Cholesterol : Control
AVOID EATING A HIGH CHOLESTEROL DIET AND INSTEAD TRY
Dietary guidelines
Total Cholesterol
Cholesterol Test Overview
A total cholesterol test is a rough measure of all the cholesterol and triglycerides in your blood.
Cholesterol is a soft, wax-like substance found in all parts of the body. Your body needs a little bit of cholesterol to work properly. But too much cholesterol can clog your arteries, and lead to heart disease.
Some cholesterol is considered "good" and some is considered "bad." Different blood tests are needed to individually measure each type of cholesterol.
See also:
Alternative Names:
Total cholesterol
How the Test Is Performed:
Blood is drawn from a vein, usually from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.
Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from your arm.
Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.
In infants or young children, a sharp tool called a lancet may be used to puncture the skin and make it bleed. The blood collects into a small glass tube called a pipette, or onto a slide or test strip. A bandage may be placed over the area if there is any bleeding.
How to Prepare for the Test:
To get accurate results, you should not eat or drink anything for 9 to 12 hours before the test. You may drink water, but other beverages such as coffee, tea, or soda should be avoided.
Your health care provider may tell you to stop taking drugs that can affect the test. Never stop taking any medicine without first talking to your doctor.
Drugs that may increase total cholesterol measurements include:
When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.
Why the Test Is Performed:
This test is often done to determine your risk for coronary artery disease. High blood cholesterol and triglycerides have been linked to heart attack and stroke.
Experts recommend that you have a complete cholesterol and triglycerides analysis every 5 years starting at age 20.
The total cholesterol test is usually done as part of a lipid profile, which also checks for LDL, HDL, and triglycerides.
Additional conditions under which the test may be performed:
Total cholesterol is an important measure of both bad and good cholesterol. Other lab tests are done to measure specific amounts of good (HDL) and bad (LDL) cholesterol. A cholesterol breakdown including LDL and HDL is preferred.
The total cholesterol values listed below are used to target therapy:
In general, a total cholesterol value over 200 mg/dL may mean you have a greater risk for heart disease. However, LDL levels are a better predictor of heart disease, and they determine how your high cholesterol should be treated.
High total cholesterol levels may be caused by:
Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.
Other risks, although rare, may include:
Pregnancy is usually associated with high cholesterol.
Removal of the ovaries may also increase cholesterol levels.
Cutting Cholesterol, an Uphill Battle
By Jane E. Brody : NY Times Article : August 21, 2007
Last December, a routine nonfasting blood test revealed that my total cholesterol level, which had long wavered between 190 and 205 milligrams per deciliter of blood serum, was now 222 and flagged as “high” by the laboratory’s computer. A heart-healthy reading should be under 200.
The HDLs, the so-called good cholesterol that protects against heart disease, were also high at 69, so that was good. My triglycerides, at 95, were well within the normal range of zero to 149. The VLDLs, also a potentially harmful form, measured 19, again within the normal range of 5 to 49.
But the LDLs, the bad guys that deposit plaque on artery walls, were 134 — “high” since they should be under 100 if I want to maintain a healthy cardiovascular system.
My doctor wasn’t too concerned because my blood pressure is low, I eat a healthful diet and I exercise every day for 60 to 90 minutes and run up and down scores of steps. Still, I decided to cut out cheese, lose a few pounds and return in three months for another test, this time after an all-night fast.
So in early March, three pounds lighter and taking a daily supplement of plant stanols, which are supposed to lower cholesterol, I had a second test. But now my total cholesterol had risen to 236 and the LDLs were up to 159.
Still, my doctor was not as alarmed as I was. My father and his father and his father’s brother had heart attacks in their 50s, and my father and grandfather died of their second attacks at 71. I was 65. Were my days going to be numbered by a surprise coronary or stroke? Not if I could help it.
Now it was time to further limit red meat (though I never ate it often and always lean), stick to low-fat ice cream, eat even more fish, increase my fiber intake and add fish oils to my growing list of supplements. But the latest test, in early June, was even more of a shock: total cholesterol, 248, and LDLs, 171.
