September is National Cholesterol Education Month, and physicians agree that understanding what cholesterol really is and why we should pay attention it to are important steps toward a heart-healthy life.

Cholesterol is not inherently bad. “It’s in the membranes of every one of our cells, and it’s used to make hormones in our body, in digestive enzymes for digesting food, and for vitamin D metabolism,” says Dr. Glenn Davison, a cardiologist with Cardiac Specialists of St. Luke’s Hospital. He likens cholesterol to pulp in an orange. Lipoprotein is the orange—the substance that carries the cholesterol through the body—and it comes in two varieties: high-density (HDL) and low-density (LDL).

“The low-density lipoprotein accumulates in artery walls and causes blockages,” Davison explains. Although blockages can form anywhere in the body, they are most dangerous when they occur in the heart and brain, potentially causing heart attack or stroke.

On the other hand, HDL is known as ‘good cholesterol.’ “It participates in what’s called ‘reverse cholesterol transport,’ ” he says. It carries cholesterol like a little dump truck away from blockages and back into the liver, where it is processed and cleared from the body. “The higher the HDL, the more protective it is,” he adds.

Striving for a balance of low LDL and high HDL is the goal. Both lifestyle choices and genetics play a part in the cholesterol equation. Limiting dietary cholesterol, saturated fat and trans-fat while focusing on fruits, vegetables, whole grains and lean protein will help decrease LDL, while exercise increases HDL.

However, genetic factors also affect cholesterol production. Some people are prone to unhealthy levels of LDL and have trouble reducing them adequately with lifestyle changes alone. Many of these individuals are among the millions of Americans who take statins, prescription drugs that interfere with cholesterol production.

“We use statins a lot because they’ve been shown in research to prevent heart attacks and reduce mortality among people who have diabetes and heart disease,” says Dr. Ben Voss with Associated Internists and on staff at Missouri Baptist Medical Center.

“There are a lot of people who are at risk for heart disease within the next 10 years who should be on a statin,” he says. “There’s been plenty of research that shows that in healthy people, statins also decrease risk of heart attacks and slight evidence that shows decreased risk of death in older people with no heart disease. But once people have heart disease and diabetes, it becomes essentially a no-brainer. You really want them to be on a statin because the evidence is so strong that statins prevent recurrent heart attacks.”

Being on a statin does not excuse someone from following a heart-healthy lifestyle. Diet, exercise and stress management remain important prescriptions. And Voss reminds patients that cholesterol is only one risk factor. Controlling blood pressure and not smoking also are crucial to a healthy cardiovascular system.

“People with bad cholesterol don’t know it,” Davison adds. “So the first step is to go see your doctor and get your cholesterol checked. Then make lifestyle changes. Do whatever you can to be a little better than yesterday. Just continually work on improving.”