Cardiovascular Disease: Hypercholesterolemia and Other Risk Factors
Guest: Dr. Maria Lopes-Virella – Medicine/Endocrinology
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I am Dr. Linda Austin. I am interviewing Dr. Maria Lopez-Virella who is Professor of Medicine and an expert in the area of lipids and diabetes.
Dr. Lopes-Virella, let’s talk some more about high cholesterol, or hypercholesterolemia, in adults. You mentioned earlier that there are different kinds of cholesterol. The high-density lipoproteins should be high and low-density lipoproteins should be low. Let’s talk about specific numbers. When you look at a panel of numbers, at what level do you begin to be concerned and think that a patient may need treatment?
Dr. Lopes-Virella: A total cholesterol, as I mentioned before, of about 200 mg/dL or more is what we consider to be high. LDL cholesterol, ideally, the goal should be less than 100 mg/dL, but it depends on the patient. For instance, if you have a patient that already had coronary heart disease, you may, in reality, push it further down and go as low as 70 or 60 mg/dL and that will be ideal for that patient, the lower, the better.
Triglycerides: We usually consider anything below 100 mg/dL normal. But, again, it depends on the patient. If the patient is diabetic, he/she would probably be better off to be under 100, although if you manage to get below 150, you can be happy with that.
The HDL, it depends if it is a man or a woman. If it is a man, it should be higher than 40 mg/dL. If it is a woman, it should be above 50 mg/dL. Women have higher levels of HDL cholesterol than men do. The VLDL (very-low-density lipoprotein) is related to the triglycerides, so 30 mg/dL is usually the ideal maximum but you should be aim to be below 30 mg.
Dr. Linda Austin: Since the importance of the HDL, the high-density lipoprotein, is that it is protective, if you have a very low LDL, can you get by with a HDL that is not quite so high?
Dr. Maria Lopes-Virella: Unfortunately, it is not as simple as that. In a lot of patients, maybe the majority of patients, if you have a high HDL and a low LDL, or total cholesterol is high because the HDL is high, not because the LDL is high, you are probably okay. But, unfortunately, there are cases where people have very high HDL cholesterol and still be what we call non-functional HDLs, so the patient, in reality, can have coronary artery disease.
So, you need to look not only at numbers but also your family history. If you have a patient that comes in with a high HDL that has already had a heart attack, or has a very strong family history of heart attacks, it means that the although the HDL is high, it is not functioning properly. In that case, the patient, in reality, should be treated just as if he/she did not have a high HDL because the HDL is not protective.
On the other hand, if that is not the case, the patient has no heart disease and there is no family history of heart disease and the patient’s HDL is high, as soon as the LDL is okay, he/she can feel comfortable even if the LDL is slightly high, but not too high. You need to be careful no to let your LDL go above 130, to feel protected, from a cardiovascular standpoint.
Dr. Linda Austin: You are really underlining the fact that the cholesterol is only one risk factor. What are the other risk factors and which are the most important ones?
Dr. Maria Lopes-Virella: There are several risk factors and that is one of the problems with cardiovascular disease. Hypertension is a very important risk factor and blood pressure should be below 130 systolic over 80 diastolic, so anything below 130/80 is okay. Anything above that needs to be brought under control.
Smoking is, of course, a major risk factor and individuals should not smoke. Inactivity is another risk factor, so exercise is important. You do not have to run a marathon but you should at least walk and do some daily exercise. It is not just a matter of weight, it is important to be physically fit to maintain cardiovascular health.
So, these are some of the most important risk factors. Another important risk factor is diabetes. If you are a diabetic, you are at much higher risk. If you have diabetes, you are at an equal risk of having a heart attack as someone who has already had a heart attack and you need to be treated as if you have already had one. If you have diabetes, you are treated very aggressively in order to avoid complications.
Dr. Linda Austin: I have heard that depression is also a risk factor for cardiovascular events.
Dr. Maria Lopes-Virella: Depression and stress are risk factors. The happier you are and the less stress you have, the better off you are from a cardiovascular standpoint. It is just a little complicated sometimes to address these problems. But you should try, if you can, to avoid things that are very stressful or a lifestyle that makes you very unhappy.
Dr. Linda Austin: People can, of course, make lifestyle decisions such as not getting themselves in over their heads financially so they have to work long hours. I think there are a lot of things people can do to bring down stress.
Dr. Maria Lopes-Virella: Absolutely. I think people nowadays stretch themselves too thin in order to acquire more material things which, in the end, may not give them a tremendous amount of happiness. It can be difficult but it is something you need to do. Feeling happy and comfortable with yourself is very important if you want to live a long and healthy life.
Dr. Linda Austin: Dr. Lopes-Virella, thank you very much.
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