My doctor’s conclusion: “Your body is spewing out cholesterol and nothing you do to your diet is likely to stop it.” I was not inclined to become a total vegetarian to see if that would help. The time had come to try a statin, one of the miraculously effective cholesterol-lowering drugs.
By studying the effects of statins in thousands of people who already had heart disease or were likely to develop it, researchers finally proved that lowering total and LDL cholesterol in people at risk was both health-saving and life-saving. I’ll know by fall if the low-dose statin I now take nightly will do the trick, or if I’ll need a higher dose.
Lifestyle Changes
Americans tend to turn far too quickly to drugs to solve their health problems. Drugs should be the last resort, if there are reasonable measures people can take first to control a problem. And there are dozens of such measures that, individually or together, can help to lower LDLs.
High LDL cholesterol is an independent risk factor for coronary heart disease, and lowering it by 60 milligrams can reduce coronary events like heart attacks, angina and sudden death by 50 percent after only two years, experts from Oregon Health and Sciences University wrote recently in The Journal of Family Practice.
The Oregon specialists, Dr. Elizabeth Powers, Dr. John Saultz and Andrew Hamilton, recommended that doctors start with lifestyle modifications when a patient has high LDLs. And Dr. Vincent Lo of French Camp, Calif., suggested that the patient’s culture, preferences and practical issues like cost and availability be considered. Not everyone can afford to join a gym, and a traveling salesman may have a hard time sticking to a low-fat, calorie-controlled diet.
These are the measures that have been found to work, based on randomized, controlled clinical trials, the gold standard of clinical research.
Alcohol.
Consuming one or two drinks a day can lower LDLs by 4 to 10 milligrams. Red wine is considered most effective. For those who cannot drink alcohol, purple grape juice may be a reasonable, albeit less effective, substitute.
Exercise
Aerobic exercise, like brisk walking, jogging, cycling and lap swimming, can reduce LDLs by 3 to 16 milligrams and raise the good HDLs. Consistency is important. Aerobic activities should be performed at least five times a week for maximum benefit.
Weight loss.
When achieved through diet and exercise, weight loss can reduce LDL levels by as much as 42 milligrams. When achieved through drug therapy, weight loss has been associated with an LDL drop of 10 to 31 milligrams.
Yoga and tai chi. These forms of exercise, which are accessible to just about everyone who can walk, even the elderly, have reduced LDLs by 20 to 26 milligrams when done for 12 to 14 weeks.
Smoking.
An analysis of several studies found that LDL cholesterol was 1.7 percent higher in smokers, but two smoking cessation studies found little or no difference. In any case, smoking is a strong independent risk factor for heart disease and sudden coronary death, so it is best avoided.
Modifying Your Diet
About 85 percent of the cholesterol in your blood is made in your body. The remaining 15 percent comes from food. But by reducing dietary sources of saturated fats and cholesterol and increasing consumption of cholesterol-fighting foods and drink, you can usually lower the amount of harmful cholesterol in your blood. My college roommate, for example, recently adopted a mostly vegetarian-and-fish diet, minus cheese but with occasional meat and chicken, and lowered her total cholesterol from 240 to 160 milligrams.
There are exceptions, of course, and I happen to be one of them. Still, I intend to continue to follow a heart-healthy diet, because that will enhance the effectiveness of the medication I’m taking.
Start by switching to low-fat and nonfat dairy products, like skim milk and, if you can stand it, fat-free cheese. Substitute sorbet, sherbet or fruit ices for ice cream, or choose ice milk or ice cream with half the fat.
Questions for Your Doctor:
What to Ask About Cholesterol
By Laurie Tarkan : NY Times Article : November 28, 2007
Cholesterol treatment should be considered in relation to your risk factors for heart disease. Here are some questions Dr. James Cleeman, the coordinator of the National Cholesterol Education Program, recommends you ask your doctor to determine the best course of treatment for you, along with notes on why they’re important.
What is my risk of heart attack or coronary disease?
