Cholesterol Highs and Lows
There is a reason why doctors may harp less about your cholesterol than they did before 2013.
The American Heart Association recommends all adults age 20 or older have their cholesterol, and other traditional risk factors, checked every five years. Cholesterol is a waxy arterial buildup that hinders blood flow. As published on Medscape (login), guidelines for the detection, evaluation, and treatment of elevated cholesterol were released in November 2013. See table below.
Is Your Cholesterol High Enough?
|Cholesterol||Desirable mg/dL||Borderline mg/dL||Undesirable mg/dL|
By now, most cardiologists and internists have incorporated appropriate guidelines into their patient consultations. Other physicians are still wrapping their heads around the assertion that there is simply no evidence from randomized controlled trials to support treatment to a specific cholesterol target level for everyone.
A man was measured to have a triglyceride reading of 3165 mg/dL, 21 times the normal level.
Cholesterol varies according to each patient’s overall condition. Gone are the recommended LDL- and non-HDL cholesterol numbers that ask physicians to treat patients with cardiovascular disease to 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.
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.
- 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.
- People with primary elevations of LDL-C of 190 mg/dL or greater
- Diabetics 40–75 years old with LDL-C of 70–189 mg/dL
- 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 estimated using what they call 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 (up to 29 percent), digestive problems, memory loss or confusion in some people 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 the use of a statin. This might lead to developing type 2 diabetes. Together with patients, doctors must weigh possible side effects of statins with risk of adverse cardiac events.
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 other serious disease of the arteries. All 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 percent 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
In general terms, to reduce dependency on statins, you want to raise good cholesterol called HDL. You also want to lower bad cholesterol called LDL. Getting the right balance typically involves a detailed combination of exercise and nutrition. Here are a few practical and simple suggestions to get you started.
- 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 percent in an Australian study.
- Eat Oatmeal Cookies: Men with high LDL cholesterol (above 200 mg/dL) who ate oat-bran cookies daily for eight weeks dropped their levels by more than 20% according to University of Connecticut researchers.
- 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 each day 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 Prevention.com to improve cholesterol levels. Others include eating grapefruit (interferes with statins) and concord grapes, building your quadriceps, boosting endurance and drinking cranberry juice.
Therapeutic Lifestyle Changes include the TLC Diet. This is a low-saturated-fat, low-cholesterol eating plan that calls for less than 7 percent of calories from saturated fat and less than 200mg of dietary cholesterol per day. Losing weight if you are overweight can help lower LDL. Regular physical activity (30 minutes on most, if not all, days) is recommended. 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 have good results.
“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.
- Cholesterol Levels: What You Need to Know. medlineplus.gov
- New Cholesterol Guidelines Abandon LDL Targets. medscape.com
- Calculating Your Cholesterol. hopkinsmedicine.org
- Statin side effects: Weigh the benefits and risks. mayoclinic.org
- Study: Potent Cholesterol Drug + Statins = Lowered Heart Attack, Stroke Risk. clevelandclinic.org
- Clinical Practice Guidelines for Prevention. professional.heart.org
- 15 Surprising Ways To Improve Your Cholesterol. prevention.com
- Proper Nutrition and Heart Health. webmd.com