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Cholesterol Questions

I am a 30 yo male, 200 lbs, 5'10"...had A-fib back in summer of 2006 with no return since. Took cardizem for about a year following and had PVCs off and on that entire year. All echos have read no prolapse of MV but some mild MR. I have had two chol. panels, unfortunately during my two most sedentary periods

(April 2005)
Total = 214
Tri = 134
LDL = 146
HDL = 42

(March 2006)
Total =  171
Tri = 206
LDL = 101
HDL = 26

Since this time I have been running 9-12 miles a week, eating soluble fiber every day and taking fish oil, CoQ10, and Mag...I have back and chest pain that every cardio has told me is probably muscular...but I am having ANOTHER stress test next Tues. just to rule out anything serious.

Here are my questions...

1. Will the stress test really tell me anything I don't already know? I've had people tell me they suffered a heart attack a month after a negative stress test? Wouldn't a scan be better? Or is this the protocol?

2. I know my cholesterol ratios are not great...I am having a panel done next week and am curious to see how my lifestyle changes over the last 18 months have helped change my cholesterol. My question is how concerning are these readings? I have no history of CAD except for the brother of my maternal grandmother. No grandparents, parents, brothers or sisters have had CAD, but is it possible that I may have inherited this uncle's genetics? I've read on this board that low HDL may be the biggest indicator of CAD...do I need to start taking niacin or some other med? Is it possible to have low HDL and never develop CAD?

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19 Comments Post a Comment
     Taking charge of your health is certainly a good thing, and you need to be commended for doing just that.   The stress test will yield useful information, and don't be surprised if you do exceptionally well.  
    The issue with cholesterol is what is happing now   will affect you years from now.  It sounds like you want to be aggressive in preventing future problems.  I would suggest two things:  The first, to help you understand a little more about cholesterol, I would suggest you go to NPR.org (National Public Radio) and do a search for cholesterol.  There was an excellent feature "Not all calories are created equal."  That should be the second thing that comes up with your search.  You can listen to that feature on line.
   The second thing is to read Arthur Agatston's book, "The South Beach Heart Program."  Agatston is a renown cardiologist and the author of "The South Beach Diet."  He writes about aggressive prevention of heart disease.  His ideas make a great deal of sense to me.  
   Allthough I am more than double your age, I have found that Lipitor (40mg/day) has taken my overall cholesterol to 113.  Niacin, exercise, diet, etc., did not seem to help.  
   Again congratulations on your active health management.  Doing the right things today will most certainly reward you years down the road.  
   One thing for sure, your excellent questions are appropriate for your cardiologist.
Thanks for the advice...I just ordered the book! I look forward to reading it.

Can you tell me any more about your history? What is/was your HDL level?

I don't remember my original numbers.  I started taking statins several years ago.  I do know it was around 220.  My ratio of HDL to LDL was always poor, with way too much LDL.  Six weeks ago, I was tested with 113 total cholesterol, 33 HDL and 66 LDL.  I had problems with a fib and had that fixed with an ablation.  So far, the only medication I do now is Lipitor and a daily aspirin.
thanks...how old are you? Have you had low HDL for a long time? Any CAD...sounds like no.

GREAT to hear your a-fib was fixed with ablation...where did you have it done.

1. Stress tests are the standard protocol.  A person can have a negative stress test and have a heart attack the same week, it happens.  The reason for this is that a stress test may not show ischemia (lack of normal blood flow) because cholesterol builds *within* the artery wall.  Most heart attacks are caused when the plaque accumulates to the point the artery wall becomes weak, and ruptures, releasing plaques into the bloodstream.  The blood forms a clot around this plaque, and voila, a heart attack happens.  This is why aggressive management of cholesterol is vital.  Stress tests are good, but not perfect by ANY means.

2. Your total cholesterol number improved, but the numbers are actually more worrisome.  Your HDL is dangerously low and your triglycerides (typically a reflection of what we eat) are quite high.  Your LDL (bad stuff) came down some, but the overall risk is increased because of the HDL drop.  Low HDL is equally as bad as high LDL.

I think it would be extremely wise to take Niacin.  My husband's HDL was 28, and is now 36, thanks to the Niacin.  As far as the risk, you have risk factors.  Family history is only part of a very big picture.  This means you could have a family full of CAD and never get it...or you could be the first who does.  It sounds like your numbers require some aggressive action.

