Although there are advocates of both butter and margarine, most cardiologists agree that if you have heart disease or are at risk and you are following a diet for high cholesterol, certain types of margarine are better for your heart than butter.

Because margarine is made from vegetable oils, it contains no cholesterol. Butter is made from milk, which is an animal protein source, so it does contain cholesterol. Butter also contains saturated fat.

But all margarines are not created equal. Many types of margarine are made from hydrogenated vegetable oil, which means that they contain trans fats; exactly what you want to avoid on a low cholesterol diet.

Look for tub margarine rather than stick margarine. In general, the more solid the margarine is, the more trans fat it contains. Look for spreadable tub margarine with 3 grams or less of total fat, including both saturated fat and trans fat.

Are you a baker? Opt for butter. Not only is it heart-healthier in stick form than margarine, it gives your baked goods more flavor, which makes it easier to perform other low-fat substitutions in recipes. But that said, feel free to experiment. For example, try making a recipe with less butter than it calls for. You may be able to get away with a quarter cup rather than half a cup. Or substitute applesauce or prune puree for half or a third of the amount of butter when baking. (Caution: you many need to adjust the amount of dry ingredients to avoid over-wet batter).

Once you turn 20, you should have your cholesterol checked as part of any regular physical exam and have it checked every 5 years if you are otherwise healthy. Cholesterol levels (both LDL and HDL) are expressed in terms of milligrams of cholesterol per deciliter of blood (mg/dl).

A healthy LDL cholesterol level for most adults is 130 mg/dl or lower. If you have other risk factors for heart disease, follow a low cholesterol diet to work on reducing your LDL to 100 mg/dl or lower, and if you already have heart disease, work on reducing your LDL to 70 mg/dl or lower.

A healthy HDL for most adults is 40-50 mg/dl for men and 50-60 mg/dl for women. An HDL of 40 or lower is considered risky for men and women. A low HDL accompanies a high LDL and the greater the imbalance, the greater your risk of developing heart disease.

If your LDL cholesterol is high and you need to begin to follow a low cholesterol diet, your doctor will likely check your cholesterol more frequently to monitor the effects of the diet. Eating healthy foods and reducing or avoiding trans fats can improve your LDL level if you’re diligent, and you can reduce your risk for heart disease and improve your heart health if you already have heart disease.

Aerobic exercise, as you know from gym class, gets your blood flowing, and that helps promote high levels of HDL while preventing excess LDL from building up in your arteries.

Because a buildup of LDL (bad) cholesterol in the body is what causes heart attacks and strokes, it’s important for everyone, especially those at increased risk for heart attack and stroke, to factor in aerobic exercise as part of a healthy lifestyle. Also, aerobic exercise strengthens the heart muscle itself. A strong heart pumps less often, and a more efficient heart means improved blood flow to all parts of the body including the brain.

The bottom line: The improved circulation that comes with regular aerobic exercise can reduce your risk for both heart attack and stroke. And since you’ll be in better shape, your “bottom line” will benefit, too. If you are a moderate exerciser, try increasing the duration and intensity of your workouts to work up to 30 minutes at a time of walking, biking, running, or swimming at a brisk pace each day. If you are older and less able to be active, talk to your doctor and ask for help to design an exercise plan that you can manage. As your body adapts, your heart and your muscles will become stronger and more efficient.

There are so many different types of fats in food that it’s hard to keep them straight. Monounsaturated, polyunsaturated, partially hydrogenated—which are good and which are bad?

Here’s a fat primer:

The “good fats” are polyunsaturated and monounsaturated fats. These two types of fats can help reduce the levels of low-density lipoproteins (LDL), which make up the unhealthy type of cholesterol.

Healthy sources of monounsaturated fat include canola oil and olive oil. Healthy sources of polyunsaturated fat include soybean oil and safflower oil, and fish.

By contrast, the “bad fats” are saturated fats and trans fats. When consumed in excessive amounts they can raise levels of LDL.

