For every item selected above, add 1 point. If your HDL is greater than 60, subtract one point. Two points give a person a 20% chance of a heart attack or stroke in the next 10 years. The more points you have, the greater your risk.
Ask Your Doctor For A Lipid Profile
All adults should have a periodic Lipid Profile to determine the level of LDL and HDL in their blood. At what age and how often you have your cholesterol level checked depends on your family history and other risk factors you have for heart disease. The blood tests are simple and require no preparation except for a 12 hour fast. Water is permissible. There is very little risk associated with taking blood from a vein in the arm, although occasionally, a bruise may develop in the area where the needle was inserted. Ask your doctor for the results, which are usually available in 2 - 3 days. Results are usually given in "mg/dL" which stands for milligrams per deciliter and is the standard unit of clinical measurement used to determine how much cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides are in the blood.
Blood tests are best arranged by your personal physician who can assess other risk factors and make decisions about treatment if necessary. For those who are reluctant to visit their doctor, the FDA has approved two cholesterol test kits that can be purchased without a prescription. The First Check Home Cholesterol Test is a home test that only takes about 12 minutes, but measures only your total cholesterol level.
LDL: How Low Should You Go?
The point is that it depends upon your overall risk. The definition of a "normal" LDL must be taken in the context of the risk assessment above. Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dl) of blood. We are born with an LDL around 40 mg/dl, which rises with age. In general, the average middle aged adult should maintain an LDL below 130 mg/dl. For all diabetics and anyone with two or more of the risk factors above, current recommendations are to reduce the LDL to below 100 mg/dl. If you already have heart disease, the new guidelines are even stricter.
When it comes to LDL in patients at the highest risk of heart disease, lower is better. A national panel of experts - including the American Heart Association, the American College of Cardiology, and the National Institutes of Health - released a revised set of guidelines in July 2004. The latest information is clear: based on the latest scientific studies, LDL should be no higher than 70 mg/dl in patients with established heart disease and more than 2 risk factors. This recommendation replaces the previous target of 100 mg/dl. The new recommendations are likely to sharply increase the use of statin drugs. Under these guidelines, over 20 million Americans are currently being under treated and it's almost impossible to reach such low LDL levels without cholesterol-cutting medications.
How do you lower your LDL?
Get more exercise. Start slow and gradually work up to about 30 minutes daily. Fewer than 15% of Americans get adequate amounts of exercise, but exercising regularly is one of the best ways to reduce the risk of heart disease. A 3-tiered exercise plan which rotates low-impact cardiovascular exercise, strength training, and stretching is best, but you don't have to join a gym. Even a simple 30 minute walk daily can improve your health. If you are over 50, you should always check with your doctor before starting a new exercise program.
Maintain a normal body weight. The answer to our epidemic of heart disease cannot rest in the pharmaceutical industry alone. Americans are getting too fat. Nearly 119 million American adults - 65 percent of the population - are now overweight and many of those are carrying 100 pounds more than they should. Reducing body weight to normal levels can sometimes dramatically lower LDL. Normal weight is best assessed by calculating your Body Mass Index, or BMI.
Eat more soluble fiber. Simply, dietary fiber - also called roughage or bulk - is the part of plants that cannot be digested by the body. Dietary fiber is found in grains, fruits, and vegetables. There is no fiber in animal products such as meat, fish, eggs, or dairy products. Just as there are many types of plants, there are also many types of dietary fiber. Some fibers can be dissolved in water (soluble fiber) and inside the small intestine form a jelly-like bulk that can lower cholesterol and reduce blood sugar. A diet high in soluble fiber can reduce LDL by as much as 15%. Soluble fiber can be found in foods such as oat bran, apples, citrus, pears, peas, beans and psyllium.
A repeat lipid profile is usually performed several months after starting a new diet and exercise program. Unfortunately, even though you can lower your LDL by changing what you eat, studies have shown that the average person achieves only a modest reduction of about 4-13% by diet alone.
Statins: the mainstay of prescription drug therapy
Statins are best taken once a day at dinnertime, since the body manufacturers most of its cholesterol at night. Grapefruit juice affects the metabolism of Zocor, Mevacor, and Lipitor, and should be avoided. Taking these cholesterol-lowering drugs at the same time as grapefruit juice can increase the risk of muscle toxicity. The problem occurs because grapefruit contains a chemical that inactivates a liver enzyme involved in drug metabolism. As a result, regular consumption of grapefruit juice can lead to excessively high levels of medicine in the blood. However, Pravachol, Lescol, and Crestor are metabolized differently and are not affected by the ingestion of grapefruit juice. They should not be taken during pregnancy.