There used to be one treatment goal when lowering high LDL, but now doctors treat LDL based on your risk factors for heart disease. The higher your risk, the lower your LDL needs to go. In a healthy patient, an LDL of 125 milligrams per deciliter may be fine, but the same LDL in a person with a high risk of heart disease is much too high. To assess your overall risk of coronary disease, you need to consider other risk factors, including high blood pressure, smoking, family history of early heart disease and your age (45 or older for men; 55 or older for women). If you have two or more risk factors, you should find out your 10-year risk of having a cardiac event. You can calculate it yourself at the Web site of the National Cholesterol Education Program. Your risk can then help determine how low your LDL cholesterol needs to go.
What is my lipoprotein profile, including my total cholesterol, LDL, HDL and triglycerides?
Patients who discuss their cholesterol profiles and heart disease risks with their doctors tend to do better on a cholesterol-lowering treatment program, a recent study reported, perhaps because they adhere better to dietary and medical advice. While your LDL, the “bad” cholesterol, will be the biggest driver of what your treatment will be, the other factors will have a bearing on how you should be treated. HDL is considered the “good” cholesterol because it helps remove LDL from your arteries. High levels of triglycerides, a form of fat in the blood, can raise your heart disease risk as well..
What is my target goal for lowering LDL cholesterol?
It’s important not to think of one LDL goal for all. Your target LDL depends on your 10-year risk of having a heart attack. A husband and wife of the same age may have different LDL goals, depending on their risk factors. For example, an LDL of 120 might be fine for a healthy 50-year-old with no other risk factors but be much too high for a person with diabetes.
If I need to lower my LDL, how important are lifestyle approaches?
The first and primary line of treatment is lifestyle modification. Anyone with high LDL needs to make therapeutic lifestyle changes that involve dietary, exercise and weight control measures. A healthy diet is low in saturated fat, trans fats and cholesterol, high in soluble fiber, and low in simple carbohydrates (choose whole grain foods instead). And it’s helpful to eat foods that contain or are fortified with stanols and sterols.
If LDL doesn’t respond sufficiently to lifestyle changes, am I a candidate for drug treatment?
This will depend on your risk profile. If you’re in the 10 percent to 20 percent or greater risk range, you will probably be put on a statin, the drug treatment of choice. But statins are never a substitute for therapeutic lifestyle changes, which will enable you to keep your drug dose lower and reduce the risk of side effects. Lifestyle changes also produce benefits that the drugs cannot. Diet and exercise can reduce not only LDL levels but hypertension, as well as your risk of diabetes and blood clotting. These additional three benefits are not prime effects of statins.
If I’m at low risk of heart disease, what can I do to keep my risk low?
Always follow therapeutic lifestyle changes to keep LDL and other risk factors low. An important study published in The New England Journal of Medicine in 2006 found that people with a mutation of the gene called PCSK9 have naturally low LDL levels, and these low levels were associated with a vastly reduced rate of heart disease. The average LDL in the subjects with the PCSK9 mutation was 100, which produced an 88 percent reduction in heart disease. The implication of this study is that a low LDL level maintained over a lifetime produces very low heart disease rates. Keeping LDL low through lifestyle changes throughout life promises to significantly reduce your overall risk of heart disease.
Do I need to be concerned about my waist circumference?
You can have normal LDL but be at high risk of heart disease if you have metabolic syndrome. This constellation of symptoms includes having a waist circumference of 35 inches or more for women, 40 inches or more for men; triglycerides of 150 or more; HDL of less than 40 in men or less than 50 in women; blood pressure of more than 130/85 (either number being higher); and a fasting blood sugar of 100 or more. The treatment for metabolic syndrome is weight loss, diet and physical activity.
How important is it that I raise my “good” HDL?
If you have low HDL and LDL is not particularly high, the first goal is to get your LDL down even further. Whilethere’s a lot of evidence that lowering LDL lowers risk of coronary heart disease and prolongs life, the same degree of evidence is not available regarding the effects of raising HDL. If you still need to lower your risk after you’ve reduced your LDL, you can treat low HDL as well. Quitting smoking, losing weight and increasing physical activity can raise HDL. If your doctor recommends medication, currently available treatments include prescription niacin and cholesterol-lowering drugs called fibrates.
