The Truth About Cholesterol By Dr. Judith Ford, MD, Lead Physician of Clinical Quality at Healthcare Partners Nevada
Elevated total cholesterol can be an indicator of failing heart health, although it is far from a death sentence. It is attainable to achieve cholesterol health by living a healthy lifestyle and following the recommendations of knowledgeable medical professionals. HealthCare Partners Nevada, a medical network with locations across Southern Nevada, strives to make patients aware of their risk factors and develop customized treatment plans suited to their needs. High cholesterol is one of the major causes of coronary heart disease, heart attack and stroke, and early detection helps save lives.
Good vs. Bad Cholesterol
There are two different types of cholesterol - low-density lipoprotein (LDL) and high-density lipoprotein (HDL) - and the body's total blood cholesterol is measured by adding the LDL and HDL cholesterol levels, along with 20 percent of the body's triglyceride level. Triglycerides are a type of fat that can enter the bloodstream through foods that are high in simple sugars, fat and carbohydrates. In addition, elevated triglyceride levels can contribute to the hardening of arterial walls and increase the risk of heart disease and stroke, according to the Cleveland Clinic.
LDL is often called "bad" cholesterol because it can build up in the arterial walls and form plaque, which can reduce blood flow and increase the risk of heart disease. HDL cholesterol is known as the "good cholesterol" because it is thought to help remove the LDL cholesterol that clogs the arterial walls. While higher HDL cholesterol levels indicate strong cardiovascular health, raising HDL cholesterol via medication has not been proven to be beneficial, according to a study published by the British Medical Journal.
Monitoring cholesterol levels is crucial, since low HDL and high LDL cholesterol are major risk factors for heart disease. Heart disease is a leading cause of death among men and women in the U.S. and, according to the Centers for Disease Control and Prevention, roughly 730,000 Americans suffer heart attacks each year. Of those, approximately 525,000 are first-time heart attacks. Heart disease claims more than 600,000 lives in the U.S. each year and is the No. 1 cause of death among most ethnicities.
Risk Factors and Symptoms
High blood cholesterol itself is not symptomatic, so many people are unaware of their condition. It is important to undergo cholesterol testing so medical professionals can begin their treatment plan. Dr. Rakesh Kalra, a HealthCare Partners Nevada physician, says something he always emphasizes to his patients is that body type is not an indicator of high cholesterol. A thin frame, regular exercise and living a healthy lifestyle does not ensure healthy cholesterol levels. On the other hand, being overweight is not necessarily an indicator of elevated cholesterol and triglyceride levels.
There are numerous ailments and lifestyle choices that can contribute to a person developing high cholesterol. According to the University of Maryland Medical Center, a diet high in saturated fat and trans fats, a lack of exercise, obesity, high blood pressure and diabetes are some of the top risk factors. Genetics are the most important risk factor, and poor cholesterol health can be passed down from a parent.
"Genetics play a key role with cholesterol," says Dr. Irene Lambiris, a physician with HealthCare Partners Nevada. "Between the ages of 20 to 30, individuals should undergo one cholesterol check. If that cholesterol check is abnormal, it is advisable to proceed to annual checkups."
Dr. Kalra says he has high cholesterol as a result of genetics. He works out and watches what he eats to help prevent the onset of heart disease. When it comes to relaying the importance of cholesterol, he says it can be difficult to get through to certain patients.
"People tell me, 'I'm thin, I don't have to worry about cholesterol,'" Dr. Kalra says. "They don't understand the importance of getting cholesterol down to prevent heart attacks and stroke. The really thin people, and even young people, often don't realize how important it is to get cholesterol under control."
Medicating High Cholesterol
When it comes to treating high cholesterol, the goal is to reduce cholesterol levels to a point where the risk of developing heart disease or suffering a heart attack decreases. Dr. Lambiris says she starts to become concerned when a patient's LDL cholesterol is above 160 milligrams per deciliter (mg/dl). Prior to starting medication, HealthCare Partners Nevada recommends a cholesterol-lowering diet, physical activity and weight management for six months. If that does not work, medication, along with diet and exercise, is the next step.
