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Cholesterol levels
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Cholesterol levels

I have some questions about cholesterol readings.  

13 years ago (age 40), after getting an initial total cholesterol reading of 305, being quite concerned, I started cutting fats from my diet, which HAD included whole milk, eggs fried in butter, lots of fat in general.  Since then I've had 5 full cholesterol screenings.    The first one was 3 months after the 305 reading, after a lot of low-fat eating.  It was total=162, LDL=102, HDL=44, TG=78, which gives a ratio of 3.7 or a percentage of 27.  Of course, this dietary regime was one that I wasn't likely to continue indefinitely.

A few years later, and eating much fast food, my figures were: Total=254, LDL=147, HDL=86, TG=105, which gives a ratio of 2.95 or a percentage of 33.9.  At this time the doctor told me my cholesterol was "great" and that I didn't have to worry about what I ate.  As he is a cardiologist this certainly surpised me but I was happy to accept it.

Some of the time these past 13 years I have done aerobics and weight training.  I am always fairly active.  During my very least active spell, "sedentary" by my standards (and also eating poorly by the way), I had a Total=236, LDL=161, HDL=66, TRI=48 which gives a ratio of 3.57 or a percentage of 27.9

My last test, last summer, had the following results  Total=288, LDL=191, HDL=88, TG=48 which gives a ratio of 3.27 or a percentage of 30.5.  The doctor suggested that I take medication to lower my cholesterol based on the high LDL reading.  I have been hesitant to do so.  I currently do step aerobics and weight work at home and since that last screening have been eating reasonably well.

So, my questions:
Is LDL ever actually measured or is it always calculated?  Wouldn't a high Total chol reading usually give you a high LDL as well, even after having subtracted a high HDL reading, and especially after subtracting one fifth of an already low TG reading?

Are there upper limits of possible Total, HDL, and LDL?  When my total was 305 might my HDL have been higher still than 88?

What are the current guidelines for determining whether a person should take cholesterol lowering medication?   Is it the LDL reading?  The HDL reading?  The ratio of Total to HDL?  

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238668 tn?1232735930
Dear Karen,
You have demonstrated very nicely that your cholesterol can be significantly lowered by diet alone - that is an achievement to be proud of!  However, since you went off the low fat diet your cholesterol has gotten progressively worse and is now in the range that the current guideline recommend adding drug treatment.

LDL can be measured directly in special labs but is expensive and not usually done.  The calculated LDL is quite accurate however and is determined by the following formula: LDL = Total cholesterol - HDL - 1/5(Triglycerides).  This should be determined from a fasting sample.

There are no 'upper limits' to cholesterol and in certain genetic disorders the blood lipid levels can get so high that the blood is a milky white color.

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.  Guidelines 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.  The desired ratio between total cholesterol and HDL should be between 3 to 4.

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.

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:


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).
Avatar n tn
My Father has very high cholesterol. He has had 2 open heart surgeries, a pacemaker, 1 stint in his heart and now his Doctor is wanting to try a procedure on him which is like a kidney dialysis. They will go in and filter his own blood and run it back through his body and this should remove some of the cholesterol. Has this been proven to work on patients? I have never heard of this procedure and I am very concerned about my Dad. Please let me know something on this procedure.
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