Do the laboratory values I receive come from a lab that has been standardized?
Most laboratories participate in the Centers for Disease Control and Prevention’s Lipid Standardization Program, which requires participating labs to do multiple analyses on frozen blood samples to make sure their results are accurate. This helps assure that the numbers are accurate, since treatment is very dependent on these lipid levels. The Cholesterol Reference Method Laboratory Network also certifies manufacturers of diagnostic products that measure total cholesterol.
The lower the better!
Total Cholesterol
- <200 desirable
- 200 - 239 borderline high
- >240 high
- <40 low
- >60 high
- <75 in diabetics or people with a known history of coronary artery disease, peripheral vascular disease, or abdominal aortic aneurysms
- <100 optimal
- 100 - 129 near or above optimal
- 130 - 159 borderline high
- 160 - 189 high
- >190 very high
- <150
- <4 optimal
Cholesterol Test Overview
A total cholesterol test is a rough measure of all the cholesterol and triglycerides in your blood.
Cholesterol is a soft, wax-like substance found in all parts of the body. Your body needs a little bit of cholesterol to work properly. But too much cholesterol can clog your arteries, and lead to heart disease.
Some cholesterol is considered "good" and some is considered "bad." Different blood tests are needed to individually measure each type of cholesterol.
See also:
- HDL test ("good" cholesterol)
- LDL test ("bad" cholesterol)
- Lipid profile
- High blood cholesterol and triglycerides
Alternative Names:
Total cholesterol
How the Test Is Performed:
Blood is drawn from a vein, usually from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.
Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from your arm.
Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.
In infants or young children, a sharp tool called a lancet may be used to puncture the skin and make it bleed. The blood collects into a small glass tube called a pipette, or onto a slide or test strip. A bandage may be placed over the area if there is any bleeding.
How to Prepare for the Test:
To get accurate results, you should not eat or drink anything for 9 to 12 hours before the test. You may drink water, but other beverages such as coffee, tea, or soda should be avoided.
Your health care provider may tell you to stop taking drugs that can affect the test. Never stop taking any medicine without first talking to your doctor.
Drugs that may increase total cholesterol measurements include:
- ACTH
- Anabolic steroids
- Beta-adrenergic blocking agents
- Corticosteroids
- Epinephrine
- Birth control pills
- Phenytoin
- Sulfonamides
- Thiazide diuretics
- Vitamin D
- Allopurinol
- Androgens
- Captopril
- Chlorpropamide
- Colchicine
- Colestipol
- Erythromycin
- Fibrates
- Isoniazid
- MAO inhibitors
- Neomycin
- Niacin
- Nitrates
- Statins
When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.
Why the Test Is Performed:
This test is often done to determine your risk for coronary artery disease. High blood cholesterol and triglycerides have been linked to heart attack and stroke.
Experts recommend that you have a complete cholesterol and triglycerides analysis every 5 years starting at age 20.
The total cholesterol test is usually done as part of a lipid profile, which also checks for LDL, HDL, and triglycerides.
Additional conditions under which the test may be performed:
- Arteriosclerosis of the extremities
- Familial dysbetalipoproteinemia
- Familial hypercholesterolemia
- Hypothyroidism; primary
- Hypothyroidism; secondary
- Type 1 or type 2 diabetes
- Primary biliary cirrhosis
Total cholesterol is an important measure of both bad and good cholesterol. Other lab tests are done to measure specific amounts of good (HDL) and bad (LDL) cholesterol. A cholesterol breakdown including LDL and HDL is preferred.
The total cholesterol values listed below are used to target therapy:
- Desirable: Under 200 milligrams per deciliter (mg/dL)
- Borderline high: 200 to 239 mg/dL
- High risk: 240 mg/dL and higher
In general, a total cholesterol value over 200 mg/dL may mean you have a greater risk for heart disease. However, LDL levels are a better predictor of heart disease, and they determine how your high cholesterol should be treated.
