High Cholesterol Numbers and Players
Posted: Saturday, October 30, 2010
by John Laurusonis
Doctors Medical Center
It's been very interesting to observe the models of cholesterol disease over the past forty years. So much of what we used to know was based on the direct pathology of a disease. That is usually what could be seen under a microscope. When find hardening of the arteries under the microscope and analyzed the content of arterial blockages to be cholesterol, we said, "Aha, cholesterol causes hardening of the arteries!" All we knew how to do was treat it with diet, and we were not seeing much inroad into the mechanisms of the disease.
So, what do we know about heart disease, based on the Framingham study? We know that cardiac risk can be calculated based on age, cigarette smoking, high blood pressure, family history of premature cardiac disease, elevated LDL cholesterol. An individual cannot do anything about two of those factors; but other factors he can. We shall focus on the alteration of LDL, HDL and cholesterol ratio in the rest of this paper.
Current thinking is that everybody needs a cholesterol profile at age twenty, and every five years thereafter. Everyone should know their own "numbers" and how they compare to ideal numbers in the prevention of heart disease. Heart disease is the number one cause of death in the US. Stroke is number three.
Cholesterol is the waxy substance that travels around in the bloodstream attached to lipoproteins that allow it to be taken into cells. It is present in all the cells of the body in cell membranes, and is used in making hormones and other vital processes. It is the food and energy sources of the blood vessels along with glucose. The liver makes and processes most of the cholesterol in the body, and it makes about a thousand milligrams a day of it. The average American diet takes in about 300 to 400 mg a day of extra cholesterol. Most of the cholesterol is attached to low density lipoproteins (LDL). The rest is attached to high density lipoproteins HDL. LDL carries cholesterol into blood vessel walls
from the liver, and is therefore called bad cholesterol. HDL carries cholesterol away from blood vessel walls back to the liver to be degraded and is called good cholesterol. LDL causes cardiovascular disease; HDL prevents and reverses it. VLDL carries eaten cholesterol from the bowel to the liver for processing.
When a person receives his cholesterol numbers it is hoped he will be able to process some of this information, and of course, receive further interpretation from his physician. The first number to consider is TOTAL CHOLESTEROL. A very healthy general number is 100 + your age. It is desirable that total cholesterol be less than 200mg/dl. If it is 200 to 239mg/dl, there is a borderline risk for heart disease. If the total cholesterol is above 240mg/dl, there is usually a high risk of heart disease. That's without breaking anything down into LDL and HDL. When dealing with the LDL, or bad cholesterol numbers, any value less than 100mg/dl is considered normal. 100 to 129mg/dl is near optimal, and 130 to 159mg/dl is borderline high but normal. 160 to 189 is high, and above 190 is very high, indicating a very high cardiovascular risk.
The numbers are the opposite for HDL. Above 60mg/dl is considered ideal, and actually takes away a point of cardiac risk factor in risk factor calculation. Consistent exercise more than 20 minutes a day i.e. 45 minutes a day increases the good HDL. 40 to 50 is somewhat less risk of heart disease, but less than 35mg/dl represents a high risk for heart disease. Cholesterol to HDL in 2.5-4.5 is theoretically ideal. This ratio above 5:1 denotes great risk and a ratio below 3:1 is low risk i.e. if your cholesterol is 225 and your HDL is 75 that's a 3.0 to 1 ratio which gives you a low risk. But if your cholesterol is 150 and your HDL is only 10 this is a 15 ratio which is very bad and gives great risk.
So, what can we do to improve our numbers? First there are lifestyle changes, for example, decreasing cholesterol food source intake to less than 300mg per day and exercising thirty minutes a day. This can make a significant change. Eating at least 20 mg per day of soluble fiber can also significantly help. When these are not enough, however, as they often are not, medication is available to accomplish the needed reductions. The statin drugs, like atorvastatin currently taken by approximately 30 million people in the US, interfere with the liver's production of cholesterol. There are several of these drugs out there, which require proper precautions and follow-up. There are the fibrate drugs which work in the liver to lower triglycerides and LDL, and raise HDL. There is a drug which blocks absorption of cholesterol from the small intestine which is sometimes prescribed. There are other drugs which prevent cholesterol from being reabsorbed from bile, which is where a lot of it ends up.
So, here's the deal: practice crunching your own cholesterol numbers. Get your cholesterol checked every five years if it's never been high and probably 2-3 years if it is being treated. Never miss a chance to have it checked, like at a health fair. Shoot to have your total cholesterol less than 50-200mg/dl, your LDL less than 100mg/dl, and your HDL above 60mg/dl. Practice lifestyle changes like exercise and a low fat/cholesterol diet. Get your weight down, your waist line down, and eliminate cigarette smoking. With this consistent approach to modification of cardiac risk factors, we expect to see a great change in the future in the incidence and severity of heart attack and stroke.
John Drew Laurusonis
Doctors Medical Center
www.doctorsmedicalctr.com
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