What you should know about your cholesterol

Everyone over the age of 25 should know their cholesterol level.  Everyone with risk factors for coronary heart disease (diabetes, smoking, high blood pressure, obesity, advanced age, family history) should be very aware of their lipid profile and have it checked regularly.

The lipid profile breaks cholesterol down into parts.  The good cholesterol (HDL) should be greater than 40-45 and the higher, the better.  The bad cholesterol (LDL) should be below 130, less than 100 being ideal.  Triglycerides should be less than 200.  This blood test requires a 12-hour fast and it should be rechecked every 6-18 months depending on the values and your risk factor profile.  Becoming aware of your cholesterol and acting before you have a heart attack or stroke is called primary prevention and medical/dietary intervention has been shown to be beneficial in multiple clinical trials.

If you have already had a heart attack, stroke, or peripheral artery disease, aggressive cholesterol lowering is a critical part of secondary prevention.  Secondary prevention trials have demonstrated a dramatic reduction in death, heart attack and stroke with the use of “statins”.  Some of the trade names include Mevacor, Zocor, Pravachol, Lipitor, Lescol, and Crestor and they need to be taken at night, when most cholesterol synthesis occurs.  Although they are moderately expensive, they are well tolerated, with rare side effects.

Significant liver and muscle enzyme elevation is an unusual complication and typically reversible with discontinuation of the drug.  But the benefits (including the potential for shrinkage of coronary plaque) so far outweigh the risk, that aggressive lowering of cholesterol through diet and medication is very strongly recommended.  The most recent evidence suggests that lowering cholesterol to subnormal levels (LDL<70) provides even further benefit. This goes for long-standing or insulin-dependent diabetics as well, even if no cardiac or vascular event has occurred yet.

The bottom line is that you should know your cholesterol profile and what it means for you, in your particular situation.  If you have already suffered a cardiac or vascular event, this awareness is no longer optional.  You will benefit greatly by staying on top of your lipid profile, insisting that your provider check it routinely and ensuring that you are on the appropriate medication and diet to reach your goals.

David R. Boston, M.D.

(The author has no financial incentive to promote any particular brand or type of therapy.)