Brought to you by: Gregg Hopkins, MD, FACC, and Sutter Medical Center, Santa Rosa and Sutter Medical Foundation, North Bay
Hey, why is my cholesterol so high?
Remember that chateaubriand you ordered at Al’s Steakhouse last Tuesday? The garlic bread, scalloped potatoes and tiramisu didn’t help much either. Remember, LabGiant has a close partnership with BankGiant, and you have a close partnership with your BankGiant VISA card.
Well, first of all, which is more important? Control of high blood pressure or high cholesterol?
As our White House Texan would likely say to his press corps “Yes.”
You mean they’re both important?
They are both critically important, not to mention under-diagnosed and under- treated. These two risk factors are similar in that they are both affected by dietary and exercise habits, and easily addressed with medication. Hypertension and hyperlipidemia both independently predict risk of heart attack, stroke, and cardiovascular death; when both are present, the risk is exponentially increased. The most recently recommended blood pressure goal is below140/90, and below 130/80 if you’re diabetic.
I’ll grant you hypertension is important and should be aggressively treated, but I’m not convinced that blood cholesterol levels truly predict heart disease.
You must belong to the Flat Earth Society. The evidence over the last 40 years is overwhelming that lipids play a primary role in the number one cause of death in this country—atherosclerotic vascular disease. It has been considered unethical to include a placebo control group in any lipid-lowering trial for almost 15 years. And, anticipating your next question, the National Institutes of Health, not pharmaceutical companies, sponsored most of these landmark studies.
What about exercise, won’t that bring my cholesterol down?
To lower your LDL (low-density lipoprotein, the so-called “bad cholesterol”) to target levels, a Scandinavian study fifteen years ago showed that you only have to cross-country ski about 8-10 hours per week--every week of your life. It said nothing about lutefisk. But you can raise your HDL (high-density lipoprotein, the protective “good cholesterol”) with more reasonable amounts of aerobic exercise, even as little as a half hour, performed 3-4 times a week. The NCEP (National Cholesterol Education Program) recommends a HDL level of 50 or higher.
I know I should change my diet, but which diet is best? The Ornish or McDougall low-fat/high-carb approach, or the Atkins/South Beach low-carb method?
Most people don’t need an extreme diet makeover. You need to eat more fruits and vegetables (there’s a news flash), less meat and dairy products, and try to eat breads and other carbs that are less processed (with a lower glycemic index). A Mediterranean diet high in fish oil, olive oil, and other monosaturated fats also helps your lipids. To lose weight, (another news flash) eat fewer calories—plain and simple.
Does everything I get at the health food store prevent heart disease?
Nope. The big disappointments include anti-oxidant vitamins (C, E, beta-carotene have proved ineffective); folic acid (expected to address high homocysteine levels, but no solid benefits); soy products (virtually no LDL-lowering effect); flaxseed oil, arginine, Coenzyme Q10 (conflicting results); and garlic (zip, nada).
So, back to my lipid panel. What should my numbers be?
The quick answer, if you’re aiming for perfection, is 70-70-70. That is HDL above 70, Triglycerides below 70, and LDL below 70. But realistically, an LDL target of less than 100 is appropriate for almost everyone unless you have known heart disease or diabetes. Notice, I said nothing about total cholesterol levels, it’s much more important to know your LDL, HDL, and triglyceride numbers.
You know, this whole lipid panel thing really bugs me. I mean, hey, I’m a well-educated person, I eat right most of the time, and I own a really expensive carbon-fiber bicycle. I really didn’t figure on high blood pressure or high cholesterol intruding on my pretty sweet lifestyle.
To paraphrase Dr. Faith Fitzgerald from UC Davis, there is a difference between a lifestyle and a life. Principally, we choose a lifestyle, whereas a life happens to us. This conceit can lead us to expect physical vigor commensurate with our perceived intellect, affluence, and social status—a so-called “Tyranny of Wellness.” Failure to be perfectly healthy must mean somebody screwed up and misbehaved. Yet almost every one in this country has atherosclerotic heart disease. I say that based upon the intracoronary ultrasound images taken of hearts used for transplantation at the Cleveland Clinic. These are hearts harvested from apparently healthy individuals struck down unexpectedly by, say, a motor vehicle accident or cerebral aneurysm. If the heart is taken from a person over the age of 50, 85% of them have significant cholesterol-related atherosclerotic plaque.
What should I do now?
Quit smoking, lose weight, get on that bicycle as much as you can, eat more fruits, vegetables and fish, and whatever you do, don’t see a cardiologist. They’re worse than anybody. Are you going to finish those fries?
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