholesterol or not enough HDL cholesterol increases the risk for cardiovascular disease. 

The higher a person’s LDL levels (above 70 milligrams per deciliter if someone already has coronary artery disease), the higher their heart attack and stroke risk. In contrast, the higher a person’s HDL level, the lower their risk of heart disease. HDL transports cholesterol out of the bloodstream, keeping blood cholesterol levels low, and preventing sticky plaques from forming.  

Lifestyle changes, medication 

If high cholesterol is diagnosed, lifestyle changes might reduce heart attack or stroke risk. Following a heart-healthy diet, exercising more, and quitting tobacco are all ways to raise HDL levels. 

If making dietary changes, exercising more, and losing weight do not lower cholesterol levels to ideal ranges, healthcare providers may prescribe medication. The choice of medication or combination of medications depends on individual risk factors, including patient age, other health conditions, and possible drug side effects. Statins are one of the most commonly prescribed medications for high cholesterol. Supplementation with Omega-3 fatty acids can lower triglycerides. 

Food Tips: 

Eat more soluble fiber, which is found in foods like oats, kidney beans, and apples. These help absorb cholesterol from your bloodstream. 

Cut out all trans fat, which is in fast food, fried foods, and vegetable shortening. 

Eat more foods rich in omega-3 fatty acids, found in nuts, seeds, and oily fish like salmon. 

Immigration and cholesterol 

Immigrants and refugees are less likely to be screened for high cholesterol than people born in the U.S. Language and cultural differences, a lack of familiarity with preventive health care, and fear and distrust of the new healthcare system all limit access to cholesterol screening and treatment. Also, according to Jenifer Daigle, a nurse practitioner working at Greater Portland Health, when foreign-born Mainers arrive, there are often higher-priority, immediate health conditions to address. These could include trauma, uncontrolled diabetes, hypertension, or latent tuberculosis. Therefore, high cholesterol may not get addressed right away. 

Yet acculturation stress has been shown to increase the risk for cardiovascular disease, diabetes, and metabolic syndrome, Daigle speculated about a link between “limited access to nutritious food if they are living in a hotel or shelter” and these problems. Immigrants and refugees may also be less likely than others to receive treatment, especially if medication is needed, because they do not have health insurance. For people with health insurance, the Affordable Care Act requires insurance plans to pay for cholesterol screening tests. Medicare may also cover cholesterol testing at no cost. 

“The Maine CDC’s data collection has not focused specifically on immigrant, refugee, or migrant worker communities and their specific health needs,” said Lindsay Hammes, Communication Director at the Maine CDC. This means that how Maine’s immigrant and refugee communities measure up in terms of rates of high cholesterol, access to treatment, or risk for cardiovascular disease is not known. Over the next five years, the Maine CDC plans to coordinate outreach from its Office of Population Health Equity (OPHE), Diabetes Prevention and Control Program, and Cardiovascular Health Program to address this knowledge gap that may be perpetuating racial and socio-economic health disparities. Systemic barriers to accessing preventive health monitoring like cholesterol screening may be causing Maine’s rates of preventable deaths from heart disease and stroke to remain elevated.