Cholesterol 101

Elevated cholesterol is known as "Hyperlipidemia." High cholesterol is a risk factor for heart attack and stroke among other things. There are misconceptions about cholesterol, which tests are most important, and how and when to treat. This page will give some basic information from which one can pursue further education.

What's the big deal?

Cholesterol is a substance that is both eaten and made by the body. Over time, cholesterol deposits on the walls of the blood vessels (namely arteries) - similar to calcium build-up in old home pipes. Cholesterol build-up (plaque) can get so big it blocks blood flow downstream. More commonly, a piece of the plaque breaks off and flows downstream until it gets to a small artery and blocks the flow. If either of these things occur in the heart, it is called a "Heart Attack." In the brain, it is called a "Stroke." (The process is much more complex, but this gives you the visual you need.

Build-up occurs for different people at different rates. Some people never have a problem. Some have problems earlier than we'd hope for. Some people can control this with lifetstyle. Some require medication. Some patients who take medication die of heart attacks and stroke. Some patients who never try to control this do not.

The fact is that higher cholesterol statistically puts patients at increased risk of heart attack and stroke.

Cholesterol Panel

LDL is the "bad" or "lousy" cholesterol. GOAL: Less than 100. Forms plaque.

HDL is the "healthy" cholesterol. GOAL: over 50. Slows down plaque formation.

Triglycerides represent "unused energy" in the blood stream. If unused, it travels across the vessel wall and deposits as fat. GOAL is under 200. There is no great evidence that targeting this directly reduces heart attack and stroke, but given the elevation leads to more fat, this may be worth treating if "too high."

Total Cholesterol is more than just the sum of HDL and LDL. It is the most overrated number in the panel. This is typically the number patient's quote: "My cholesterol used to be over 200, but now it is 180." A patient could have an LDL of 98, and HDL of 93. The total cholesterol, then, would be well over 200. Focus should be placed on HDL and LDL ... not Total Cholesterol.

VLDL, hsCRP, Homocysteine, and Many, many Others were tests that were obtained for a while by select physicians. There was hope that by looking at further breakdown of the specific cholesterol molcules would gave some insight as to prevent heart attack and stroke. Although some correlations were made, no interventions or alterations in these molecules did anything to better protect patients. Neither Dr. Peffley nor Dr. Lucas order these because they cost significantly more and do not provide any further benefit or direction for treatment or prognosis.

What causes High Cholesterol?

-(We're really concerned about what contributes to high LDL!)

• Food is a big one - Saturated Fat and Trans Fat - fatty meats and chicken skin and dairy - all raise LDL.

• Being overweight, inactive, older than 20, and having low thyroid function.

• SMOKING! "Oh really?" you ask. "Definitely!" we say. Another reason to quit.

• GENETICS (family history). This one is a big factor and no one has any control over it. Sometimes, patients are just programmed to make tons of cholesterol.

What can be done?

• Modify your lifestyle! - Stop smoking, exercise more (30 minutes a day, sweating, breathing hard, heart rate over 100)

• Eat Better! - More fish. Less beef, chicken skin., fried foods. More vegetables and nuts.

• Lose weight! - See "exercise" above. Don't eat as much quantity (specifically calories).

• Take Medication if the above is not enough.

Medication

The best class of medication for this is the "STATIN" class. Common statins include ZOCOR, LIPITOR, snd PRAVACHOL. These medications are GREAT for not only reducing the amount of LDL in the body, but the plaque build up in the arteries.

Statins primarily work to decrease the liver's production of cholesterol. Since statins work in the liver, they can irriate the liver (this could cause soreness in the right upper abdomen). One reason blood is checked 6-8 weeks after starting this medication is to monitor liver enzymes. Statins can also interact with muscle proteins. When this occurs, patients may report muscle aches (usually backs of arms and legs).

If ANY side effects occur, patients are to simply stop this medication. The effects of the medication on the liver and muscle is reversible once the medication is stopped - as long as the patient doesn't ignore the symptoms and continue to take the medication. Just because one statin causes a problem, does not mean others will. It may take a period of trial and error to discover the "right" statin. Unfortunately, there are a small number of patients who cannot tolerate any statin.

There is one other type of medication called ZETIA, which is great at lowering LDL, but does NOT reduce the size of plaques. It is expensive.