HIGH CHOLESTEROL

About 25% of Americans ages 45 and older took a statin drug in the years 2005-08. That's up from just 2% in 1988-94. These numbers come from the National Center for Health Statistics.

There are roughly 127 million Americans over age 45. So that means there are almost 32 million statin users. That's equal to the entire populations of Florida and Georgia combined.

Are too many people taking a statin or not enough? Before we tackle that thorny question, here's the good news. Just over 13% of Americans have high total cholesterol levels. This is much better than the government's 17%. The results are based on a survey done in 2009 and 2010 by the U.S. Centers for Disease Control and Prevention (CDC).

The CDC defined high total cholesterol as 240 milligrams per deciliter (mg/dL) or greater.

The CDC did not find out why cholesterol levels continue to fall. It would be great to attribute this to healthier eating and more exercise. But the more likely reason is the huge increase in the number of people taking statins or other drugs to lower cholesterol.

Let's go back to the question of too much or too little statin use. People who would say "too much" believe that many of those who take statins for slightly high cholesterol are at low risk of heart disease and stroke. They therefore are not really getting any benefits.

The main reason for taking a statin is to reduce risk. Simply lowering a number does not make you feel better, have better health or live longer. So, this group says, why take a medicine that might have side effects?

Those in the "too little" camp say that what we call a normal cholesterol level is really much too high. They say a normal cholesterol level should be under 150 mg/dL. And they say high cholesterol is not just a number. Coronary artery disease, stroke and other blood vessel diseases are the No. 1 U.S. cause of death. Many people who develop these conditions have cholesterol levels well within the so-called normal range.

What Changes Can I Make Now?

You should be on a statin if you have:

Coronary artery disease
Chronic (long-term) kidney disease
A prior heart attack or stroke
Statin treatment also is usually needed if you have a high LDL cholesterol level and diabetes or other factors that increase your risk of heart attack or stroke. An extremely high LDL almost always requires a statin or other drug to lower cholesterol.

Otherwise, diet and exercise are the best treatment to try first.

Different foods lower cholesterol in various ways. Some deliver soluble fiber. This type of fiber binds cholesterol in the digestive system and drags it out of the body before it can get into circulation. Some foods give you polyunsaturated fats, which directly lower LDL. And some contain plant sterols and stanols. They help to block the body from absorbing cholesterol.

Here are 10 specific foods you can eat to lower your cholesterol level.

Oats -- Start your day with a bowl of oatmeal or a cold, oat-based cereal such as Cheerios for breakfast.
Barley and other whole grains -- Like oats and oat bran, barley and other whole grains can help lower the risk of heart disease. They do this mainly by supplying soluble fiber.
Beans are especially rich in soluble fiber. They also take a while for the body to digest. You feel full longer after a meal. That can help you lose weight.
Eggplant and okra -- These two low-calorie vegetables are good sources of soluble fiber.
Nuts -- Almonds, walnuts, peanuts and other nuts lower LDL. They have additional nutrients that protect the heart in other ways.
Vegetable oils -- Use liquid vegetable oils such as olive, canola, sunflower, safflower and others. Using these oils in place of butter, lard or shortening helps lower LDL.
Apples, grapes, strawberries and citrus fruits -- These fruits are rich in pectin, a type of soluble fiber that lowers LDL.
Foods fortified with sterols and stanols The foods include margarines and some others. Sterols and stanols extracted from plants gum up the body's ability to absorb cholesterol from food.
Soy -- Eating soybeans and foods made from them, such as tofu and soy milk, can lower LDL by 5% to 6%.
Fatty fish -- Eating fish two or three times a week can lower LDL in two ways. Fish replaces meat, which has LDL-boosting saturated fats. It also provides omega-3 fats that help to lower LDL.
While exercise won't lower LDL, it will raise your HDL (the good cholesterol). Even if these numbers don't change, exercise reduces your risk of heart attack and stroke later in life.