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Heart Disease (Expert Forum)
HIGH CHOLESTEROL
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HIGH CHOLESTEROL
by Lee, Jan 24, 2000 12:00AM
MY HUSBAND IS 41 YRS OLD, THIN, EATS HEALTHY AND EXERCISES MODERATELY. HOWEVER HIS CHOLESTEROL LEVELS FLUCTUATES BETWEEN 270 AND 300. HIS LAST TEST SHOWED A RATIO OF 5/1. HIS DOCTOR STILL HAS NOT PRESCRIBED A DRUG TO LOWER THIS LEVEL. WHEN DO YOU RECOMMEND STARTING ON A CHOLESTEROL LOWERING DRUG. IS THERE A DIFFERENCE BETWEEN THE DIFFERENT DRUGS? ARE THE SIDE AFFECTS SERIOUS?
Doctor's Answer
by CCF CARDIO MD - CRC, Jan 25, 2000 12:00AM
Dear Lee,
Your question raises several important points concerning cholesterol. A high cholesterol level was identified as a major risk factor in the development of heart disease in the 1970s. Lowering cholesterol for secondary prevention, that is preventing second heart attacks in persons who already had had one, was next demonstrated in the eighties and primary prevention of heart attack and stroke (In persons who had never had a prior event) demonstrated in the nineties. The most recently published studies have demonstrated that lipid lowering therapy decreases cardiac events even in those persons with normal cholesterol.
Total cholesterol is broken down into different categories. High density cholesterol (HDL) is the "good cholesterol" that acts as a cleaning cholesterol. Low density cholesterol (LDL) is the "bad cholesterol" that clogs up arteries throughout the body. LDL is not usually measure directly but is calculated from the following equation: LDL=Total-HDL-triglycerides/5. If the triglycerides are too high the LDL calculation is not valid. Triglyceride is another type of cholesterol whose significance is not well established. Very high levels (>1000) can lead to pancreatitis and other health problems. Cholesterol should be measured after an 8 hour fast. Sometimes ratios of "bad" cholesterol to "good" cholesterol are calculated with a desired ratio of less than 3 to 4.
Guidelines have been established as to the treatment of high cholesterol. It has been recommended that everyone over that age of 25 has their total cholesterol and HDL measured. If these are abnormal a full cholesterol panel should be done. Guideline for the treatment of cholesterol depend upon the risk factors that the person has. Risk factors are a family history of heart disease, high blood pressure, male >45 yrs or female >55 yrs, diabetes (counts as two risk factors), smoking and obesity. Someone at low risk should have a goal LDL cholesterol less than 130 and should be on a special diet if LDL is greater than 160 and on medication if it is greater than 190. Someone with one or two risk factors should start medical treatment at 160. Someone with more than two risk factors or with established heart disease should have a goal LDL of less than 100 with medical treatment started at 130.
Diet plays a large role in the elevation of cholesterol and the first step of any treatment program should be to begin a low fat, low cholesterol diet. It may be necessary to get the help of a dietitian to achieve a good diet. Many people think they are following a healthy diet but are actually consuming quite a large percentage of fat. Diet will not work in everyone however as genetic makeup is also a factor in cholesterol levels. Therefore even thin people can have an elevated cholesterol. In some people medical treatment will need to be added to diet and exercise.
Medical treatment of cholesterol includes resins which bind cholesterol, niacin, gemfibrazole (useful for elevated triglycerides) and statins (e.g. leschol, pravachol, mevacor, lipitor, baychol, zocor). All of the drugs except the resins may have a negative effect on the liver and liver function tests should be monitored. If there is an increase in the liver enzymes it is usually reversible if the drug is stopped. A rare but potentially serious side effect is myositis (muscle inflammation) and if muscle pain should occur the drug should be stopped and the prescribing doctor notified. Most side effects are uncommon. The choice of which drug to use for a given individual is beyond the scope of this forum and should be discussed with one's doctor.
Q: What would cause a decline in HDL levels over a five year period?
A: HDL levels are effected by mainly by exercise and genetics. Increasing exercise increases HDL levels and decreased exercise lowers HDL levels.
Q: Is there anything that has been known to increase HDL?
A: Exercise has been shown to increase HDL levels as has small quantities (1/2 glass) of daily red wine. Niacin is the best drug therapy to increase HDL but it must be taken in sufficient quantities (i.e. 2- 4 grams per day) to have an effect.
Q: How serious at risk factor for heart attack/stroke is a low HDL?
A: In recent years it has been recognized that a low HDL is a more serious risk factor than was previously thought. The current recommendations is that a low HDL be aggressively treated to reduce the risk for heart attack.
