February 4, 2011
Cholesterol: The Good, The Bad and The Ugly
Carl Juneau, MD, Cardiologist, Carson Tahoe Cardiology
Cholesterol is found among the fats of the bloodstream and in cells in every part of our bodies. It helps the body build new cells, insulate nerves and produce hormones. The liver creates all the cholesterol we need. So where’s the problem? In addition to what the body produces naturally, cholesterol is also in the foods we eat. When we have too much cholesterol in our bloodstream, that’s when the trouble begins.
Too much cholesterol in the bloodstream can build up on the walls of the arteries and form plaque. This plaque narrows the lumen of the arteries, decreasing the space for blood to flow. Over time, this can lead to high blood pressure or can even block blood flow completely, resulting in a heart attack or stroke.
Cholesterol and fats don’t dissolve in the bloodstream. They are taken care of by the liver. Here’s what you need to know: there are two lipoproteins that are involved in transporting cholesterol to and from the cells. These are the levels that your doctor will test for, kind of an indirect method of measuring your cholesterol.
LDL, Low-Density Lipoprotein, is sometimes referred to as the “bad cholesterol”, because it forms plaque. You can remember that it’s the bad one by thinking L for lousy. Lower LDL levels reflect a lower risk of heart attack. HDL, High-Density Lipoprotein, is referred to as the “good cholesterol”. Think H for happy. These lipoproteins carry cholesterol away from the arteries and back to the liver, where it’s excreted from the body. Higher HDL levels lower your risk of heart attack.
The goal is a low LDL and a high HDL. How do we accomplish this? There are three ways: a low cholesterol diet, exercise, and, if that’s not enough, your doctor can prescribe medications. Modifying your diet is the first and easiest step on the road toward a healthy heart.
The American Heart Association offers the following recommendations:
- Eat a diet rich in vegetables and fruit
- Choose whole-grain, high-fiber foods such as peas and beans
- Eat fish at least twice a week
- Avoid partially hydrogenated oils and saturated and trans fats. Oils and fats that are solid at room temperature aren’t good for you.
- Choose lean meats and poultry and don’t eat the skin of poultry.
- Select fat free or low fat dairy products
- Switch to egg whites rather than whole eggs
- Minimize salt intake
- Cut back on sugary drinks
The second step on the path toward heart health is an exercise regime. It doesn’t have to be much, just any kind of physical activity at least four times a week. It can be a walk after dinner, a hike up a mountain, a bike ride, whatever feels good. Remember, if it’s not fun, you likely won’t keep it up. And, exercise has the added benefits of helping to control weight, diabetes and high blood pressure.
Medications are the third step. Several types of medications are available that help lower your cholesterol. Among these are Niacin, Fibrates and Fish Oil. Your doctor may prescribe statins, a kind of medication that helps lower LDL. These require monitoring of liver enzymes as well as cholesterol levels and will necessitate consistent follow up visits to your care provider. And, of course, the fourth thing, need it even be mentioned? STOP SMOKING!
Cigarettes raise your risk of heart disease, lung disease, emphysema, stroke, high blood pressure and a multitude of cancers. They are just plain bad for you.
So there’s your overview of what cholesterol is, how it’s measured and how we can lower our levels. It’s easy really. Eat healthy, exercise often, stop smoking, and take your meds as prescribed. Do it for yourself, to feel better, and do it for the people that love you. They’ll feel better too.
Dr. Juneau is a Board Certified Cardiologist at Carson Tahoe Cardiology.
June 9, 2010
Cholesterol By the Numbers
Dr. Anthony Field, Cardiologist, VP of Medical Affairs at Carson Tahoe
When it comes to reviewing your cholesterol panel, there is so much more to know than just the total cholesterol. Total cholesterol should be less than 200 mg/dl. The other sections of the cholesterol panel that are important factors in your overall health are triglycerides, high density lipoprotein or ‘good cholesterol,’ and low density lipoprotein or ‘bad cholesterol’.
According to the National Cholesterol Education Panel (NCEP), men’s HDL cholesterol should be greater than 45 mg/dl. Women’s HDL cholesterol should be greater than 50 mg/dl. If the HDL cholesterol is below 40 mg/dl, this is a risk factor for heart disease. The NCEP guidelines suggest that the cholesterol/HDL cholesterol ratio be less than 4.5. Anything greater is associated with increased risk of coronary artery disease. Exercise, niacin (large doses directed by your physician), low alcohol consumption and smoking cessation can all help raise the HDL cholesterol value.
Elevated triglycerides are also a risk factor for heart disease. Triglycerides should be less than 150 mg/dl. Exercise, weight loss, decreasing the carbohydrates in your diet and increasing dietary alpha omega-3-fatty acids (e.g., fish oil, flax seed oil and salmon products) can help decrease the triglyceride value.
The LDL cholesterol is the most discussed part of the cholesterol panel and should be 130 mg/dl or less if you are postmenopausal or greater than 45 years of age (without heart disease or diabetes). If you have heart disease or diabetes, the LDL cholesterol should be less than 100 mg/dl. Exercise, smoking cessation and eating less saturated fat can help decrease cholesterol value.
Other risk factors for heart attack and stroke include aging, genetic background, smoking, diabetes, obesity and a sedentary lifestyle. Hopefully this will clear up some of the confusion patients have when receiving their cholesterol panels. Feel free to leave comments and I will respond in a general manner. Above all, know your numbers and discuss your entire cholesterol panel and other risk factors with your doctor so that he can give you more specific answers and proper medical advice.
Here's to Your Health 