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Lee Kirksey, MD  
Male
Cleveland , OH

Specialties: Peripheral Arterial Disease, PAD

Interests: vascular, specialist, treatment options
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Elevated Choleterol 101-who needs to be treated

Aug 13, 2008 - 11 comments
Tags:

hypertension

,

Diabetes

,

Cholesterol

,

High blood cholesterol and triglycerides

,

Stroke

,

treatment



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There are always a lot of questions about the "art" or treating cholesterol. It's a good time to refresh everyone's minds about some common guidelines. Remember that they are just that...Guidelines. Discuss the options with your physician. Most of all, remember that a health lifestyle specifically a low fat diet can reverse many of these issues.

What can cause high cholesterol?

Elevated cholesterol levels can be caused by several factors, including heredity, poor diet, obesity, sedentary lifestyle, age, and gender (premenopausal women have lower cholesterol levels than men.) Of these causative factors, only heredity, age and gender cannot be controlled.

"Secondary" elevation of cholesterol

Some people have elevated cholesterol levels as a result of specific medical conditions, including diabetes, hypothyroidism (low thyroid,) obstructive liver disease, chronic renal (kidney) failure, and drugs (anabolic steroids, progesterone drugs, and corticosteroids.) In these patients, treating the underlying disorder often improves cholesterol levels.

Who needs to be treated for elevated cholesterol?

Deciding when to treat can be based on two factors: lipid levels (total cholesterol, LDL, and HDL,) and the presence of additional risk factors, as follows.

Desirable lipid levels:
Total cholesterol: Desirable levels are below 200 mg/dL. Total cholesterol is considered "borderline high risk" at levels between 200 and 239, and "high risk" at levels above 240. LDL cholesterol: Optimal LDL levels are less than 100 mg/dL. Near optimal levels are between 100 and 129 mg/dL. Levels between 130 and 159 are considered "borderline high risk;" and levels between 160 and 189 are considered "high-risk;" and levels of 190 and above are considered "very high risk." HDL cholesterol: HDL cholesterol levels below 41 mg/dL are considered too low.

Additional risk factors that modify cholesterol goals:
cigarette smoking
diabetes
hypertension (high blood pressure)
low HDL cholesterol
family history of premature heart disease
age greater than 45 in men, or greater than 55 in women
10-year risk of heart attack greater than 20% The 10-year risk is calculated from a formula that takes into account the individual's the lipid levels and other risk factors. Click here for the NIH's on-line version of the 10-year risk calculator.

Based on these two items (i.e., lipid levels and presence of additional risk factors) treatment is recommended as follows:
For those with 0 - 1 risk factors:LDL target: 160 or lower. Lifestyle changes should be initiated for LDL > 159, and ************** for LDL > 189.
For those with 2 or more risk factors:LDL target: 130 or lower. Lifestyle changes should be initiated for LDL > 129, and ************** for LDL > 159.

If heart disease is present or 10-year risk > 20%, or diabetes is present:LDL target: 100 or lower. Lifestyle changes should be initiated for LDL > 100, and ************** for LDL > 129.


What about treatment for high triglycerides?
The latest guidelines for the first time, recommend treating patients who have elevated triglyceride levels. This recommendation is based on recent analyses strongly suggesting that triglycerides are indeed an independent risk factor for coronary artery disease. The decision to treat is generally based on the triglyceride levels themselves. Normal triglyceride levels are less than 150 mg/dL. Borderline high levels are 150-199 mg/dl. High levels are 200 - 499 mg/dL, and very high triglyceride levels are greater than 500 mg/dL.  For people with borderline or high triglyceride levels, treatment should emphasize weight reduction and exercise. Drugs are recommended for people with very high triglyceride levels. Most people who need treatment for high triglyceride levels have metabolic syndrome X.

What other "special circumstances" deserve attention?
Patients with very high LDL cholesterol levels (greater than 189 mg/dL): These patients often have a genetic form of lipid disorder. Not only do they have a high risk of premature heart disease without aggressive therapy, but also their family members should be screened for elevated cholesterol levels, and those with high cholesterol levels also need to be treated. Patients with low HDL cholesterol levels (less than 40 mg/dL):  The latest guidelines recognize low HDL levels as a strong independent risk factor for coronary artery disease. Many of patients with low HDL will have diabetes or "metabolic syndrome x." They are often overweight and physically inactive. Other causes of low HDL levels are smoking, very high carbohydrate diets (greater than 60% of calories), and drugs (anabolic steroids, progesterone, and beta blockers). Unfortunately, current drug therapy usually does not markedly increase HDL levels. Treatment for patients with low HDL levels is usually aimed at weight reduction, smoking cessation, exercise, and controlling other risk factors (such as hypertension, LDL cholesterol, and triglycerides.)  

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by whits_end, Aug 13, 2008
Dr. Kirksey Help me out.  I have had high triglyceride levels.  I have always have healthy levels for my overall cholesterol. Can colestipol used for excess bile production cause "hypo colesterol" drop HdL belove the 40 mg/dl?

I generally have a low blood pressure.  I was put on synthroid 2 years ago.  I am happy with the effects.  My healthy gall bladder was removed in 2001 and I have had chronic diarhea ever since.

