Medication

Good morning.  I'm 32 years old, male, family history of heart disease.  My last physical in December included a normal electrocardiogram, normal blood pressure, cholesterol 198 (down from 270 last year), but I'm still about 30 pounds overweight.  The doctor also sent me for an echo test for the first time which also turned out normal.

Although my cholesterol level was down significantly, my LDL is still far higher than my HDL and my triglycerides were, in the words of my doctor, off the chart.  He had suggested last year my going on Zocor but decided to hold off since the overall number had gone down.

I had never heard triglycerides mentioned before, so can you explain what they are and how the overall cholesterol measurement number is calculated?  Also, will I be able to stay off meds through diet and exercise or will my family history eventually catch up with me?  I have suffered from anxiety on and off for more than ten years so there are times when I think I am having heart disease symptoms but there has never been any problems found.  I'm nervous that being on meds would make these episodes become more frequent.

Thanks.

[CCF-M.D.-RCJ]

Xchange,
Congratulations getting your cholesterol down below 200.  Fat from your intestines is packaged as triglycerides (TG), and in some people they can become quite high, usually in association with a familial syndrome, but sometimes from medicines such as cyclosporine, some diuretics, from excessive alcohol intake, or from eating prior to giving the blood.

To properly answer your question I really need to know the level of the triglycerides and whether or not you had fasted before giving the blood sample.  However, assuming that your doctor is prone to exageration and that your TG are not "off the chart", then there is certainly a chance that you could further reduce your cholesterol and triglycerides by exercise and weight loss alone.  I would certainly recommend trying an exercise program (assuming your doctor approves) before starting a medicine.

The Friedewald equation is commonly used to calculate the LDL, but the total cholesterol, HDL, and triglycerides are measured.
The equation is:
LDL = Total cholesterol - HDL - TG/5.
This equation, however, does not work for people with TG > 400.

Hope that helps.