Every American should be paying attention to the health of their heart, and particularly to the health of the arteries in their heart, because cardiovascular disease is the number one killer of Americans, including women. Overall, about 480,000 American women die of heart disease each year, which is 60,000 more women then men.

Women are very concerned about breast cancer and whether or not they should take hormones. What most women don't realize is that they have a much higher risk of dying from heart disease than dying from breast cancer. Heart disease is different for women and men. Women need to focus more on the health of their small arteries, whereas men with heart disease often have blockage of their larger arteries. The prevention and treatment of problems in the small versus large arteries are different. More importantly, we will be reviewing several basic steps that everyone should be taking to keep their hearts healthy.

More than half the people who have heart attacks have normal cholesterol. You do need to concern yourself with abnormally high or low cholesterol, but normal cholesterol levels do not protect you from heart attacks.

A cholesterol check is not the best test for determining whether or not you are at risk for coronary artery disease (I'll refer to it as heart disease). In fact, the American Heart Association now agrees that people with heart disease all have one factor in common, and it isn't high cholesterol. It's inflammation in their arteries (Heart guidelines urge test for inflammation; USA TODAY, Jan. 28, 2003).

The inflammation stimulates the body to use the cholesterol as a band-aid and cover up that irritated area in the blood vessels. So, chasing the cholesterol away from someone's arteries is like chasing the firefighters away from the fire. What we really should be doing is putting out the fire and not chasing the firefighters away.

Are there any functions that cholesterol has in the body or is it just something to get rid of?

Cholesterol has many very important functions in body; it is definitely not just a byproduct to get rid of. Cholesterol is an important part of each and every cell membrane. It acts as the rebar which stabilizes your cell membranes.

Additionally, all steroid hormones are made from cholesterol. Our steroid hormones include estrogen, progesterone, DHEA, testosterone, and cortisol. We all need those hormones, so we all need cholesterol to make those hormones. Vitamin D is also made from cholesterol, and we are learning more and more about the benefits of optimal amounts of vitamin D.

We definitely need cholesterol. Most people are worried about high cholesterol, but low cholesterol can also be a warning sign. An adequate cholesterol level is actually a sign of a healthy liver because the liver makes cholesterol.

The standard medical recommendation is for the LDL cholesterol - the "bad" cholesterol - to be less than 130 mg/dl and even below 100 mg/dl for people who have had a heart attack or are considered high risk for a heart attack.

I encourage people to look at the big picture and not just focus on a number. If your LDL is slightly elevated and you start taking a statin drug to lower your LDL cholesterol the benefits of your overall health are uncertain at best.

Can you decrease your cholesterol levels by changing your diet?

You can influence cholesterol levels by changing your diet, but the answer is not to remove all the cholesterol from your diet. The idea that eating cholesterol is what causes you to have high cholesterol is false. If you don't eat cholesterol, your body will make it. The body knows how much cholesterol it wants and, for some reason or other, it might allow too much cholesterol. Only 15% of cholesterol in the body comes from the diet anyway. The liver makes the other 85%.

However, you certainly can affect cholesterol by your diet. A significant way to lower cholesterol is to include adequate amounts of healthy fiber in your diet. Your body doesn't waste. Instead, your body is continually recycling; it even recycles cholesterol. If we have enough fiber, then the fiber acts as a sponge. So all the cholesterol that makes its way into the intestinal tract will not be reabsorbed but will attach to the fiber and be eliminated. The America Heart Association recommends including up to 30g of fiber/day.