High total cholesterol levels may be caused by:
- Biliary cirrhosis
- Familial hyperlipidemias
- High fat diet
- Hypothyroidism
- Nephrotic syndrome
- Uncontrolled diabetes
- Hyperthyroidism
- Liver disease
- Malabsorption (inadequate absorption of nutrients from the intestinal tract)
- Malnutrition
- Pernicious anemia
- Sepsis
Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.
Other risks, although rare, may include:
- Excessive bleeding
- Fainting or feeling light-headed
- Hematoma (blood accumulating under the skin)
- Infection (a slight risk any time the skin is broken)
Pregnancy is usually associated with high cholesterol.
Removal of the ovaries may also increase cholesterol levels.
Cutting Cholesterol, an Uphill Battle
By Jane E. Brody : NY Times Article : August 21, 2007
Last December, a routine nonfasting blood test revealed that my total cholesterol level, which had long wavered between 190 and 205 milligrams per deciliter of blood serum, was now 222 and flagged as “high” by the laboratory’s computer. A heart-healthy reading should be under 200.
The HDLs, the so-called good cholesterol that protects against heart disease, were also high at 69, so that was good. My triglycerides, at 95, were well within the normal range of zero to 149. The VLDLs, also a potentially harmful form, measured 19, again within the normal range of 5 to 49.
But the LDLs, the bad guys that deposit plaque on artery walls, were 134 — “high” since they should be under 100 if I want to maintain a healthy cardiovascular system.
My doctor wasn’t too concerned because my blood pressure is low, I eat a healthful diet and I exercise every day for 60 to 90 minutes and run up and down scores of steps. Still, I decided to cut out cheese, lose a few pounds and return in three months for another test, this time after an all-night fast.
So in early March, three pounds lighter and taking a daily supplement of plant stanols, which are supposed to lower cholesterol, I had a second test. But now my total cholesterol had risen to 236 and the LDLs were up to 159.
Still, my doctor was not as alarmed as I was. My father and his father and his father’s brother had heart attacks in their 50s, and my father and grandfather died of their second attacks at 71. I was 65. Were my days going to be numbered by a surprise coronary or stroke? Not if I could help it.
Now it was time to further limit red meat (though I never ate it often and always lean), stick to low-fat ice cream, eat even more fish, increase my fiber intake and add fish oils to my growing list of supplements. But the latest test, in early June, was even more of a shock: total cholesterol, 248, and LDLs, 171.
My doctor’s conclusion: “Your body is spewing out cholesterol and nothing you do to your diet is likely to stop it.” I was not inclined to become a total vegetarian to see if that would help. The time had come to try a statin, one of the miraculously effective cholesterol-lowering drugs.
By studying the effects of statins in thousands of people who already had heart disease or were likely to develop it, researchers finally proved that lowering total and LDL cholesterol in people at risk was both health-saving and life-saving. I’ll know by fall if the low-dose statin I now take nightly will do the trick, or if I’ll need a higher dose.
Lifestyle Changes
Americans tend to turn far too quickly to drugs to solve their health problems. Drugs should be the last resort, if there are reasonable measures people can take first to control a problem. And there are dozens of such measures that, individually or together, can help to lower LDLs.
High LDL cholesterol is an independent risk factor for coronary heart disease, and lowering it by 60 milligrams can reduce coronary events like heart attacks, angina and sudden death by 50 percent after only two years, experts from Oregon Health and Sciences University wrote recently in The Journal of Family Practice.
The Oregon specialists, Dr. Elizabeth Powers, Dr. John Saultz and Andrew Hamilton, recommended that doctors start with lifestyle modifications when a patient has high LDLs. And Dr. Vincent Lo of French Camp, Calif., suggested that the patient’s culture, preferences and practical issues like cost and availability be considered. Not everyone can afford to join a gym, and a traveling salesman may have a hard time sticking to a low-fat, calorie-controlled diet.
These are the measures that have been found to work, based on randomized, controlled clinical trials, the gold standard of clinical research.
