May 16, 2023: Patients have many questions about how to lower cholesterol and what to do after a high cholesterol diagnosis.
Dr. Ashish Sarraju answers some of these common questions including why fasting before your test is important, what all of the different tests tell your doctor and what you can do to help your heart.
Lp(a), pronounced “L-P little A” is like LDL cholesterol, but stickier, which can speed up narrowing of your arteries. If you have too much Lp(a), you have a higher chance of clogged arteries, heart attack, stroke, and heart valve problems.
There are three general types of large molecules of which our body is composed. There are PROTEINS, essential components of the Nanomachines that power of our bodies, the CARBOHYDRATES which can form structures, as well as provide and store nutrients, and LIPIDS, which can function as a storehouse of nutrients.
Lipids, unlike carbohydrates and proteins, are essentially nonpolar, that is they have no profusion of charged molecules. The main characteristic of lipids is that they do not dissolve in water, thereby allowing for domains and structures to develop in the cell and beyond.
Cholesterol is a lipid that is essential to our cell membranes, and therefore to life. As people get older, however, cholesterol tends to accumulate and get stored in unwanted places, such as under the lining membranes of blood vessels. In this location, they can cause blockages that threaten the very life for which they are essential.
All of the lipids measured in the comprehensive lipid panel measure lipids in different forms that have different functions and significance in the body. The only one of the lipids that is almost always good, or at least neutral, is the high density lipoprotein, the HDL. The level of this lipoprotein is under genetic control and is increased by EXERCISE and FISH OIL, among other things.
“Good Genes”, healthy diet and exercise will help keep down the bad lipids, especially the LDL, and elevate the main good lipid , HDL.
Coronary artery disease and strokes are the main killers in mid and into later life, and are therefore very important to control. Many people do not seem to have the self-discipline that healthy diet and exercise requires. Fortunately, we have a miracle drug. the HMG- CoA inhibitors, the “statin” drugs, which most people tolerate without the muscle pain and myolysis side effect.
I have taken the statin drugs for years, ever since I discovered my cholesterol was 220, above the optimal level. Fearful of muscle effects, since I am a heavy exerciser, I started out on 1/2 of the lowest dose, 2.5 mg., of Rosuvastatin. This amazingly took my cholesterol level all the way down to 180, and my LDL down below 100, a powerful medication indeed.
My most recent Lipid panel results are below:
Result value. Ref. Range
Triglycerides. 51 mg./dL. <150 mg./dL
Cholesterol. 186 mg./dL. <200 mg./dL
HDL. 90 mg./dL. > 60 mg./dL
LDL direct. 95 mg./dL. <100 mg./dL.
The authorities have lowered the normal range a couple of times during my lifetime. It is true that even lower values than mine show ever more benefit.
It is best to keep your lipids under control with diet and exercise, so stay healthy!
—Dr. C.
Target LDL depends on many factors, including your age, family history, and personal history of cardiovascular disease. For people at intermediate risk, LDL should be lowered by 30% to 50%. For those who have already had a heart attack, target LDL is no more than 70 mg/dl (note: automatic download).
Five non-statin therapies described in this post aim to help people achieve target LDL goals while minimizing side effects. They may be combined with a statin or given instead of statins.
Each helps lower LDL cholesterol when diet and statins are not sufficient, such as when there is a family history of high cholesterol (familial hypercholesterolemia). But so far, only two options are proven to reduce cardiovascular risk — the risk for heart attack, stroke, heart failure, and other issues affecting the heart and blood vessels.
Ezetimibe (Zetia)
What it does: Lowers LDL and cardiovascular risk by reducing cholesterol absorption.
How it’s given: A daily pill
Relatively inexpensive and often given with statins.
PCSK9 inhibitors, alirocumab (Praluent) and evolocumab (Repatha)
What it does: A protein called PCSK9 controls the number of LDL receptors on cells. These medicines are monoclonal antibodies against PCSK9 that increase LDL receptors on the liver, helping to clear circulating LDL from the bloodstream.
How it’s given: A shot every two to four weeks
Highly effective for lowering LDL, but expensive and may not be covered by insurance.
Mayo Clinic Minute – What you need to know about cholesterol.
Cholesterol is any of a class of certain organic molecules. A cholesterol is a sterol, a type of lipid. Cholesterol is biosynthesized by all animal cells and is an essential structural component of animal cell membranes. When chemically isolated, it is a yellowish crystalline solid.
There are two types of cholesterol: LDL cholesterol, which is bad, and HDL, which is good. Learn why too much cholesterol and elevated triglycerides can lead to heart disease and stroke. Make it a priority to have your cholesterol checked.
The STATIN medications are one of medicine’s greatest achievements, in my opinion. They REDUCE blood CHOLESTEROL and HEART ATTACKS in very low doses and have a good safety profile. They truly deserve to be the Best Selling class of drugs. 13 Nobel prizes have been awarded during the centuries of cholesterol research.
I have never had a heart attack, but do have some calcification in my Coronaries. Moreover, I have an untreated serum cholesterol level of 220 mg/dL. This is above the recommended level of 200 mg/dL, so I read up on the statins. The only concerning side effect from my viewpoint was MUSCLE PAIN.
I already have some muscle soreness from my exercise program, and did not want more, so I started at ½ of the 5 mg. dose of the statin suggested by my family doctor. This tiny dose of Rosuvastatin produced a dramatic 40 mg. Drop in my Cholesterol, and I am still hovering around the recommended level of 200 mg./dL. Instead of breaking the 5 mg. tablet in half, I now take 5 mg. every other day, since Rosuvastatin has a long half life.
One of my friends took a higher dose, and drove his cholesterol down to 100 Mg./dL. Apparently there is no serum level of cholesterol where further reduction fails to help.
Total cholesterol is divided into HDL and LDL components. My HDL, the “good” cholesterol, is thought to offset some of the cholesterol-plaque-causing effects of the LDL, or “bad” cholesterol. This makes me less than eager to raise my cholesterol and risk muscle pain.
My HIGH HDL is probably due to a combination of EXERCISE, FISH OIL and Genetics. Many of my friends “don’t tolerate” the statins, meaning that they developed muscle pain. Since they were taking the drug on faith, and not because of already-developed heart problems, they just don’t take the medication any more.
If your doctor has recommended one of the Statin drugs because of an elevated cholesterol, you might ask her to start at a lower dose. You can always work up to a higher dose if necessary. If you develop muscle pain at the higher dose, you can drop back to the dose you tolerated. Enjoy “Personalized” Medicine.
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