What if statins don't work?
One such drug is Niacin, also known as nicotinic acid or vitamin B3. Niacin lowers the total cholesterol, "bad" LDL-cholesterol, and triglyceride levels, while raising the "good" HDL-cholesterol level. It is inexpensive and widely accessible to patients without a prescription, but must not be used for cholesterol lowering without the monitoring of a physician because of the potential serious side effects. It is seldom used as a primary form of treatment.
Bile acid resins work by binding to the bile acids your liver makes for use in digestion. The resins remove much of the bile acid from inside your small intestinal tract. When your body works to replenish the supply of bile acid, it takes cholesterol--a major building block for bile acids--out of the bloodstream. The result: lower levels of cholesterol in the blood. Doctors sometimes prescribe bile acid resins in combination with other cholesterol-lowering drugs such as one of the statins to lower blood cholesterol levels even further. The common bile acid resins are Questran (cholestyramine), Colestid (colestipol) and WelChol (colesevelam).
Sometimes a combination of a low dose statin with a different medication called Tricor (fenofibrate) will work when a statin alone does not. With this treatment, liver blood tests must be followed closely. This combination can also help reduce another blood fat called Triglycerides and may raise the HDL level somewhat.
A few years ago, a new type of drug Zetia (ezetimibe) was approved by the FDA in the battle against high cholesterol. Unlike statins which block excessive liver production of cholesterol, Zetia works in the small intestine by blocking absorption of cholesterol from the diet. In fact, Zetia is also offered in combination with the statin Zocor and sold as Vytorin. This drug was widely advertised and very profitable for Merk pharmaceuticals. Unfortunately, more recent studies suggest that while Zetia may decrease LDL cholesterol somewhat, it does not prevent clogging of the arteries. There also have been cases of liver damage from the use of Zetia so it has lost much of its original appeal.
Policosanol (poly-CO-sanol) is a non-prescription dietary supplement that some say may help reduce LDLcholesterol. Originally found in Cuba, policosanol is a natural plant product derived from sugar cane. Policosanol acts on cholesterol metabolism in the liver, but at a different part of the metabolic pathway than statins. Unfortunately, when studied scientifically, there was little benefit. In another independent study on Cuban policosanol in 2006, German researchers found it ineffective. Another study found policosanol made in the U.S. from sugar had no effect either. It’s also not known if other sources of policosanol, besides sugar, work. In European studies, neither policosanol from wheat germ nor policosanol from rice showed benefits. and it can't be recommended. Policosanol also reduces the "stickiness" of platelets, the blood elements that promote blood clotting, so this supplement should be used with caution, if at all, in patients taking blood thinners such as Coumadin. No other major drug interactions are known.
HDL: How High Should You Go?
Unfortunately, although we now have a variety of effective therapies to lower LDL, there currently is a no simple way to raise your HDL. Current therapy includes exercise (especially lower body workouts with weights that build the quads such as squats, leg extensions, and leg presses), a diet high in monounsaturated fats (olive oil, peanuts, hazelnuts, almonds, macadamia nuts) and foods rich in omega-3 fatty acids (walnuts, soybeans, flaxseed, mackerel, lake trout, herring, sardines, albacore tuna and salmon).
Alcohol in moderation ( men = 2 drinks per day; women = 1 drink per day) also raises the HDL somewhat. A few studies suggest that red wine and beer, which contain flavonoids, have the most beneficial effect. A drink is defined as 12 oz of beer, 5 oz of wine, or 1.5 oz shot of 80-proof spirits. Drink more than that and you can do more harm than good by weakening the heart muscle. Flavonoids are also found in purple grape juice.
Stopping smoking is mandatory! Smoking decreases HDL. Cigarette smoking increases the risk of coronary heart disease by itself. When it acts with other factors, it greatly increases the risk. Smoking increases blood pressure, decreases exercise tolerance and increases the tendency for blood to clot. Cigarette smoking is so widespread and significant as a risk factor, that the Surgeon General has called it "the most important of the known modifiable risk factors for coronary heart disease in the United States."
For more information, go to the Live Healthier, Live Longer website which is sponsored by the National Cholesterol Education Project and the National Institutes of Health.