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Lee Kirksey, MD  
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Cleveland , OH

Specialties: Peripheral Arterial Disease, PAD

Interests: vascular, specialist, treatment options
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What is high cholesterol? When Should it be Treated

May 19, 2008 - 17 comments
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high cholesterol

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Cholesterol

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cholestasis

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atherosclerosis

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Stroke

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Diet

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Diet and Exercise

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Cardiovascular Disease

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Heart Attack



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What Is High Blood Cholesterol?

Cholesterol levels are determined through chemical analysis of a blood sample taken from a finger ***** or from a vein in the arm. Home cholesterol kits, first approved in 1993, test only for total cholesterol levels but are as accurate as tests done in a doctor's office, says Steven Gutman, M.D., director of FDA's division of clinical laboratory devices. "These tests can give a consumer very valuable information when screening for high cholesterol," he says. "But they shouldn't be considered substitutes for a test conducted in a doctor's office." He adds that if test results are elevated, consumers should see a doctor right away for a more refined blood analysis. The National Cholesterol Education Program considers cholesterol testing in a doctor's office to be the preferred way because the patient can get advice immediately about the meaning of the results and what to do.

Besides determining total cholesterol levels, doctors often order a lipoprotein profile that shows the amounts of LDL, HDL, and another type of blood fat called triglycerides. This information gives doctors a better idea of heart disease risk and helps guide any treatment.

Cholesterol levels are measured in milligrams per deciliter (mg/dL). The National Cholesterol Education Program developed the following classifications for people over age 20 who do not have heart disease:

Desirable blood cholesterol--Total blood cholesterol is less than 200 mg/dL; LDL is lower than 130 mg/dL.
Borderline high cholesterol--Total level is between 200 and 239 mg/dL or LDL is 130 to 159 mg/dL.
High blood cholesterol--Total level is greater than 240 mg/dL or LDL is 160 mg/dL or higher. For patients with heart disease, LDL above 100 mg/dL is too high. In addition, an HDL level less than 35 mg/dL is considered low and increases the risk of heart disease.

The main goal of cholesterol treatment is to lower LDL in people without heart disease. If the LDL level is in the "high" category and fewer than two other risk factors for heart disease are present, the goal is an LDL level lower than 160 mg/dL. If two or more risk factors are present, the goal is less than 130 mg/dL. If a patient already has heart disease, LDL levels should be 100 mg/dL or less. By reducing LDL, heart disease patients may prevent future heart attacks, prolong their lives, and slow down or even reverse cholesterol buildup in the arteries, according to the National Heart, Lung, and Blood Institute.

Treating High Blood Cholesterol

When a patient without heart disease is first diagnosed with elevated blood cholesterol, doctors often prescribe a program of diet, exercise, and weight loss to bring levels down. National Cholesterol Education Program guidelines suggest at least a six-month program of reduced dietary saturated fat and cholesterol, together with physical activity and weight control, as the primary treatment before resorting to drug therapy. Typically, doctors prescribe the Step I/Step II diet (see "Food for Thought") to lower dietary fat, especially saturated fat. Many patients respond well to this diet and end up sufficiently reducing blood cholesterol levels. Study data reinforce these benefits. For example, a 1998 Columbia University study examined 103 male and female patients of diverse ages and ethnic backgrounds and found that reducing dietary saturated fat directly affected blood cholesterol. For every 1 percent drop in saturated fat, the study showed a 1 percent lowering of LDL in patients.

But sometimes diet and exercise alone are not enough to reduce cholesterol to goal levels. Perhaps a patient is genetically predisposed to high blood cholesterol. In these cases, doctors often prescribe drugs. The National Cholesterol Education Program estimates that as many as 9 million Americans take some form of cholesterol-lowering drug therapy. The most prominent cholesterol drugs are in the statin family, an array of powerful treatments that includes Mevacor (lovastatin), Lescol (fluvastatin), Pravachol (pravastatin), Zocor (simvastatin), Baycol (cervastatin), and Lipitor (atorvastatin). Many doctors say statin drugs have revolutionized patient care.



