Cholesterol Highs and Lows

Is There a Cholesterol Problem?


The American Heart Association recommends that all adults age 20 or older routinely check their choles­terol and other traditional risk factors. Cholesterol is a waxy arterial buildup. Your body needs it to form cells.

Too much cholesterol can pose a problem. As published on Medscape (login), guide­lines for the detection, evalua­tion, and treat­ment of elevated choles­terol were released in November 2013. See table below.

Most cardiologists and internists already have appro­priate cholesterol guide­lines for their patient consultations. Some physi­cians grapple with the 2013 notion that there is no evidence from random­ized controlled trials to support treatment to a specific choles­terol target level for everyone.

Is Your Cholesterol Too High?
Choles­terolDesirable mg/dLBorderline mg/dLUndesirable mg/dL

What is the highest cholesterol level ever recorded? Terry Culton (USA) was measured to have a triglyceride reading of 3165 mg/dL, 21 times the normal level of 150 mg/dl, based on a sample of his blood taken to measure his cholesterol on 3 June 1998 at Austin Medical Center, Minnesota, USA. —Guinness Book of World Records

Cholesterol varies according to each patient’s overall condition. The recommended LDL for patients with cardio­vascular disease is less than 100 mg/dL or the optional goal of less than 70 mg/dL. There is more reliance on optimal ranges, considering a variety of data points.

Having cholesterol that is too low is uncommon. There is no consensus on how to define very low LDL cholesterol, but LDL would be considered very low if it is less than 40 mg/dL, which has been associated with several health problems, including hemorrhagic stroke and cancer.

There are no recommendations of specific LDL-cholesterol or non-HDL targets for the primary and secondary prevention of athero­sclerotic cardiovascular disease (ASCVD). Instead, recent guidelines identify 4 groups of primary- and secondary-prevention patients in whom physicians should focus their efforts to reduce cardiovascular disease events. In these 4 patient groups, the guidelines of 2013 recommend the appropriate “intensity” of statin therapy in order to achieve relative reductions in LDL cholesterol.

  1. Individuals with clinical ASCVD, including not just people with prior heart attacks, angina, or coronary artery disease resulting in a stent or bypass but also people with atherosclerotic stroke, TIA (ministroke), or peripheral arterial disease.
  2. People with primary elevations of LDL-C of 190 mg/dL or greater
  3. Diabetics 40–75 years old with LDL-C of 70–189 mg/dL
  4. Individuals, 40–75, without clinical ASCVD or diabetes with a LDL of 70–189 mg/dL, but an estimated absolute 10-year risk of ASCVD (non-fatal MI, CHD death, non-fatal and fatal stroke).

The risk should be calculated using what is called Pooled Cohort Equations. The traditional Friedewald equation estimates LDL choles­terol this way: total choles­terol minus HDL choles­terol minus trigly­cerides divided by five (TC-HDL-Tg/5). Johns Hopkins has developed a more accurate method that is available in the App Store and Google Play.

How Do Statins Work?

Statins block a substance your liver needs to make choles­terol. This causes your liver to remove choles­terol from your blood. Occa­sionally, statins could increase the level of enzymes that signal liver inflam­mation.

While statins are highly effective, they are linked to myalgia (≤29%), digestive problems, memory loss or confusion, and may rarely contribute to liver damage. Caution is advised among patients with existing adverse liver conditions.

There is a small risk that your blood sugar (blood glucose) level may increase with statin use. This might lead to developing type 2 diabetes. With patients, doctors must weigh possible side effects of statins with risk of adverse cardiac events.

A man was measured to have a triglyceride reading of 3165 mg/dL, 21 times the normal level.

A clinical study was published in the New England Journal of Medicine that included more than 27,500 patients who previ­ously had a heart attack, stroke or another serious artery disease. All patients had an LDL choles­terol level of 70 mg/dL or higher.

After two years of therapy, the patients taking a com­panion drug called evolocumab were 15% less likely than patients taking placebo to experi­ence death, heart attack, stroke, hospitaliza­tion for angina or the need for a heart bypass or angio­plasty.

Some Cholesterol is Good For You

Alternatives to Cholesterol-Fighting Statins


In general, to reduce dependency on statins, we want to raise good choles­terol called HDL. You also want to lower bad choles­terol called LDL. Getting the right balance typically involves a complex combination of exercise and nutrition. Here are a few practical and simple suggestions to get you started.

  1. Eat More Nuts: Eating two ounces of nuts can increase the ratio of HDL to LDL in the blood by 8.3%. When men replaced 15% of their daily calorie intake with macadamia nuts—12 to 16 nuts a day—their HDL levels went up by 8% in an Australian study.
  2. Eat More Oats: According to the University of Connecticut researchers, people with high LDL choles­terol (>200 mg/dL) who who added oatmeal to their diet for eight weeks dropped the LDL cholesterol levels by >20%.
  3. Become a Part-Time Vegetarian: Men who added a couple of servings of vegetarian food such as whole grains, nuts, and beans to their diets for a month lowered their LDL choles­terol by nearly 30% in another study.

These are just three simple diet-based tips of the 15 offered at to improve choles­terol levels. Others include eating fruits and vegetables, exercise regularly that will boost your endurance and physical activity level.

Therapeutic Lifestyle Changes (TLC) diet, includes a low-saturated-fat and low-cholesterol eating plan. It calls for less than 7% of calories from saturated fat and less than 200mg of dietary choles­terol per day. If your weight is categorized as being overweight, losing weight can help lower LDL.

Regular physical activity (30 minutes on most, if not all, days) is recommended. You may achieve good results from vitamins such as niacin, which blocks the liver from removing HDL and lowers triglycerides, and omega-3 fatty acids, which increase the level of HDL and lowers triglycerides.

“Some researchers say that, as a nation, we could cut our rate of heart disease by one-half if we took more magnesium.” Carolyn Dean, MD, ND, author of The Miracle of Magnesium, suggests taking 300 mg of magnesium oxide, magnesium citrate, or magnesium glycinate two to three times a day with at least 8 daily glasses of water.

Magnesium supplements can interfere with the absorption of certain statin medications and may cause diarrhea, so be sure to talk to your doctor first. A popular reference for medical offices is the Understanding Cholesterol human anatomy poster, available from ClinicalPosters.

To support the writing of useful articles about cardiology, ClinicalPosters sells human anatomy charts, scientific posters and other products online. Slide extra posters into DeuPair Frames without removing from the wall or leave an encourag­ing comment to keep the work going.

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