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What is Cholesterol?

                Cholesterol is a molecule found in foods and also produced in our own bodies. This molecule is essential for normal bodily function, but too much can be bad.  Over the past few decades we have learned that high levels of cholesterol can significantly increase the risk of heart disease and stroke by forming plaques that block and damage arteries.  More importantly, we have discovered that we can dramatically reduce the risk of developing these diseases in many people if we reduce their cholesterol levels.

Why is my Cholesterol level high?

                    The cholesterol which is found in our bodies comes from two sources.  Some cholesterol comes directly from our diet.  While some foods have no cholesterol, others have very high amounts. If your cholesterol level is high, it is important to pay attention to the cholesterol content of foods that you eat.  It is also important to pay attention to the fat content and the type of fats found in the food you eat since these substances can be easily converted to cholesterol by the body.  Much of the cholesterol in our bodies does not come from our diet at all, but is actually manufactured by the body.  Cholesterol is produced by the body through a series of chemical reactions. The rate at which cholesterol is produced is controlled by several "enzymes". Enzymes are proteins in our bodies which can speed up the rate at which a reaction takes place. We all inherit slightly different versions of these enzymes.  The result is that some of us produce a lot of cholesterol, and others produce only a little.  Many of the most frequently prescribed cholesterol medications work by inhibiting these enzymes and slowing down the production of cholesterol by the body. 

What is "Good and Bad" Cholesterol?

            You may have heard the terms "Good" and "Bad" cholesterol before.  These terms refer to several distinct types of cholesterol in the body that have different effects on heart disease and stroke risk.  The cholesterol number that most people quote is the Total Cholesterol.  The total cholesterol is actually the sum of all the good and bad cholesterol numbers.  

Think of the Tryglycerides and LDL's as the "litter bugs". They travel through the blood stream and leave cholesterol deposits along the arteries. These deposits can ultimately clog the arteries and lead to a heart attack or stroke. HDL then is like the "sanitation crew". It travels through the blood stream also, but it picks up cholesterol from those deposits and brings it back to the liver to be broken down. Ideally you want your LDL and Triglyceride as low as possible and your HDL as high as possible. 

What should I do if my Cholesterol is abnormal?

                The treatment of high cholesterol depends on whether or not you have other heart disease and stroke risk factors.  To determine what your numbers should be you can use the link below to calculate your cardiac risk. Then determine what risk factors you have. Finally use the the table to figure out what your goal should be for LDL. Of course you should always ask your doctor what his recommendation is.

Step 1

Click here to calculate Your Cardiac Risk

Risk Factors *CHD ( Coronary Heart Disease) equivalents High Blood Pressure  Coronary Heart Disease Family History ( heart disease in a 1st degree male relative before age 55 or female before age 65 Peripheral Vascular Disease Smoking Abdominal Aneurysm   Age ( Men >40, Women >55) Symptomatic Carotid Artery Disease Low HDL <40 Diabetes

Lowering your cholesterol: TLC and Medication

1) Therapeutic Lifestyle Changes ( TLC): - Diet and Exercise

The first step in controlling cholesterol usually involves increasing exercise levels, and changing to a low cholesterol low fat diet. Most fats can be quickly converted to cholesterol by the body.  Saturated fats  and "Trans fats"  are particularly easy to convert into cholesterol. They have been shown to increase your LDL ( bad cholesterol) and lower your HDL ( good cholesterol)

  This is why some foods that have no cholesterol may still be bad for you if you are trying to lower your cholesterol. It is important to read the labels. Food that are high in saturated fats or transfats should be consumed in very limited quantities.  

Recommended Fat and Cholesterol  Intake

    Here is a list of useful resources to help you get started on a low cholesterol diet:

Low-Cholesterol-Recipes - Web site with some helpful tips Foods to Use and Food to Avoid  Brief Summary of the good, the bad, and the ugly of the food world How to Lower Your Cholesterol Level - Another useful web site  The New American Heart Association Cookbook 25th Anniv, Ed. - This is a great book with a wealth of  info on how to start and stick with a low cholesterol diet

2) Medication:

Dietary changes are an important part of controlling high cholesterol ( see table below), but patients who also have additional risk factors may require more aggressive treatment with medication.

Do I really need to take medication?

            If you're physician prescribed a cholesterol lowering medication it's because your cholesterol level puts you at greater risk of a heart attack or stroke.  Diet and exercise alone have been unable to bring your cholesterol down to an acceptable level and your doctor has determined that you need this medication to reach that goal. Many studies done over the past two decades have shown that people who take these medications can expect to have a greatly reduced risk of cardiovascular diseases.

            There are many misconceptions about cholesterol lowering medications.  Medicines like Zocor, Lipitor, Pravachol, ( the "statins") and others are now used by thousands of people in this country.  Numerous studies show that these medications are safe and can dramatically reduce the risk of heart attack and stroke.  Below is a list of Frequently Asked Questions ( FAQ's) and corresponding answers.  

          Q. How does this medicine work?

A. There are several different types of medication which can lower cholesterol levels.  Some medications work by preventing cholesterol absorption in the intestines. Other medicines known as "statins"inhibit the body from producing cholesterol.   The body uses enzymes to make cholesterol from many other substances. These enzymes are like little factories, and the medication slows down their ability to manufacture cholesterol.

          Q. What side effects does the medicine have?

A. Most cholesterol medications used today are very safe and effective. All medicines do have the potential for side effects, and for this reason, we monitor all such patients on a periodic basis. Some people have a hard time metabolizing these drugs. In these patients the liver may show signs of stress. As a matter of routine, we periodically measure something called Liver Enzymes in patients who take cholesterol lowering drugs. If a problem is noticed the medicine is stopped and the levels usually return to normal. A much rarer side effect is an inflammation of the muscles which can cause muscle pain. If this happens stop your medication, and let us know.

          Q. Will I have to take this medication forever?

A. The reason you are being prescribed this medication is because you either consume or produce too much cholesterol. If you consume too much it may be possible that in the future you may be able to alter your diet to the point where you won’t require medication anymore. If you produce too much cholesterol then this is something that is genetically predetermined. Since we can’t change your genetic makeup you will most likely need to take medication on a permanent basis to keep your levels down.

Q. Now that I'm taking this mediation, can I eat whatever I want?

A. NO!!! The medicine does not give you the ability to eat whatever you want. The idea here is to try to lower your cholesterol. If you increase your fat intake you will cancel out the benefit of the medication. In addition you will gain weight which will put you at further risk for heart disease. So stick to your diet!

If you have other questions about the cholesterol lowering medication you have been prescribed please ask your physician.

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