1. Cholesterol Screening
It is recommended to screen men for elevated cholesterol in their mid to late 30s and women in their mid to late 40s. If you have a strong family history of heart or vascular disease, seek a screening at an earlier age. When your doctor orders a blood test to check cholesterol levels, the results are reported as total cholesterol, bad cholesterol, or low density lipoproteins, good cholesterol, or high density lipoproteins, and triglycerides. The total cholesterol is calculated by combining the HDL and LDL. Having elevated cholesterol levels predisposes one to the development of cardiovascular disease; treating cholesterol in high risk groups reduced the risk of heart attack, stroke or cardiovascular death.
2. Bad Cholesterol (LDL)
As the name implies, bad cholesterol or LDL raises your risk for cardiovascular disease. This compound is created by the uptake of dietary cholesterol is synthesized by the liver. LDL transfers itself into the cells of the body and eventually is laid down into the walls of arteries. LDL attracts inflammatory cells into these plaques inside the vessels. The more LDL in the walls the higher the risk of heart attack and stroke. Treatment with a cholesterol lowering agent like a statin reduces the LDL levels by decreasing its production by the liver. Other agents like bile sequestrants can decrease the levels by decreasing the uptake of the cholesterol in the intestine. Factors that increase the LDL level are obesity and high intake of saturated and trans-fats. LDL levels should be less than 100mg/dl in patients with documented cardiovascular disease of the known risk equivalents (diabetes, renal failure and peripherals arterial disease). Many physicians, including myself, opt to lower the LDL to levels below 70mg/dl in these high risk patients. Lipoprotein a, also known as Lp(a), is another form of LDL and when elevated it can accelerate the progression of plaque build up. As an interventional cardiologist the most important cholesterol to me is the LDL. After a heart attack or angioplasty, I know if I lower the LDL agressively, I can reduce the chance of another heart attack or a future event such as stroke or even cardiac death.
3. Good Cholesterol (HDL)
The good cholesterol, or High Density Lipoprotein (HDL), is known as protective form of cholesterol. The HDL molecule works to help the body remove cholesteol from the liver and the arterial walls. A lower HDL, is an indepedant risk factor for heart attack. Women typically have a higher HDL level than men. Although, in some people a very high level of HDL fails to be protective. In certain cases, I choose to perform tests that will devide the HDL into various sub-units that can differentiate is the HDL that a patient has is truly protective. The best way to raise the HDL is exercise and changes in diet. If medical therapy is needed, niacin is the best choice.
4. Triglycerides
Triglycerides are essentially fats in the blood. They are elevated in diabetics, smokers, alcoholics, and in patients with high carbohydrate diets. If the triglycerides are elevated it often follows that the total cholesterol and the LDL is very elevated and the HDL is low. Elevated triglycerides are another independent risk factor heart disease. Changes in lifestyle including decreasing dietary consumption of carbohydrates and and increasing exercise are ways to treat elevated triglycerides. In a patient that requires medical therapy the goal is first to lower the total cholesterol to the goal level and then treat the triglycerides with additional medications if still needed.
5. Cholesterol Myths
Treating cholesterol with medications does not give you free reign to eat anything you want. Medical therapy with statins, niacin, or fibrates is only one part of an effective treatment regimen. Patients being treated for elevated cholesterol need at lest 30 minutes of exercise a day and should follow a heart healthy diet. Patients should avoid saturated fats (particularly red meat and foods cooked in lard) and trans-fats. Chicken, fish, and lean meats are better choices. Foods that are rich in fiber will also help to lower total cholesterol.