You're my age.  That means your risk factors based on age are low, however, having the numbers you do at this point in your life means you need to do all you can to get and keep things in check.  It sounds like you're doing a lot of good things!  Hopefully next check your numbers will show the benefits.  Stay on track.  If that HDL is still rock bottom, please ask about Niacin.
thanks for the thoughful response. I basically am waiting for this next workup. Interestingly, my cardio's response to my last panel (the one with low HDL) was that "everything looks good...you can lower the triglycerides by not eating so much fast food". She didn't seem concerned. Anyway, I'm going to a new guy now...and hopefully my numbers will be better. My HDL was 42 before...so not great...but I think that is within the normal range?

I am going to ask about Niacin...

What risk factors do you see besides the low HDL?

I am 5'10", 200-205 lbs. I know that is technically "overweight"...but I have a lot of muscle mass left over from being an athlete...my waste is 36-37 inch range.

1) Stress tests are informative but not perfect. This is what one web site said about it

"What is the reliability of a Regular Stress Test? If a patient is able to achieve the target heart rate, a regular treadmill stress test is capable of diagnosing important disease in approximately 67% or 2/3 rd of patients with coronary artery disease. The accuracy is lower (about 50%) when patients have narrowing in a single coronary artery or higher (greater than 80%) when all three major arteries are involved. Approximately 10% of patients may have a "false-positive" test (when the result is falsely abnormal in a patient without coronary artery disease)".

2) Nispan ( prescription niacin) was the only thing that raise my HDL. I cut out smoking, watch my diet, jog 9-15 miles a week.  Nothing help but niaspan. (I am not sayiing these things might not work for you, but they didn't help me in the HDL department.) I had a heart atack just about 2 years ago when I was 53.  I made real changes in my diet.  I  thought that cutting out the trans fat would help my HDL but it did not.

I now take 2000 mg of Niaspan at night. (I also take 20 mg Lipitorone one night/ 40 mg Lipitor the next night to lower my LDL.)

Here's my cholesterol numbers

Before heart attack,

Total 198
Tri     123
LDL:  139
HDL   35


Total 95
Tri   38
HDL  45
LDL  42

Niapsan can cause flushing in some people but I have had any problems.  You won't know until you try it.

I have heard that pomegranate juice raises HDL.  I didn't try it because it is in the same family as grapfruit juice.  Grapefruit juice can increase the effect of the statin (much lower LDL).  My Drs don't want my LDL to drop any lower so I didn't pursue pomegranate juice.

If your HDL numbers are still low, you may want to exercise more frequently, like 5-6 times a week, and for longer periods of time. There is some evidence in the literature that you need to cross a threshold of exercising to raise the HDL but I couldn't find a magic number.

Good luck!

Thanks for the advice...I will see what kind of numbers they come back with next week. If there hasn't been a change (from 18 months ago) I will ask about Niacin. Are there any dangerous side effects like there are with statins?

Do you have a family history of heart disease? Did they do a CABG or a stint after your MI? Thanks again for the good input...I appreciate it.

I guess the only thing I wonder is...will a 10 or 15 pt. increase in HDL really make a difference or is someone just predisposed to this.

Also, are there people out there with low HDL, high LDL or high TGL that simply never experience the negative effects of this increase?
The Drs will monitor your liver enzymes, just like they would for statins. The chief side effect is the flushing effect. The flushing can be severe and some people describe it as if you are burning up. According to the manufacturer, the longer you are on Niaspan, theless likely you are to flush. Each person is different. You will just have to try it and see how it goes. (Taking a single aspirin about 30 minutes before you take the pills or eating a low fat snack can also stop the flushing.)

My father had had his first attack when he was 40 and died at 50 from congestive heart failure. (His brother and sister are still alive and kicking in there 80s). I had one stent put in after my heart attack. It was in the circumflex artery.

It is my opinion that raising your HDL will help reduce your chances of having a heart attack. There have been several studies that show this.  I  think it is worth taking.  I would talk to your doctor and get his/her opinion on niacin.

I don't think you are necesarily predispose to heart disease. I think you can do things that improve your chances of avoiding a heart attack or do things that reduce your chances of having a heart attack. There are no gurantees; no one can say who will have a heart attack or not. A doctor or medical researcher can only say that in a population with certain risk factors a certain proportion will get a heart attack.  As to which individuals will be the "lucky duckies" no one can say.