So the MD gave me colestipol.    Frustrated with on off diarhea, I took synthroid every moring and colestipol one hour later.  I became constipated and added metimucel to the day.  eventually, I became so swollen my shoes wouldn't fit. MY clothes were too small and my brain and eyes fuzzied, I was miserable.  I started having unbearable pain where my gall bladder was it spread to 360 and started up my back.  By bowel movements got lighter and lighter until they were white.  I think the colestipol caused stones that clogged my ducts.
I stopped the colestipol.  My MD sent me to the Gastroenterologist. I gave him the above details.  He tuned me out and concluded that there was gold up my *** and wanted to send a camera up there to find it.  I declined.  Figured I needed to spend my money with a real physician and not an *** gold digger.
Well the pain in my gall bladder subsided but is still there.  Sometimes my back flairs up again.
The DDS gave me a steriod for my swollen gums/tooth.  This made the liver/gall bladder pain lessen.  I have been careful of my diet and write everything down and I have diareah again.
I believe the colestipol absorbed the synthroid.  What do you think?
If I let the gastro mine my *** for gold, can I claim it and use it to pay the Doctor bill?  Apply it to liver tests?  He checked that I had insurance before signing me up for the mining expedition.  Aug 31 I will not have insurance.
I have no faith in the medical community.
I am an obese female, age 48, AC1 is 5.8 to 5.9.
As for the colestipol absorbing the synthroid.  I forgot to take it one day.  In the night I was awoken by an over whelming chest pain and a big heart thump.  I got up I could feel the cold floor under my feet so I knew I was alive.  The only thing worse then this would have been to go to the emergency center and be treated like a crazy women and not be taken serious.  So I kept it to myself. The chest pain subsided after about a week.

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by dcordes, Aug 14, 2008
my HDL soared after i began niacin therapy.  i cannot take the statins as they cause problems for me.  1500 mgs of niacin twice a day did the trick.  went from 38 to 73 hdl.  i built up my tolerance to naicin very very slowly.  e.g. i began with 50 mgs 1 time a day and when i stopped flushing - after 4 or 5 days at that dose - i increased the dosage.  to get to my current dosage with minimal flushing took almost three months. i have my liver enzymes monitored by my doctor (regular blood tests) and so far...things are good.

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by madjlp, Aug 16, 2008
Can you comment at all on the developing fringe opinion that high LDL is actually an expression of underlying inflammation in the body and that that inflammation is the real causative health issue and not the high LDL itself (ie addressing LDL through statins is simply addressing a secondary expression and not working witt the causative factor - this idea may have received a  boost with some of the recent statin data aggregation showing limited effect on outcomes despite lowered LDL levles)?  Thank you.

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by marcybaby, Aug 17, 2008
hi. there is something wrong with me. i usually have a normal cycle but i start late all the time.I usually only have the stomach pains the first day i get my period and i never bleed when im in the shower.

this time was way different.

my stomach hurt for four days before i started, i started my period an extra two weeks early, my stomach hurt extra bad the entire time i was on my period, it hurt wen i used the bathroom, i bleed ALOT while i was in the shower(really weird-to much blood), and I was on my period an extra 9 days.

do you know wuts wrong with me????

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by kat4, Aug 17, 2008
I think you are in the wrong forum, and you ought to go see an obgyn.  (Could you have had a miscarriage?  If so, that is all the more reason to see a doctor.)

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by tehami, Aug 18, 2008
dear lee
wots a poly systic ovary.

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by WandaS, Aug 19, 2008
well now im confused!!! all my dr told me is im at 215 and wold check it again sometime, so what do i do now??

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by PamHolloway, Aug 26, 2008
Let me know what they find (DR.) My daughter has something similar. God Bless/In Christ Pam

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by supermomma531, Sep 22, 2008
Dear Dr.Kirksey:
        I came across this particular site and read the cholesteral page that you wrote. My husband was recently put on simvastastin for high cholesteral. And I've been looking for appropriate low cholesteral recipes to be able to make for him and our whole family. I really do not have much use of a computer and was wondering if you could direct me to a direct appropriate web site or cook book. Something is better than nothing. Even if you could give me some strict guidelines for a low cholesteral diet. This would be greatly appreciated.

                                                                                                                   Thank-you so much, Sarah

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by Sam1971, Oct 02, 2008
can medications a person take effect  their choleserol? I Admit  I do like pasta I cook it once a week. and it's white and I eat a potato a week, but I don't eat out.  The thing I do , is take lots of meds. At the moment because of health my activity has slowed down,(2 months) but when up I walk a mile a day and run around with 3 year olds all day so my weight is not part of it either I'm 104 so perplexed.

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by ozzy48, Oct 19, 2008
My total cholesterol number was 309 so my doctor prescribed Simvastatin.  After a few days I developed deep muscle pain in my quadricepts.  It continued to escalate until it started affecting my sleep and had to get up a few times to stretch my leg muscles.  I changed to Lovastatin but it didn't help.  Now my doctor put me on Pravastatin and the pain has disappeared!  I can sleep all night and it's wonderful.  My doctor told me that Pravastatin stores the medicin in water in the body instead of in the fatty tissue in muscles.  I'm pleased with my new cholesterol number of 150.  I hope this will help others who are experiencing achy side effects.  

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