Cholesterol — Why the numbers, healthy diet really do matter
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If cholesterol numbers make your head spin, doctors say here’s the bottom line: Get tested ASAP to find out your “bad” cholesterol number because your long-term health may depend on it.
Everyone should get their cholesterol checked — and children no later than ages 8 to 11 — to identify a potentially fatal genetic cholesterol disorder that can be cured with early treatment. The checkups should continue every four to six years, according to the American Heart Association.
The effort will be worth it because most Americans’ bad cholesterol — the so-called “lousy” or LDL cholesterol — is too high and puts them at increased risk of cardiovascular disease, studies show.
And one in 250 Americans inherits even higher levels of bad cholesterol, called familial hypercholesterolemia.
Armed with your personal cholesterol information, you have far greater control over your risk of heart attack or stroke than you may realize, even if you inherit the higher levels, experts say. Heart disease and stroke are America’s No. 1 and No. 4 killers, respectively.
A healthy lifestyle can cut your risk in half, even though people with the inherited high cholesterol still require drug treatment, said Dr. Jennifer Robinson, a professor in the college of public health at the University of Iowa and the incoming president of the National Forum for Heart Disease and Stroke Prevention.
“Usually, age 50 is where people’s lifestyles or their genes are catching up with them,” Robinson said. “We often need at that point to turn to preventive drug therapy that’s safe and generic.”
What’s a healthy lifestyle? The ideal goal includes:
— Control the portions you eat, keeping in mind that one portion is half a cup;
— Eat as many as five fruits and vegetables each day;
— Avoid white carbs like white bread and rice;
— Avoid processed foods that are more likely to include saturated fat and high fructose corn syrup;
— And get at least 30 minutes a day 5 days a week of moderate exercise or 75 minutes each week of vigorous exercise (or a combination of moderate and vigorous activity), according to American Heart Association guidelines. [SEE SIDEBAR for specific diet recommendations]
Though doctors disagree on specific targets for the so-called “lousy” cholesterol, the lower the number, the better. Cholesterol levels are measured in milligrams per deciliter of blood (mg/dL).
And even if you have high levels of the good guy – the “hero” or “helper” cholesterol called HDL — no amount of boosting HDL has been shown to lower the risk, experts say.
The latest guidelines from the American College of Cardiology and the American Heart Association say that doctors and patients should collaborate on the best way to control bad cholesterol, rather than focusing specific numerical targets. High-risk patients should take statins, research has concluded.
So who is most at risk? Studies show that African-Americans are at higher risk of heart attack than their white counterparts with the same bad cholesterol levels. The guidelines also identified three specific high-risk groups:
“The goal is to lower your risk with a good diet, regular exercise, stopping smoking and keeping your weight down,” said Dr. Neil J. Stone, the Robert Bonow professor of medicine at Northwestern University’s Feinberg School of Medicine.
“For people under age 40, lifestyle is crucial,” Stone said. It’s never too late, but people who cling to unhealthy patterns into their 60s may not be able to reverse the damage they’ve already done, he said.
Guidelines from the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE), published in the April issue of Endocrine Practice recommend for the first time an LDL goal of less than 55 milligrams/dL for people at “extreme risk” for heart disease; less than 70 for those with a “very high risk;” less than 100 for “high to moderate risk” people, and less than 130 for people at “low risk.”
While most people with heart disease have symptoms, some at increased risk, including many with diabetes, are unaware of their “silent” heart disease, said Paul S. Jellinger, the lead author of the 2017 AACE/ACE Treatment of Lipid Disorders Guidelines and professor of clinical medicine at the University of Miami’s Miller School of Medicine.
“In all these individuals, LDL cholesterol should be lowered, regardless of where the LDL is to begin with,” he said.
Jellinger says people whose risk remains unclear after considering the well-known risk factors should ask their doctors to measure their coronary artery calcium score, a useful predictor of risk, to estimate the amount of plaque in their arteries.
People at a very high risk of a heart attack can take statins in combination with ezetimibe or with PCSK-9 inhibitors, endocrinologists say. The latter are powerful LDL cholesterol-lowering drugs that regulate LDL receptors so they pull the bad cholesterol out of your blood and put it back into your liver cells where it belongs.
But the PCSK-9 inhibitors can cost be very expensive since insurance companies can make it difficult for people to get coverage to help pay for the drugs, Jellinger said.
“The key questions to ask your doctor, he said, are: ‘What is my risk? What is my LDL level? And what LDL target should I aim for, based on my risk level?’”
Sandra Guy is a local freelance writer.