Further information can be found at the site below:
http://www.amhrt.org/Heart_and_Stroke_A_Z_Guide/chol.html
The Cleveland Clinic has a special prevention center that deals with cholesterol, diet, exercise and executive physicals. If you would like to be seen at the prevention center please Call 1 - 800 - CCF - CARE for an appointment in the preventative cardiology clinic (Dr. Dennis Sprecker - head).
Your question raises several important points concerning cholesterol. A high cholesterol level was identified as a major risk factor in the development of heart disease in the 1970s. Lowering cholesterol for secondary prevention, that is preventing second heart attacks in persons who already had had one, was next demonstrated in the eighties and primary prevention of heart attack and stroke (In persons who had never had a prior event) demonstrated in the nineties. The most recently published studies have demonstrated that lipid lowering therapy decreases cardiac events even in those persons with normal cholesterol.
Total cholesterol is broken down into different categories. High density cholesterol (HDL) is the "good cholesterol" that acts as a cleaning cholesterol. Low density cholesterol (LDL) is the "bad cholesterol" that clogs up arteries throughout the body. LDL is not usually measure directly but is calculated from the following equation: LDL=Total-HDL-triglycerides/5. If the triglycerides are too high the LDL calculation is not valid. Triglyceride is another type of cholesterol whose significance is not well established. Very high levels (>1000) can lead to pancreatitis and other health problems. Cholesterol should be measured after an 8 hour fast. Sometimes ratios of "bad" cholesterol to "good" cholesterol are calculated with a desired ratio of less than 3 to 4.
Guidelines have been established as to the treatment of high cholesterol. It has been recommended that everyone over that age of 25 has their total cholesterol and HDL measured. If these are abnormal a full cholesterol panel should be done. Guideline for the treatment of cholesterol depend upon the risk factors that the person has. Risk factors are a family history of heart disease, high blood pressure, male >45 yrs or female >55 yrs, diabetes (counts as two risk factors), smoking and obesity. Someone at low risk should have a goal LDL cholesterol less than 130 and should be on a special diet if LDL is greater than 160 and on medication if it is greater than 190. Someone with one or two risk factors should start medical treatment at 160. Someone with more than two risk factors or with established heart disease should have a goal LDL of less than 100 with medical treatment started at 130.
Diet plays a large role in the elevation of cholesterol and the first step of any treatment program should be to begin a low fat, low cholesterol diet. It may be necessary to get the help of a dietitian to achieve a good diet. Many people think they are following a healthy diet but are actually consuming quite a large percentage of fat. Diet will not work in everyone however as genetic makeup is also a factor in cholesterol levels. Therefore even thin people can have an elevated cholesterol. In some people medical treatment will need to be added to diet and exercise.
Medical treatment of cholesterol includes resins which bind cholesterol, niacin, gemfibrazole (useful for elevated triglycerides) and statins (e.g. leschol, pravachol, mevacor, lipitor, baychol, zocor). All of the drugs except the resins may have a negative effect on the liver and liver function tests should be monitored. If there is an increase in the liver enzymes it is usually reversible if the drug is stopped. A rare but potentially serious side effect is myositis (muscle inflammation) and if muscle pain should occur the drug should be stopped and the prescribing doctor notified. Most side effects are uncommon. The choice of which drug to use for a given individual is beyond the scope of this forum and should be discussed with one's doctor.
Q: What would cause a decline in HDL levels over a five year period?
A: HDL levels are effected by mainly by exercise and genetics. Increasing exercise increases HDL levels and decreased exercise lowers HDL levels.
Q: Is there anything that has been known to increase HDL?
A: Exercise has been shown to increase HDL levels as has small quantities (1/2 glass) of daily red wine. Niacin is the best drug therapy to increase HDL but it must be taken in sufficient quantities (i.e. 2- 4 grams per day) to have an effect.
Q: How serious at risk factor for heart attack/stroke is a low HDL?
A: In recent years it has been recognized that a low HDL is a more serious risk factor than was previously thought. The current recommendations is that a low HDL be aggressively treated to reduce the risk for heart attack.
Further information can be found at the site below:
http://www.amhrt.org/Heart_and_Stroke_A_Z_Guide/chol.html
The Cleveland Clinic has a special prevention center that deals with cholesterol, diet, exercise and executive physicals. If you would like to be seen at the prevention center please Call 1 - 800 - CCF - CARE for an appointment in the preventative cardiology clinic (Dr. Dennis Sprecker - head).
Member Comments (6)
by Robert, Jan 24, 2000 12:00AM
I'm not a doctor and have no idea how this works - I was trying to find out something about homocysteine levels - when you talk with the doctor - ask him or her about it.
by OleBluEyez, Feb 03, 2000 12:00AM
I am looking for foods that will increase my level of HDL. I do not drink alcohol so i cannot drink red wine. I get plenty of exercise during the summer but am prohibited at times during the winter and my HDL level is at 34. Could you please recommend any other foods that will help increase my HDL