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by alienshadow, May 19, 2008
okay i had mine done last week total was 170 last time i took it it was 220 what i dont understand is my good cholesterol was 34 it was 35 can you explain
and what would be a good way to raise your good thanks

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by ladybug52, May 19, 2008
What a blessing that you posted this.
I just returned from the dr.'s office with the HDL of 239 and LDL of 148.
My triglycerides are 70
I've never had high cholesterol before, and my LDL was never this high.
You put out a lot of info in this post.
Thanks so much....

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by md101706, May 19, 2008
Taking Cholesterol Medication! Have Elevated CPK!!
by md101706

Taking Lipitor, Niacin and baby Aspirin 81mg to control cholesterol! Recently took a blood test and noticed elevated Creatine PhosphoKinase at 268! I exercise, diet and take medications mentioned as part of an overall plan to control cholesterol and blood pressure! Is this elevated CPK of 268 something to be concerned about! What is considered a dangerouis level of CPK? Is it possible CPK is a result of exercising(running and weightlifting) or is it the cholesterol medications that's elevating my CPK? Appreciate your expertise and thoughts on this matter, Thanks!!


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by Jane204, May 20, 2008
I'm a 64 yr old female, 5'10" 135 lbs, taking Fosomax 70 mg once a week.   My cholesterol is 285 with 117 HDL.  My primary care physician has told me not to worry about the high number because the HDL counteracts it.  In the meantime, my application for a life insurance policy was changed from "preferred" to "standard" with double the premium because of the cholesterol flag.  There is also a family risk of cancer which probably affected the insurance -- my sister had breast cancer before the age of 61.

Should I be concerned about the 285 cholesterol?  I'm hearing conflicting opinions.

Thank you.

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by Lee Kirksey, MDBlank, May 20, 2008
Jane
What is your LDL? In history of htn, smoking, dm, activity level family hx MI, stroke?The guidelines whould suggest that your PCP is correct if you dont have risk factors for MI



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by ladypar, May 20, 2008
my total choes is 285 ldl 177 hdl73 trig 85 have hbp and exercise everyday eat healthy but the ldl stays up. i have unsustained vt and take topal ,minimal valve disease ans mild cardiomegly. is this heart disease anough to take statins?

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by Frank303, May 21, 2008
I've never had my blood cholestorol checked. Is testing recommended if, say under 40, smoker, active job, BP at rest (Doctors surgery) c.120/80? Where can I get blood cholestorol checked, other than through my GP, who recently must be getting fed up with me?



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by Lee Kirksey, MDBlank, May 21, 2008
ladypar
It's a judgement decision but you have a high LDL with several risk factors. You would fall well within consideration for statin therapy along with optimization of your diet with lo saturated fat <15-20 gms/day

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by DaGord, May 27, 2008
Hi,

I'm a 50-year old female who has been hospitalized three times since September, 2006 for hyper-triglyceride induced pancreatitis.  All they really seem to be able to do is give fluids, withhold food, and pain management.  The 1st time my Triglycerides were 888, the 2nd time it was 710; however, this last time (April, 2008), my Triglycerides were 1,152 at the time I was released from the hospital.

My HDL and LDL were 38 and 80 respectively the first time for a total cholesterol number of 288.  I don't have my HDL and LDL numbers from my April '08 hospitalization, but I was told my total cholesterol was 443.

I also have high blood pressure and take Lisinopril for it.  I was on Advicor for the cholesterol but did not tolerate the side effects well.  I don't smoke, I eat a very low fat, high fiber diet and am well within my desired weight range, I do yoga and walk regularly (but am not a "speed walker" by any means.)  The dr's tell me it's genetic...father & older sister had HBP, father had an enlarged heart,etc.

I feel like a stroke waiting to happen and am not sure what to do next?  Lipitor has been suggested for the cholesterol issue but I'm still on the fence about the meds.  Any suggestions?

Thanks

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by FitnessBuff, Jun 20, 2008
I wanted to report success using sustained-release niacin and pantethine to help a life-long problem with cholesterol. These are over-the-counter drugs and require no prescription (although because they do their magic in the liver, that organ should be monitored by occasional blood tests once or twice a year as a precaution.)

Anyway, after a lipid panel showd my cholesterol at 274, LDL at 171, and triglycerides at 214, I picked up a copy of Kowalski's "8-week Cholesterol Cure" and followed his regimen -- after just 6 weeks my cholesterol was 244, LDL 136, and triglycerides had fallen to 77. Even better the Total Cholesterol / HDL Ratio had dropped from 4.57 to an almost ideal 2.6 (because my good HDL skyrocketed to 93.)