Trans fats are the fats in processed foods, including most commercial baked goods (think Twinkies) and many fried foods. Saturated fats are the fats found in most animal products, such as fatty meats, whole milk, and some types of cheese. Try to keep foods high in bad fats to a small part of your diet; saturated fats should not be more than 10 percent of your daily calories if you want to avoid weight gain and cholesterol problems.

And remember: even good fats are fattening. Although it is important to include healthy fats in your diet, including monounsaturated fats, polyunsaturated fats, and omega-3 fatty acids, be sure to adjust your total fat intake to account for your calorie needs.

If you are overweight, try to limit the fat in your daily diet to 30 percent of your daily calorie intake. And remember that calories count, even if they come from fat-free cookies.

Every second counts in cases of heart attack and stroke; it’s essential to act fast if you have any of the following signs and symptoms, or if you see someone who is exhibiting these symptoms:

• Chest discomfort. Feelings of pressure, squeezing, or pain in the center of the chest that last for several minutes at a time.
• Shortness of breath.
• Discomfort or cramping feelings in the upper body, including the back, neck, jaw, or one or both arms.
• Feelings of nausea, lightheadedness, or cold sweat in conjunction with any of the previous three symptoms.

The symptoms of a heart attack are the same for men and women, but studies have shown that women are more likely than men to report symptoms of nausea, shortness of breath, and back pain in addition to chest discomfort.

Call 911 immediately if you or someone else experiences these symptoms. Don’t delay; it’s better to be safe than sorry. Although some heart attacks are sudden or intense (like you see in the movies) in most cases the pain is moderate and people aren’t sure what is wrong with them and so they delay going to the hospital or calling for help. It’s better to call 911 and have an ambulance take you to the hospital; you will be treated more quickly than if you try to drive yourself or have a friend of family member drive you.

If your triglyceride levels are high, you may be at increased risk for heart disease, especially if you have a family history of heart problems. Including foods that are high in omega-3s in your diet can help promote healthy triglyceride levels.

Fish and other types of seafood are excellent sources of omega-3 fatty acids. And don’t be afraid of the word “fatty.” Omega-3s are among what are called “favorable fats,” which are fats that can help reduce the risk of death, heart attack, and stroke in people with heart disease or a family history of heart disease.

Omega-3s help keep your heart healthy by lowering triglycerides, which are the chemical form of most fats in food and in the body. When the body has used the calories it needs for immediate use, the excess energy is converted to triglycerides and stored in fat cells, from which energy is released as needed to meet the body’s demands.

Some evidence suggests that omega 3 fatty acid supplements may increase the risk of bleeding if you are already taking medications that increase this risk, such as blood thinners and non-steroidal anti-inflammatory drugs. If you are taking these medications, talk to your doctor before taking omega 3 supplements. Try to include foods rich in omega-3s in your diet instead.

Don’t like seafood? Try to eat flaxseed or flaxseed oil. Flaxseed and flaxseed oil are among the best food sources of alpha-linoleic acid, which is an ingredient in omega-3 fatty acids if other nutrients are also present in your body.

Most people can tolerate flaxseed and flaxseed oil, and the safest way to consume it is by sprinkling ground flaxseed on your food every now and then. Sprinkle some ground flax on top of a pasta dish and you won’t even notice that it’s there. Consult your doctor if you are taking or would like to take a flaxseed supplement to make sure it won’t interfere with other medications.

Want a good piece of advice? Stop smoking. Not only will quitting smoking help your physical and fitness activity levels, but it will help your heart. Did you know the benefits of quitting smoking happen immediately? Consider this: 20 minutes after your final cigarette, your blood pressure and pulse rate will drop, and the body temperature in your hands and feet will increase. The oxygen level in your blood will increase toward a normal level after eight hours. After a few days, your chance of a heart attack decreases and your taste and smell senses begin to improve.

If you've just started a quit smoking program -stick with it! If you're considering stopping smoking, now is the best time. Substitute your smoking habit with a new exercise routine!

