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Heart Disease (Expert Forum)
CHOLESTEROL
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve Prolapse, Pacemaker, PAD, Stenosis, Stress Tests.
CHOLESTEROL
by iv, Aug 29, 2001 12:00AM
HELLO,
MY QUESTION IS CONCERNING MY CHOLESTEROL COUNT. I WENT TO THE DOCTOR YESTERDAY AND HE TOLD ME MY CHOLESTEROL COUNT WAS 209. MY HDL WAS 57, LDL WAS 141 AND MY TRI 57. I'M NOT SURE HOW THEY ADD IT UP BUT IT CAME TO 209. MY QUESTION IS, IS 209 STILL A DANGEROUS AMOUNT SINCE MY GOOD CHOLESTEROL IS AT 57? ALSO, I JUST RECENTLY HAD A BABY 4 MONTHS AGO AND HAVEN'T YET TAKEN OFF MY PREGANANCY WEIGHT. (I AM CURRENTLY WORKING ON IT) COULD THIS BE THE REASON WHY MY CHOLESTEROL WENT UP? FINALLY, MY LAST QUESTION IS WHEN ARTERIES GET BLOCKED UP BY CHOLESTEROL, ONCE THE CHOLESTEROL GOES BACK DOWN THROUGH EXCERCISE AND DIET DOES IT GO BACK TO NORMAL? I AM TRYING TO KEEP FIT AND LIVE A HEALTHY LIFE STYLE. ANY INFORMATION YOU COULD GIVE ME WOULD BE HELPFUL. THANK YOU!
MY QUESTION IS CONCERNING MY CHOLESTEROL COUNT. I WENT TO THE DOCTOR YESTERDAY AND HE TOLD ME MY CHOLESTEROL COUNT WAS 209. MY HDL WAS 57, LDL WAS 141 AND MY TRI 57. I'M NOT SURE HOW THEY ADD IT UP BUT IT CAME TO 209. MY QUESTION IS, IS 209 STILL A DANGEROUS AMOUNT SINCE MY GOOD CHOLESTEROL IS AT 57? ALSO, I JUST RECENTLY HAD A BABY 4 MONTHS AGO AND HAVEN'T YET TAKEN OFF MY PREGANANCY WEIGHT. (I AM CURRENTLY WORKING ON IT) COULD THIS BE THE REASON WHY MY CHOLESTEROL WENT UP? FINALLY, MY LAST QUESTION IS WHEN ARTERIES GET BLOCKED UP BY CHOLESTEROL, ONCE THE CHOLESTEROL GOES BACK DOWN THROUGH EXCERCISE AND DIET DOES IT GO BACK TO NORMAL? I AM TRYING TO KEEP FIT AND LIVE A HEALTHY LIFE STYLE. ANY INFORMATION YOU COULD GIVE ME WOULD BE HELPFUL. THANK YOU!
Doctor's Answer
by CCF-M.D.-CRC, Aug 29, 2001 12:00AM
Dear iv,
Cholesterol has been identified as a major risk factor in the development of heart disease. Early studies established high cholesterol as a risk factor for developing heart disease. 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.
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. A total cholesterol of 209 is borderline high but would be less concerning due to the high HDL. An LDL of 149 is slightly high. Pregnancy may cause an increase in cholesterol and you should have a repeat test after 6 months of a lower cholesterol diet and exercise.
Medical treatment of cholesterol includes resins which bind cholesterol, niacin, gemfibrazole (useful for elevated triglycerides) and statins. 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.
Here are some previous questions.
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
Cholesterol has been identified as a major risk factor in the development of heart disease. Early studies established high cholesterol as a risk factor for developing heart disease. 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.
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. A total cholesterol of 209 is borderline high but would be less concerning due to the high HDL. An LDL of 149 is slightly high. Pregnancy may cause an increase in cholesterol and you should have a repeat test after 6 months of a lower cholesterol diet and exercise.
Medical treatment of cholesterol includes resins which bind cholesterol, niacin, gemfibrazole (useful for elevated triglycerides) and statins. 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.
Here are some previous questions.
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