Alcohol.
Consuming one or two drinks a day can lower LDLs by 4 to 10 milligrams. Red wine is considered most effective. For those who cannot drink alcohol, purple grape juice may be a reasonable, albeit less effective, substitute.
Exercise
Aerobic exercise, like brisk walking, jogging, cycling and lap swimming, can reduce LDLs by 3 to 16 milligrams and raise the good HDLs. Consistency is important. Aerobic activities should be performed at least five times a week for maximum benefit.
Weight loss.
When achieved through diet and exercise, weight loss can reduce LDL levels by as much as 42 milligrams. When achieved through drug therapy, weight loss has been associated with an LDL drop of 10 to 31 milligrams.
Yoga and tai chi. These forms of exercise, which are accessible to just about everyone who can walk, even the elderly, have reduced LDLs by 20 to 26 milligrams when done for 12 to 14 weeks.
Smoking.
An analysis of several studies found that LDL cholesterol was 1.7 percent higher in smokers, but two smoking cessation studies found little or no difference. In any case, smoking is a strong independent risk factor for heart disease and sudden coronary death, so it is best avoided.
Modifying Your Diet
About 85 percent of the cholesterol in your blood is made in your body. The remaining 15 percent comes from food. But by reducing dietary sources of saturated fats and cholesterol and increasing consumption of cholesterol-fighting foods and drink, you can usually lower the amount of harmful cholesterol in your blood. My college roommate, for example, recently adopted a mostly vegetarian-and-fish diet, minus cheese but with occasional meat and chicken, and lowered her total cholesterol from 240 to 160 milligrams.
There are exceptions, of course, and I happen to be one of them. Still, I intend to continue to follow a heart-healthy diet, because that will enhance the effectiveness of the medication I’m taking.
Start by switching to low-fat and nonfat dairy products, like skim milk and, if you can stand it, fat-free cheese. Substitute sorbet, sherbet or fruit ices for ice cream, or choose ice milk or ice cream with half the fat.
- For protein, choose fish and shellfish, poultry without the skin and lean meats, all prepared with low-fat recipes. Eat more dried beans and peas (cooked, of course), soy products like tofu, and nuts like walnuts and almonds. Grains should be mostly or entirely whole — 100 percent whole wheat bread and cereals made from whole wheat or oats, brown rice, bulgur and the like. Oats and oatmeal are rich in soluble fiber, which lowers cholesterol.
- Pile on the vegetables and fruits. Especially helpful are those high in fiber like Brussels sprouts, cabbage, spinach, carrots, blueberries, oranges and apples.
- Cook with canola or olive oil, and use margarine made from plant stanols.
- And enjoy a glass of wine with dinner.
- Equally important are the foods to limit or avoid: organ meats like liver, egg yolks, most fried and fast foods, doughnuts and pastries, full-fat cheeses and ice cream, processed meats like salami, bacon and other fatty cuts of pork, and untrimmed red meats.
Questions for Your Doctor:
What to Ask About Cholesterol
By Laurie Tarkan : NY Times Article : November 28, 2007
Cholesterol treatment should be considered in relation to your risk factors for heart disease. Here are some questions Dr. James Cleeman, the coordinator of the National Cholesterol Education Program, recommends you ask your doctor to determine the best course of treatment for you, along with notes on why they’re important.
What is my risk of heart attack or coronary disease?
There used to be one treatment goal when lowering high LDL, but now doctors treat LDL based on your risk factors for heart disease. The higher your risk, the lower your LDL needs to go. In a healthy patient, an LDL of 125 milligrams per deciliter may be fine, but the same LDL in a person with a high risk of heart disease is much too high. To assess your overall risk of coronary disease, you need to consider other risk factors, including high blood pressure, smoking, family history of early heart disease and your age (45 or older for men; 55 or older for women). If you have two or more risk factors, you should find out your 10-year risk of having a cardiac event. You can calculate it yourself at the Web site of the National Cholesterol Education Program. Your risk can then help determine how low your LDL cholesterol needs to go.