Good luck!
I would add one more thing. I have read that 1/3 of the population of the US has low HDL (lower than the desirable amount). But if you think about it, 1/3 of the population doesn't died of heart attacks at an early age.  The average life expectancy is 70 or 72.  I think low HDL is one more risk factor in the  mix. I do everything I can to lower my risk.  I take Niapsan because I think it help reduce my chances of having another heart attack. You will have to decide for yourself after talking to your Drs.
To respond to your questions:  I am age 64 (6'5" and 205 lbs.)  I live an active Wyoming lifestyle.  I do have CAD, which was detected with a CT a few months ago---two arteries 40-70% blocked.  Shortly after receiving the diagnosis, I did a 10 mile round trip day hike/fishing excursion in the mountains up to 10500 feet.  Two cardiologists told me that despite my partial blockages, I am probably in the top third of 64 year old males when it comes to over health and cardio fitness.  
   You had good advice from anacyde regarding niacin.  I take it in addition to statins.  It appears to have helped my HDL.  Keep in mind, however, that many people receive no benefit from niacin.  
   Regarding my HDL and LDL ratio, it has been poor since I have been measuring my cholesterol.  It is likely that genetics is the major culprit, and I would guess is your problem also.  The good news is it is very manageable with "aggressive prevention."  Again congratulations for your awareness and getting started early in your cardiovascular management.  
Thanks for the info! I am anxious to see what my scores are since I have been really implementing the healthy lifestyle factors for almost 16 months now. Hopefully my levels will have worked themselves out.

Has anyone else used the Framingham calculator to determine MI risk? I did it and plugged in my numbers (including HDL) and my 10 year risk was "less than 1%"...is this a pretty good measuring stick or is it inaccurate? I noticed the interventional cardiology doc on this site recommended it.
Hello all,

I posted on the doctor's forum that I received some discouraging results this week. My cholesterol results were:

Total: Up 170 to 175
LDL: Up 101 to 126
HDL: barely up 26 to 27
Tris: Down 206 to 145

This is after 20 months of regular, solid exercise (30 minutes 4 times a week at HR of 140-160), taking fish oil, taking COQ10, and taking Magnesium for PVCs. I feel like I have been watching my diet (very little fast food, watching the bad fats, EATING OAT BRAN EVERYDAY)...and the results were not good. I feel like at this point I have two options...

1. Start taking Niacin and maybe even a statin

2. Try the South Beach Heart Diet and see if it helps. I'm in pretty good shape I feel...but I am 5'10" and 200 lbs which I know the numbers say is too much weight. I'm going to try the diet with my wife and see if it helps. Honestly I don't care about losing weight unless it helps my cholesterol.

Ofcourse my cardio has not called me to follow up and the doc on the forum (and a friend who is a cardio) both said they WOULD NOT start taking meds at my age (30)...but this seems to directly contradict what the South Beach doc says...

Any other thoughts? Thanks
I saw your post and the doctors responses. I was really puzzled by parts of his/her second response to you.

" We know that in estimating CAD risk, high HDL takes away one point, but the opposite can't be said about low HDL.  The evidence for low HDL causing CAD is not that strong.  "

From what I seen, there is lot of evidence that having low HDL increase your risk.  Whenever there is a discussion of cholesterol risk factors, having an HDL below 40 for a male increases the risk. If the evidence is not that strong, why would they (Drs) harp on it? If it didn't matter, why would call HDL the good cholesterol.

"In fact there was a recent trial where we tried to increase HDL via taking an experimental medication, and that actually led to more problems than solutions"

The new drug was torcetrapib and indeed cause problems. The study was stopped which was a bummer since there very few drugs that can raise HDL.  Niaspan has been in used for around 10 years and I have not heard of any problems like they had for torcetrapib. To me, throwing out Niapsan because torcetrapib had problems doesn't seem rational.  I don't get it.

It is true that the studies done with niacin have all been done on people with a documented history of heart disease.  A combination ofnicain and a statin help them. (see Brown, Eur Heart J, 7, Supplement F, F34-F40, 2005.  It doesn't seem to be too unreasonable  to think it might help people w/o heart disease.

I would try following the South Beach diet and get retested in 6-8 months. I would also try to loose some weight.  I saw that your waist is 36-37.  Is this from a tape measure or pants label?  I found out the hard way that pants label is not always true. For example I was buying jeans with waist size of 36; when it was measured by the dietician, it was 40 in. I am 5"10" and was 182 lbs at the time. I have since lost about 30 lbs.

Do you know what fasting blood sugar is? Is it below 100?
Hey...thanks again for all of your good info. I agree that I was a little puzzled by the doc's response. Especially in light on the South Beach Doc's information.

