The Cholesterol Maze


Within the last three years the National Cholesterol Education Program (NCEP) guidelines have been re-defined. With such strict recommendations, one can’t help to wonder if everyone will need a statin-type drug to meet these goals! The new goals for a person with coronary heart disease and/or diabetes, and/or multiple risk factors are to obtain an LDL cholesterol of 70 or less, and an HDL cholesterol of 45 or greater.

As a little review, the major blood lipids which are actually blood fats include LDL cholesterol, HDL cholesterol, and triglycerides. However, not all lipids are bad. HDL cholesterol commonly referred to as the “good” cholesterol, actually carries cholesterol from the circulation to the liver where it can be processed and removed from the body. Other than favorable genetics, factors associated with high HDL levels include exercise, body leanness, estrogen, and freedom from cigarette smoking. LDL cholesterol, on the other hand, is commonly referred to as the “bad” cholesterol, because it transports cholesterol to the circulation where it plays a big role in plaque formation in the coronary and other blood vessels, thereby setting the stage for heart attacks and strokes.

To make matters even more confusing, not all LDL cholesterol is the same. I frequently perform an additional lipid blood test to sub-classify the LDL particle size. A small dense particle size (Pattern B), is more easily oxidzed or chemically altered, allowing easy entry into the arterial wall, causing potentially dangerous plaques. Large buoyant pattern LDL (Pattern A) is more resistant to this chemical alteration. This distinction is important because both dietary and drug treatment differs for the two entities. To make maters even more complex, it is not merely LDL cholesterol that constitutes the problem. It is when the LDL particle oxidizes, as I alluded to above, that the stage for plaque formation and heart attacks and strokes is set.

Returning to the need for intervention, I always prefer conservative management whenever possible. As I see it, the problem in this country, possibly compounded by the influence of powerful pharmaceutical giants, is that many individuals are being over treated, and simultaneously many individuals are being under treated. What I find indisputable is that those with coronary heart disease ,whether or not they have experienced a coronary event in the past, should be aggressively treated. This also holds true for diabetics, which should not sound surprising, as approximately 70 % of diabetics eventually succumb to a heart attack. Often young individuals in their twenties and thirties are referred to me for treatment of elevated cholesterol. It is this population, which is huge, that I recommend conservative management and to whom I offer counsel on healthy life-style interventions. Remember cholesterol is but one piece of the pie when it comes to heart attacks and strokes.

In another article I will touch on both diet therapy and the usage of various supplements to treat this rather complex disorder.

Dr. Elkin is a board-certified internist, cardiologist and anti-aging medical specialist.

VERY IMPORTANT NOTE / DISCLAIMER: I am offering—always—only general information and my own opinion in these articles. Always contact your physician or a health professional before starting any treatments, exercise programs or using supplements.
©Howard Elkin MD FACC, 2012

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