Elevated Cholesterol Levels

[C Burnette]

How high and for how long do cholesterol levels have to be elevated to do any artery damage? My husband is a 39 year old white male. His total cholesterol level for the past 12 years or so has been 240 or greater. His last cholesterol level test was in January of 2000 and fasting total was 307, HDL was 50, LDL was almost 200 and triglycerides were 291. There have been times when his cholesterol could not be calculated because of triglyceride levels being in excess of 400. He was diagnosed with Type 2 diabetes in 1995, hypothyroidism in 1997, high blood pressure in 1999. In 1995, the physician made a note in my husband's medical records that he had hyperlipidaemia. We were not told this. He is experiencing quite a lot of fatigue. He exercises 3 times a week, eats a low fat and as a low cholesterol diet that he can. He started taking 10 milligrams of Lipitor daily on February 1, 2000. He has a family history of heart disease and diabetes. His father passed away recently at the age of 72 with a heart attack. His father's cholesterol levels were always within normal limits. In March 1999, my husband had a stress test performed. It came back showing a slight abnormality. A week later he had a thallium stress test which apparently came back normal. He has been experiencing chest pains as well. He went to see a cardiologist in February 2000 and the doctor performed a stress echo. The results of the stress echo were normal as well. Given the fact that my husband's family history is extensive with risk factors, and that my husband has all of the risk factors as well, should we push for more extensive testing for CAD? Can the results of the stress echo and the thallium stress test be reliable enough to say that my husband does not have CAD? I have heard coultless situations where people had stress tests resulting in normal readings and a few months down the line having a heart attack or needing bypass surgery. My husband's father had a stress test in early or mid 1999 and the results were normal. In mid December he went into vfib on 3 separate occassions. On December 22, 1999 he had a cardiac cath and it showed the left main artery was 95 percent blocked. A bypass operation was scheduled for Christmas Eve-he died in surgery as a result of a massive heart attack the doctors said. Is it possible to go from a normal result stress test and six months or so later have a 95 percent blockage? We do not want to be told by the doctors that there is not a problem and then have a problem to manifest itself in a big way and have them say maybe there was a problem and that it was not caught in time. Are there any other types of tests to determine CAD other than stress tests?

Thank you for your time.

[CCF CARDIO MD JMF]

Dear C. Burnette

You have posed many important and difficult questions for me.  Let me see if we can move through them.

How high and for how long do cholesterol levels have to be elevated to do any artery damage? My husband is a
     39 year old white male. His total cholesterol level for the past 12 years or so has been 240 or greater. His last
     cholesterol level test was in January of 2000 and fasting total was 307, HDL was 50, LDL was almost 200 and
     triglycerides were 291. There have been times when his cholesterol could not be calculated because of triglyceride
     levels being in excess of 400.
Your husband has the typical lipid pattern associated with adult onset diabetes.  In general, weight loss and aggressive control of the diabetes with correct some of these changes.  He might also require the addition of a statin to control his LDL.  Fatty streak, the beginning of blockages develope early in life.  these levels in combinaton with his other risk factors will accelerate the aterosclerotic process.

Given the fact that my husband's family history is extensive with risk factors, and that my husband has all of the risk
     factors as well, should we push for more extensive testing for CAD? Can the results of the stress echo and the
     thallium stress test be reliable enough to say that my husband does not have CAD?  I would recommend a second opinion for the evaluation of chest pain in your husban.  If his chest pain is truly typical for angina,meaning that it is provoked with exercise and predictably relieved with nitroglycerin or rest, then i might consider a cardiac catheterization in view of his high risk burden and his family history.  

Is it possible to go from a normal
     result stress test and six months or so later have a 95 percent blockage? A normal stress test does not mean that a blockage will not develope.  in fact, we know that the majority of heart attacks are the result of rupture of a cholesterol plaque that does not cause a significan blockage.
  
     Are there any other types of tests to determine
     CAD other than stress tests?  The gold standard is a cardiac catheterization.  This is generally recommended in the setting of symptoms of coronary insufficiency and or chest pain.

[C. Henson]

My husband and I recently went for a blood analasis test. My results were Cholesterol 234 Cholesteral/hdl ratio 7.80.LDL chol, calculated 127, triglycerides 385 iron 119 and HDL cholesterol 30. Don't understand these numbers. Also ALT was 42 and don't even know what this is. I am a 42 year old female and heart disease runs  in my family. Could you please explain these figures to me. Also my husbands was Cholesterol 227, cholesterol/HDL Ratio 7.09 LDL Chol, calculated 139, Triglycerides 282, Iron 210 and HDL Cholesterol 32.What is transferrin saturation. His was 64.His wbc was 12.2 and hematocrit was 51.0, MCV 98.2. He was diagnosed in Feb. 1999 with Pulmonary Fibrosis. His oxygen level keeps dropping and they are trying to figure out why. He also has spells at night where he almost quits breathing and they don't know why yet. He just gasps for air it is like there isn't enough air. He is on Predizone, Singulair, and Prilosec. He is on Cipro right now for water behind the ear. If you could help explain these results for me. Thank-YOu

[ray]

I had normal tests for a long time and in 6 months, I had a full physical including a stress test, after it was slightly abnormal, I was given a thallium stress test.....abnormal then the next day for a cath.....Wham.....quadruple bypass(99,95,90,85% blockages).

18 months later I went back for a thallium test(normal) then on to Atlanta for a PET test. This showed that my arteries are beginning to clog up again.

I am all over this with the Ornish diet and 5 day a week running. My last test showed BIG gains in HDL and total cholestorol of 145. My ratios are almost 1:1.

You CAN do something. I fully support getting tested and a second opinion. You have to take charge of your own health.
Do research, read, ask questions and by all means insist on full testing of your heart. If you don't do it, you are leaving all the decisions up to someone else.

Good luck.

[JeanBean]

Can you give me any information on the latest heart blood test that is called:  CRP?  There was a news article on T.V. about it just a few days ago.   They said it seems to be quite valuable and is inexpensive.   That is all the information I have.

Thank you.

[Sara]

Hi, I am 52 female, thin, good health..stopped excersizing two years ago because of high stress family problems..began frequent heart pain-  I was diagnosed with high resting heart rate (107) and high cholesterol 250..Doctor states it is due to the stress i have been under last two years.  He is suggesting a beta blocker and Lipitor to lower cholesterol. I prefer diet and excersize which he also recommends.  Questions- I have always had low cholesterol 145, and resting heart rate of 75 until the stress began. Is there any link between high cholesterol and stress? How do the beta blockers work?  All tests were normal except for these two problems.  Any suggestions or comments would be welcome..no family history of heart disease.
thanks for the help

[[e-mail]]

My cholestrol is at 209 Tryglycerides ar 455 I take Pravachol 40mg. In January I was taking Pravachol 20 MG and Triglicerides (triglycerides)
were at 168 and Clolestrol at 209.
Can you give advise. On diet and Medicine.(lost?)

[RICHARD BENTON]

I RECENTLY RECIEVED A CARDIO CRP RESULT OF 8.3 MG/L.
CAN YOU TELL ME WHAT A NORMAL REFERENCE RANGE WOULD BE?
CAN THESE RESULTS BE SKEWED BY A CONCURRENT RESPRITORY INFECTION?
THANKS.