What is my lipoprotein profile, including my total cholesterol, LDL, HDL and triglycerides?
Patients who discuss their cholesterol profiles and heart disease risks with their doctors tend to do better on a cholesterol-lowering treatment program, a recent study reported, perhaps because they adhere better to dietary and medical advice. While your LDL, the “bad” cholesterol, will be the biggest driver of what your treatment will be, the other factors will have a bearing on how you should be treated. HDL is considered the “good” cholesterol because it helps remove LDL from your arteries. High levels of triglycerides, a form of fat in the blood, can raise your heart disease risk as well..
What is my target goal for lowering LDL cholesterol?
It’s important not to think of one LDL goal for all. Your target LDL depends on your 10-year risk of having a heart attack. A husband and wife of the same age may have different LDL goals, depending on their risk factors. For example, an LDL of 120 might be fine for a healthy 50-year-old with no other risk factors but be much too high for a person with diabetes.
If I need to lower my LDL, how important are lifestyle approaches?
The first and primary line of treatment is lifestyle modification. Anyone with high LDL needs to make therapeutic lifestyle changes that involve dietary, exercise and weight control measures. A healthy diet is low in saturated fat, trans fats and cholesterol, high in soluble fiber, and low in simple carbohydrates (choose whole grain foods instead). And it’s helpful to eat foods that contain or are fortified with stanols and sterols.
If LDL doesn’t respond sufficiently to lifestyle changes, am I a candidate for drug treatment?
This will depend on your risk profile. If you’re in the 10 percent to 20 percent or greater risk range, you will probably be put on a statin, the drug treatment of choice. But statins are never a substitute for therapeutic lifestyle changes, which will enable you to keep your drug dose lower and reduce the risk of side effects. Lifestyle changes also produce benefits that the drugs cannot. Diet and exercise can reduce not only LDL levels but hypertension, as well as your risk of diabetes and blood clotting. These additional three benefits are not prime effects of statins.
If I’m at low risk of heart disease, what can I do to keep my risk low?
Always follow therapeutic lifestyle changes to keep LDL and other risk factors low. An important study published in The New England Journal of Medicine in 2006 found that people with a mutation of the gene called PCSK9 have naturally low LDL levels, and these low levels were associated with a vastly reduced rate of heart disease. The average LDL in the subjects with the PCSK9 mutation was 100, which produced an 88 percent reduction in heart disease. The implication of this study is that a low LDL level maintained over a lifetime produces very low heart disease rates. Keeping LDL low through lifestyle changes throughout life promises to significantly reduce your overall risk of heart disease.
Do I need to be concerned about my waist circumference?
You can have normal LDL but be at high risk of heart disease if you have metabolic syndrome. This constellation of symptoms includes having a waist circumference of 35 inches or more for women, 40 inches or more for men; triglycerides of 150 or more; HDL of less than 40 in men or less than 50 in women; blood pressure of more than 130/85 (either number being higher); and a fasting blood sugar of 100 or more. The treatment for metabolic syndrome is weight loss, diet and physical activity.
How important is it that I raise my “good” HDL?
If you have low HDL and LDL is not particularly high, the first goal is to get your LDL down even further. Whilethere’s a lot of evidence that lowering LDL lowers risk of coronary heart disease and prolongs life, the same degree of evidence is not available regarding the effects of raising HDL. If you still need to lower your risk after you’ve reduced your LDL, you can treat low HDL as well. Quitting smoking, losing weight and increasing physical activity can raise HDL. If your doctor recommends medication, currently available treatments include prescription niacin and cholesterol-lowering drugs called fibrates.
Do the laboratory values I receive come from a lab that has been standardized?
Most laboratories participate in the Centers for Disease Control and Prevention’s Lipid Standardization Program, which requires participating labs to do multiple analyses on frozen blood samples to make sure their results are accurate. This helps assure that the numbers are accurate, since treatment is very dependent on these lipid levels. The Cholesterol Reference Method Laboratory Network also certifies manufacturers of diagnostic products that measure total cholesterol.
The lower the better!
