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Cholesterol 101

Do you know your cholesterol?  You should.  If not, a simple blood test can help predict whether you need medications, further testing, and help predict your risk for developing heart disease.  All adults over the age of 20 should have their cholesterol levels measured and review the results with their doctor.  The standard lipid panel measures fat levels in the blood and includes:  total cholesterol, triglycerides, high density lipoprotein (HDL) and low density lipoproteins (LDL).

Low Density Lipoprotein (LDL)

The LDL, or “lousy” cholesterol has been associated with increased risk for heart disease.  This is often treated with a class of medications called statins.  This class of medications has been shown to lower the risk of heart attacks, strokes, and dying from heart disease.  There are side effects with these medications and blood tests are required periodically.

High Density Lipoprotein (HDL)

This is commonly referred to as the “good” cholesterol.  It is the vacuum cleaner for the arteries and higher levels are associated with a lower risk of heart disease.  This level can be adversely affected by smoking, steroids, and inactivity.  An HDL level below 40 mg/dL is considered low based on current guidelines.  However, exercise and weight loss along with certain medications can help raise the HDL.

A new class of medications called CETP inhibitors, which raise the HDL up to 120%, are currently being studied to see if higher levels on these medications can lower risk of heart attacks, strokes and dying from heart disease.

Triglycerides

This is a measure of the fat in the blood.  Very high triglycerides (>500) can increase your risk for developing pancreatitis.  The most common causes for elevated triglycerides are obesity, physical inactivity, cigarette smoking, excess alcohol intake, high carbohydrate diets (>60% of calories), certain diseases (diabetes, chronic kidney disease), pregnancy, and certain medications/drugs (steroids) as well as certain genetic disorders.

The management of high triglycerides is determined by your doctor based on the levels obtained during testing.

Beyond the standard lipid panel

If you have a family history, diabetes, pre-diabetes (also known as metabolic syndrome); you may benefit from further laboratory testing beyond the standard cholesterol panel.  This may include Lipoprotein (a), a marker not affected by diet and determined by genetics.  It can confer up to a 6-8 fold increased risk for heart attacks and strokes.  In addition, the most commonly prescribed cholesterol medications, statins, do not affect the risk conferred by this particle.

Get a traffic report on your arteries

Another blood test to ask along your doctor about is a serum apoB particle test.  The cholesterol numbers in a standard lipid panel are measured using concentrations, not absolute numbers.  However, we know that the cholesterol itself is carried into the arteries to deposit plaque/fat and cause narrowing of the arteries by particles, like passengers in a car.  If you think of traffic at rush hour, it’s not the number of passengers in the cars that is the problem, it’s the number of cars on the road.  By measuring the apoB, it gives a better measure of your risk of developing heart disease

Measuring inflammation

A study (JUPITER) studied people without a history of heart disease with “normal” cholesterol levels used a measure of inflammation in the arteries called high sensitivity c-reactive protein (hsCRP) to determine who would benefit from a statin medication called Crestor.  It showed that people with elevated levels of hsCRP (>2) benefit from Crestor.

What can you do to help lower cholesterol and your risk for heart disease beyond medications

First and foremost is always diet and exercise.  Current guidelines recommend at least 30 minutes of moderate intensity activity at least 5 days a week.  Moderate activity is defined as strenuous enough that it is difficult to maintain a conversation during exercise.  As always, discuss with your doctor before beginning any exercise program.

Diets should contain <25-35% of calories from fat with focus not just on quantity but quality of the food you eat with lots of fruits and vegetables.

Based on some of the testing above, you can empower yourself and loved ones to make healthy choices and be proactive in preventing heart disease, the number one killer in the world.

Daniel Tarditi, DO, FACC, is a clinical cardiologist with the Heart House

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