There are myriad cholesterol medications that help regulate cholesterol levels, including statins, bile acid sequestrants, nicotinic acid, fibric acids and cholesterol absorption inhibitors. Statin drugs, including Lipitor and Crestor, are very common in cholesterol treatment and lower LDL and triglyceride levels while slightly raising HDL levels. Cholesterol absorption inhibitors and bile acid sequestrants lower LDL levels and can be taken alone or in conjunction with statin drugs. Nicotinic acid drugs lower LDL cholesterol and triglyceride levels, while fibric acids are typically implemented to treat high triglyceride and low HDL levels.
Statins are recommended for most patients because they are the only cholesterol-regulating medications that have been proven to decrease the risk of a heart attack. They reduce the amount of cholesterol deposited into the lumen of the artery, which is the hollow part of the artery in which blood passes through. Statins also lessen the inflammatory state of the artery, making the plaque more stable so that it does not break off and cause a heart attack. Dr. Lambiris compared the lumen to pipes in a house, saying "If they keep getting clogged, that's a problem."
The Red Meat Debate
According to Dr. Kalra, red meat can have an adverse impact on cholesterol, since it is generally high in cholesterol and saturated fat. Dr. Kalra says red meat is typically safe to eat occasionally, although it is important to select the right kind. If people are going to eat beef, he suggests purchasing lean beef with 10 percent fat or less. The American Heart Association recommends consuming no more than six ounces of cooked, trimmed lean meat a day, which includes shellfish, skinless poultry, and trimmed, lean red meats.
Processed, highly salted red meats such as bacon, sausage and salami are associated with a much higher risk of heart disease. They are loaded with calories and saturated fat and are often packed with sodium. According to a Harvard T.H. Chan School of Public Health study, eating 50 grams a day of processed red meats like sausage and bacon resulted in a 42 percent greater risk of heart disease and 19 percent higher risk of Type 2 diabetes.
"The sodium content in processed red meats is exorbitant, and eating too much salt can increase blood pressure as well," Dr. Lambiris says. "I encourage my patients to avoid eating processed red meats."
Eggs were long considered harmful to heart health because of their high cholesterol content. In recent years, that school of thought has changed, and many medical professionals sing the praises of eggs as a nutrition-packed staple of a well-balanced diet. In fact, most healthy individuals can eat at least seven eggs a week without increasing their risk of heart disease, according to the Mayo Clinic. In addition, studies have shown that egg consumption can also reduce the risk of stroke.
The negative perception of eggs has led to Americans eating fewer than ever. According to the U.S. Department of Agriculture, the average American in 1945 ate 421 eggs per year, a number that dropped to 250 by 2012.
"People can eat two eggs a day, and it will not impact cholesterol like we used to think," Lambiris says. "I would rather have my patients eat an egg omelet in the morning than oatmeal."
Oatmeal is high in carbohydrates, which raises the body's triglyceride levels, Dr. Lambiris says. She notes that oatmeal is broken down into sugar and stored as fat, whereas protein and fat sources like eggs are broken down more easily and used as fuel much quicker than carbohydrates. While eggs are high in cholesterol, the impact of egg consumption on blood cholesterol is minimal when compared with trans fats and saturated fats. The risk of heart disease may be more closely related to the foods many people eat with eggs, such as the sodium in bacon, sausage, ham and the saturated fat or oils with trans fats used to fry eggs and hash browns.
While having in-depth diet discussions with his patients, Dr. Kalra provides them with a handout outlining healthy foods low in saturated fat, fat free or 1-percent dairy products, lean meats, whole grains, fruits and vegetables. In addition, he suggests consuming 25 grams of fiber per day. According to the Mayo Clinic, fiber contributes to reducing "bad" cholesterol levels, controls blood sugar and helps maintain bowel health.
"I have seen miraculous health improvements in patients committed to diet and lifestyle changes," Dr. Lambiris says. "Sometimes, lifestyle changes are not enough because of genetics, but we do want to get them on that path where they are living healthier lives."
And a healthy lifestyle, combined with regular checkups and a commitment to medications, can help keep cholesterol levels in check. HealthCare Partners Nevada's primary care providers and cardiologists are committed to promoting healthy cholesterol levels and are happy to answer any questions about cholesterol and heart health.