Although a number of companies manufacture niacin and pantethine, I followed the book's recommendation for a mail-order company in Oregon called "Endurance."  They have a combined 500 mg niacin / 200 mg. pantethine pill, which I take twice daily, which they call "Endur-thine."  After I take the pill there is a brief and mild "flush" feeling that goes away in about an hour (this is effect is much reduced from the regular -- non-sustained release -- niacin.)

I was pretty dubious at first that a simple "trick" like this could work so well -- I don't know if everyone will do so well with it, or what other variables (careful diet and high exercise in my case) are crucial variables as well.  Also, I do not know how effective niacin and pantethine are with really severe cases of high cholesterol -- maybe even better or maybe not, or maybe it depends on the individual.  But I would say to anyone, it is worth a try.

The regimen apparently takes a couple months to really get rolling, so I am hoping the next blood tests shows even better results.







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by help786, Jul 25, 2008
Hello Dr. Lee Kirksey,

I recently had a lipoprotein profile done. My total cholesterol was 159, HDL 33, LDL 96 and Triglycerides 219.

I also have heart palpation time to time. sometime every other week and sometimes months. I had a holter test few weeks ago and doctor found palpation in the result. He asked me if I want I can use beta blocker. But I am not using it for now.
I also have  uncomfortable feeling on  my heart.

My cardiologist advised me to take Simcor one tab daily. apparently my cholesterol level looks fine than why do I have to take cholesterol medication. I haven't started taking the medication.

I also take Lisinopril 30 mg for my hypertension.

I will appreciate your advise.



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by solo1980, Mar 05, 2009
just got my from a weight loss center, cholesterol level is 274 and tryglicyrides is 254. what should i do i'm going take diet pills they gave me. should i follow up with my regular doctor or wait 6 month  and have it done again after couple of pounds lighter. im 28 years male 5'5" tall. 226lbs.????

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by nononblonde, Sep 09, 2009
Today I got  my blood test results.
I am 5'10, weigh 136 and I smoke, do not drink.
My cholesterol is 274
triglicerides 239
HDL cholesterol is 65
percent HDL 24
LDL cholest. 169

what does this mean? am I going to have a heart attack?

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by angel45879, Jul 14, 2010
I just got my blood work back why is my LDL 38 and my cholesterol 103 and my Triglycerides are 91 just wondering  why my LDL is low.my total Choesterol is 159 is that good or what can i do to make it better,and am 5'5 and 216 pounds and i smoke about pack and a half a weekand i dont drink.

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by V_RAMANAN, Aug 23, 2010
I am 51 years old Male
I just got my blood test result
Haemoglobin is 14.9 gms%

Random Blood sugar 94mgs/dl

Creatinine  1.0mgs/dl

Cholesterol total is 204mg/dl

Triglycerides   124mg/dl

Now just tell me what I Got to do

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by ozmanashraf, Nov 20, 2010
Dear Dr. Lee Kirksey,

i am male and MY age is 28 and my cholesterol was 250 , triglycerides was 111 , HDL was 50 and LDL was 179  . my both parents are also facing high cholesterol .  after this lipid profile test i started doing exercise regularly and started following a strict diet plan e.g(oat meal.walnuts,tuna ) after exact two months i lost 5kg weight and now my weight is 77kg and my height is 5'9.  i again did my lipid profile test and my cholesterol was  243 , triglycerides 61 , HDL 54 and LDL 179.do u think i should start taking a medicine for lowering my cholesterol or these results are encouraging .i dont have have any blood pressure problems or pain in my knees or sugar . plz plz advice .

rgds
ozman




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by AndreaMa, Sep 24, 2012
Dr. Lee Kirksey
I'm a 29 female, 5 1" tall, 104 pounds. I stopped eating meat and poultry 5 years ago, I have a healthy diet and exercise regularly and my  total cholesterol is 243, hdl 77, LDL 148 and triglycerides 90. How can I lower my cholesterol? Should I see a doctor and star medication? I believe my only risk factor is inheritance (grandparents with arteroesclerosis and heart attack at a young age).
Thank you so much

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