Although many health recommendations can be confusing (high-protein? low-fat? high-fiber?) most health professionals now agree that we should all reduce the amount of trans fats that we eat because they have a double negative effect on cholesterol. Trans fats increase the “bad” (LDL) cholesterol and decrease the “good” (HDL) cholesterol. This combination significantly increases your risk of heart disease, especially if you have other risk factors such as obesity or diabetes.

Ironically, trans fats were originally thought to be a healthy alternative to animal fats because they are unsaturated and they come from plant oils. But the process of adding hydrogen to the oils (hydrogenation) creates trans fatty acids, and excessive consumption of foods high in trans fats has been associated with an unhealthy balance between LDL and HDL cholesterol. This unhealthy balance can promote heart disease because the increased LDL builds up on the walls of the arteries and inhibits blood flow.

There is no good evidence to show how much trans fat you need to eat before it has a negative impact on your cholesterol, but to promote heart health over time, try to reduce the amount of processed foods in your daily diet. Many food companies now make products with healthy oils that do not contain trans fats, and many restaurants (even fast food chains) are getting on the bandwagon and have taken action to eliminate oils with trans fats from their meals.

Reducing the amount of unhealthy fat in your diet is an important step in the process of keeping your heart healthy. You can eliminate a lot of unhealthy fat simply by altering the way you prepare certain foods, so you don’t have to give up your favorite foods. For example, try making some of your favorite dishes with herbs and other healthy seasoning instead of using unhealthy oils, butter, margarine, or salt. Try these easy substitutions:

• Use vinegar or lemon juice to season cooked vegetables rather than butter; add them to the veggies just before serving to bring out the flavor.
• Avoid prepackaged seasoning mixes; they are often high in salt. Instead, create a mix of herbs at home: make a “heart healthy chef’s blend” of your personal favorite combinations, such as basil and oregano or pepper and dill.
• Use liquid vegetable oil or nonfat cooking spray rather than solid shortenings when cooking. Choose canola oil, vegetable oil, or olive oil (these oils are the lowest in unhealthy fats).

In addition, incorporate some of these heart-healthy cooking strategies into the preparation of your favorite foods:

• Stir-frying. Use a wok to cook meat and vegetables and you don’t have to use much oil. But avoid seasoning with too much soy sauce; it is usually high in salt.
• Roasting. Use a rack in the roasting pan so the meat doesn’t absorb its own fat drippings. When basting roasting meat, use lemon juice, tomato juice, or even wine, instead of the meat drippings.
• Grilling. When grilling meat, use a rack to the fat drips away from the food.
• Steaming. Buy a small stainless steel steamer basket to fit inside any cooking pot. Steamed vegetables hold more of their flavor than boiled vegetables.
• Sauteing. Use a nonstick pan to saute foods and you only need to use a little oil (or none). Be sure to add plenty of herbs and spices.

Studies have shown that apart from any other risk factors, being obese, and even being overweight, is a major risk factor for coronary artery disease, which can trigger a heart attack.

Obesity increases your risk for heart problems because carrying excess fat increases your blood pressure, blood cholesterol, and triglyceride levels (which contributes to artery blockage; not a good thing). Being overweight or obese also increases your risk of developing diabetes, which in itself is a risk factor for heart disease.

Are you overweight or obese? It’s helpful to know your body mass index (BMI), which is a way of measuring body composition by comparing your weight to your height.

The World Health Organization defines obesity as a BMI of 30 kilograms per meter squared (kg/m2) or higher, while overweight is a BMI between 25 and 30. A BMI below 18.5 is considered underweight, and a BMI in the 18.5 to 24.9 range is considered healthy.

To figure out your BMI, take your weight in pounds and multiply it by 703, then divide it by your height in inches, and divide that number again by your height in inches. This corresponds (approximately) to the metric measurement of kg/m2, which is used on BMI charts.

In addition, waist circumference is a simple way to get a rough idea of your BMI. If you’re a woman, a waistline larger than 35 inches may increase your risk for heart disease. If you’re a man, a waistline larger than 40 inches can increase your risk.