hypercholesterolemia

My husband works out an hour a day, is in the best shape of his entire life at 46, eating a very clean diet that I cook for him.  He has no family history at all of heart disease, although everyone has high cholesterol in his family. The past three years, he has worked out vigorously, is very muscular, has no beef, fried foods, pork, or fast food, and eats a very high fiber diet. His BP is fine. My question is, does he really need to go on lipid-lowering medication? This appears to be his only risk factor besides being male. He has a rather high bilirubin too (1.6), so could it be some kind of liver problem causing his cholesterol to rise?

[Lee Kirksey, MD]

Congratulations on your efforts to live a healthy and enjoyable life. Its works very well when its a family effort. Cholesterol comes from food or family and it seems like through your diet you are controlling your fatty intake. The fact that he has a family history of high cholesterol is important. It would be interesting to know how severe the family cases are and what age they began.

Its also important to not only know the total cholesterol but the breakdown specifically the LDL. This determines a lot of treatment strategies. Current recommendations are for treating LDL>130 in people with known disease or equivalents after dietary and behavioral changes have failed.

T bilirubin is not as important as the transaminase liver function enzymes in determining the liver function as it pertains to cholesterol

I would recommend considering calcium scoring to give you another indication of the need for treatment.

Good luck

[SheShe62]

Dr. Kirksey;
Thanks for your reply.  My husband's cholesterol is 260, but his ratios, both HDL/cholesterol and HDL/LDL are in the good range.  Would you suggest a CRP be drawn to help decide whether statin's are necessary.  His bilirubin is 1.3 and we're both nervous about taking statins in treating him.  

[Lee Kirksey, MD]

A creactive protein is very nonspecific. I would recommend calcium scoring by way of CT. what is the exact number for the LDL? The AST and ALT are the more important indicators of liver function. Its really a risk benefit discussion based upon all of these factors that should be made after a discussion with his treating physician