But I also just spent 45 minutes on the phone with a friend who is a cardiologist and he was also very helpful. I'll try to share some of what I am hearing from all ends...

HDL- my cardio friend said, yes it is a risk factor and you want to try and raise the number...but according to the Framingham study (which he called the longest tested and gold standard)...and according to that my risk factors put me at a less than 1% chance of an event in the next ten years. So he said, according to the noted guys he's talked to...I should try to get the number lower...but that there are bigger indicators than just HDL. I am going to try the OTC niacin first and see if it helps...while simultaneously trying the South Beach Diet (my wife is joining me).

SBD- Do you think this diet is realistic unless you are willing to almost become a vegan? I really want to try it because I do eat way too many carbs and and sugars.

My blood glucose was 88 on this last test.

My waste size is probably 36-38...I wear 38 size pants and I need a few belt loops...but I will measure to see for sure.

Good news is my cardio nurse called and I am making an appointment with their cholesterol management specialist in the next couple weeks. I hope I can get these numbers straightened out.

Thanks again...let's keep this diaglogue going...it really helps!
Can someone suggest if these readings are abnormal?
My doctor hasn't put me on statins yet. He says medication
is not required but asked me to keep a close eye on diet and
exercise. I don't think diet is the cause of my cholesterol as I don't
eat any food that has cholesterol. Probably my liver is producing more

Total cholesterol  237 H

Triglyceride level 156 H
HDL 45  
LDLLdl test Calculated 161
Total Cholesterol to  HDL Ratio 5.3

Do I need to be concerned or just follow my doctor's suggestion?

Thanks in advance!
   I just read the doctors second response and I don't find it that puzzling.  Allthough Agatston recommends statins as part of his "aggressive prevention" routine, I am not sure he is talking about asymptomatic 30 year olds.   The reason, I believe, statins weren't recommended by the on line doc is because of your age and the fact statins have only been available for 20 years.  There are no long term studies regarding the safety of statins beyond 20 years, and you presumably will have a lot more time than that taking them--assuming taking statins is a lifetime commitment.  I believe had I asked the question of the doctor and he was aware two of my arteries being narrowed 40-70%, as well as my age (64), he would have strongly recommended statins.  Being aggressive in prevention of heart disease is not a one size fits all program.  Again, your age and making a lifetime commitment to a heart healthy lifestyle will serve you very well down the road--without medication.
   I would also agree that your inability to change your HDL (also my problem) is due to genetics.  
  Cholesterol questions are very complex.  Again, I would refer you to listening to the National Public Radio feature that appeared November 2 which addresses some interesting ideas:  
   According to this radio interview high LDL may not be a problem for some people because LDL comes in different sizes.  Some LDL can be quite harmful, and other subtypes or sizes can be quite benign.  There is a lot of ongoing research, so hang in there and stay tuned!
I think you should follow your Dr's advice and lower your cholesterol, particularly your LDL.  You should also exercise 5 times a week for about 30 minutes each time.

It's the saturate fat and/or trans fat that has been shown to raise your cholesterol.  It's not just foods that contain cholesterol.  For example, potato chips or french fries have no cholesterol, yet depending what they are fried in, they can have large amounts of saturate fat and/or transfat making them rather unhealthy.

What type of diet did your Dr suggest?  Maybe he/she can refer you to a dietician.

I follow a mediteranean type diet. It's about 30% fat diet. Basically it 5-8 servings of fruits/vegetables a day, 3-4 servings of legumes like kidney beans a week, an ounce of almonds or walnuts a day, 1-2 tablespoons of olive oil a day. You should have at least 2 servings of fish like salmon or trout as well as chicken or turkey. The serving size for fish or poultry is 3.5 oz, size of deck of cards. Red meat should be reduced or eliminated. You should try to increase your soluble fiber consumption to about 13-15 grams a day.
Thanks for the reply.
My doctor didn't specify any particular diet.However I am taking
proactive measures to reduce my LDL. I am taking flax seeds
and sesame seeds as they are proven to reduce total cholesterol significantly.
I am a vegetarian and so my source of cholesterol is almost 0 or negligible.
My diet is mostly rice, wheat and vegetables. I take a small cup of milk. So,
I think my cholesterol is coming from my liver.
I don't want to take statin unless it's inevitable.
I have a blood test coming up next month and if I don't see
any reduction I have to ask my doctor to put me on medication.
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