You and Your Cholesterol - A Constant Concern
We have all heard of the relationship of cholesterol in preserving health and preventing heart and other vascular disease. Nevertheless, it is important to repeat the message from time to time since high cholesterol leads to atherosclerosis which leads to hardening of the arteries in our heart and major arterial blood vessels. This can in turn lead to heart attacks and strokes. The kicker in all this is that as we age, our bodies manufacture more cholesterol, especially the so called LDL or low density lipoproteins. This is the "bad" cholesterol as compared to HDL or high density lipoproteins that is "good."
How do I know what my cholesterol is?
It is recommended that from age 20 about every five years a blood test be run that will tell you and your physician what your cholesterol values are. As we age, our cholesterol tends to increase and women are protected until menopause, but after that women will match men in cholesterol increase. It is important to get a lipid profile more often after age 50 and insurance and the affordable health care act and Medicare insurance will pay for this screen. So get it done!
The table below lists target values for the lipids reported in a lipid profile.
It is important in evaluating your results that you are your physician pick targets for you based on your risks for cardiovascular disease. For example if you have a history of cardiac disease, it is likely that your cardiologist or general medical physician will have a more aggressive target for LDL like perhaps less than 50 even though that is well within the normal range for people without a history or known cardiac disease.
What can I do to lower LDL?
Since we know that LDL is bad and we do not want much of it in our blood, what can we do to lower it? There are three proven strategies that are known to lower LDL, often raise HDL, and reduce the risk of cardiac events. These are not new to us but bear repeating. First is lifestyle, second is diet, and third is exercise. Let us review each. Exercise is recommended every day for about 30-60 minutes, even if it is just walking. Regular aerobic exercise (getting the heart rate up) is proven to lower LDL and sometimes this is all that is necessary to keep LDL at a target level.
Diet is essential and the more one understands this the easier it is to control cholesterol. Simply put, one should eat as little saturated or trans fats as possible. These items in our diet raise LDL. They are found in red meat, many prepared foods, and dairy products like milk and cheese. The government has now required labeling for most of the foods we buy and prepare at home. The figure to the right shows a typical label and we will focus on the cholesterol relevant part of the standard label.
The label shows how much total fat there is in the product and how much of the daily dietary value is in the preparation. This same section shows how much of the fat is saturated (bad) or trans (also bad). It is best to limit the saturated and trans fats and to have them as low a percentage as possible of the total fat that you plan to consume. The total cholesterol amount is also shown and the less the better. Another important factor in the diet that is shown on the label is fiber. Fiber is good for lowering LDL and products high in fiber such as oats, grains, beans, eggplant and okra are important to a healthy diet. Fruits, nuts, and fish are very good as well.
Many people with high LDL will have difficulty reducing it with exercise and diet alone, although it is possible if one is very diligent. If these two strategies do fail however, there is a very potent class of drugs called "statins" that reduce the amount of cholesterol in the diet that is absorbed from the bloodstream or that is manufactured in the liver. There are now many statins on the market and all must be prescribed by your physician. Some are generic and others are still under patent, but as a class they all will affect each person as a means of lowering cholesterol. Three commonly used statins are Vytorin, Lipitor, and Zetia. Some are better than others and. like all medicines, sometimes one that works well in one patient may not be as effective in another. You and your physician have to work out the best for you as well as the best dose. These drugs do have side effects in some people that make them hard to take, but lower doses tend to be well tolerated by most patients. This is also an area of intense investigation and newer compounds are being perfected with different modes of actions, so it is likely that non-statin medications will be available some time in the future.
The bottom line is that as we age we will have a cholesterol problem, most of us that is, and men and women should have their lipid profile done annually with the aim of keeping the LDL below normal. We can do this with exercise, diet, and/or medications, but it is important to do so to lower the chance of heart attack.
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For more information consult MUSC Med-U-Nurse or your physician.