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Cholesterol: What every patient needs to know

By jeremyc | September 30, 2009

Cholesterol is a waxy, fatty substance made in the liver. It can also be found in certain foods, including dairy products, such as whole milk, as well as eggs and meat. Cholesterol is a vital component of many parts of the body, including our hair, skin and blood cells. However, when cholesterol is in excess, it may deposit in our blood vessels, which can lead to a heart attack or stroke.

Elevated cholesterol levels can increase a patient’s risk of developing coronary heart disease (heart attacks, angina). Through “primary prevention” we work to prevent chronic diseases by keeping ourselves healthy through diet, exercise and preventive medication.

Components of a cholesterol test:
• Total Cholesterol: This figure indicates the total composition of your cholesterol. It includes low-density lipoprotein, high-density lipoprotein and triglycerides, and should be less than 200 mg/dL. LDL is what we call “bad” cholesterol. This cholesterol (when in excess) can lead to blockage and buildup in heart vessels. Your LDL should be less than 100 mg/dL. HDL is what we call “good” cholesterol. This cholesterol helps to carry bad cholesterol away from heart vessels to be digested in the liver. Your HDL should be greater than 60 mg/dL. Triglycerides indicate the amount of fat in blood. People with high triglyceride levels tend to have high LDL and low HDL levels. Normal levels of triglycerides in the blood are less than 150 mg/dL for both men and women.
• Optimal cholesterol levels: Cholesterol levels fluctuate depending on the patient’s current health. Physicians typically recommend that total cholesterol levels stay below 200. Levels between 200 and 239 are considered borderline high. Anything more than 240 is high. However, optimal levels are significantly different for patients with heart disease or diabetes than they are for patients without these diseases.

All test results should be reviewed by a health care provider who will give instructions on how to manage cholesterol levels.

Here’s how to decrease your cholesterol levels:

• Diet: Every person should try to increase his/her daily intake of fresh fruits and vegetables. All bread products, including pasta, should be exchanged for whole-grain varieties. People should consume lean protein, including grilled chicken breasts and grilled fish. Some fish are plentiful in omega-3 fatty acids (especially salmon) and are thought to help decrease triglyceride levels. Minimize the amount of fried food and junk food (chips, ice cream, etc.) and control caloric intake.

• Exercise: The American Heart Association recommends 30 minutes of cardio exercise per day for at least six days a week.* Although this goal is difficult to achieve for some, patients should realize that any activity is better than no activity at all. If time is an issue, try walking 10 minutes in the morning, 10 minutes at lunch and 10 minutes in the evening. *Note: make sure to visit your physician prior to starting an exercise routine.

• Natural/herbal medications and supplements: Unfortunately, many natural/herbal medications and supplements in the marketplace claim to decrease cholesterol levels, but very few have proven effective in legitimate medical trials. The FDA does not regulate these products. Omega-3 polyunsaturated fatty acid may be recommended as a dietary supplement because some legitimate clinical research indicates it may have a positive effect in combating high triglycerides. However, this supplement is not recommended for the general population at this time.

• Medical therapy: Many people require medical therapy despite optimizing lifestyle factors. Do not let medical therapy discourage you; all diet and exercise routines should be continued to decrease the amount of medication needed.

There are a large variety of medications available to help decrease cholesterol levels. The most widely used medications are the HMG-CoA Reductase Inhibitors (statins). There are several types of these medications, with many generics available. Physicians will see what works best for the patient and monitor for side-effects. Common side-effects of these medications include muscle aches and elevated liver enzyme levels. Should any of these occur, you and your doctor can work together to find an optimal medication and dose.

Remember, primary prevention is the process of preventing chronic diseases by keeping ourselves healthy through diet, exercise and preventive medication. Take control of your health and stay informed. Work with your physician to decrease or eliminate your risk factors for disease.

Dr. Alexis P. Dunne,is an internist at Dreyer Medical Clinic in Oswego.

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