Cholesterol – We all have it…we all need it, but maybe not so much!
We have all heard about Cholesterol, and probably what you know about it is that there is “good” cholesterol (HDL) and “bad” cholesterol (LDL) and you probably have been told yours should be lower.
The last 5 years has been a veritable revolution for the way we look at cholesterol as physicians. New data has really shown us what we have assumed all along. We need lower cholesterol levels, and these lower levels will make us live longer (and better!).
Since I left medical school in 1992, the goal for LDL Cholesterol (the “bad” cholesterol that clogs up your arteries and leads to heart attacks and strokes) has dropped by 30 points every 3-5 years, like clockwork. First it was 190, then it was 160, then it was 130, and now “they” (the “experts”) would like our LDL cholesterol to be under 100, ideally.
Whoa Fella! Can this possibly be right? I think patients, and even some physicians, were a little incredulous initially. After all, we need cholesterol for production of cell membranes and a healthy nervous system. As it turns out, the “experts” were right. The statement I make below has been validated by so many well designed and documented studies, that I believe it can be taken entirely at face value:
For every 1% you drop your LDL Cholesterol (between all values from 40 to 200), you will get a corresponding 1% drop in your yearly risk for a heart attack or a stroke.
That’s right. If you drop your LDL Cholesterol from 160 (happens to be my LDL cholesterol before medication) down to 80 (my current LDL Cholesterol with the help of a little pill I’ve taken since 1996), you reduce your risk of a heart attack or stroke by 50%. This is an enormous difference in lifespan (4-6 years for most people) and you are getting additional “good years”, before you have a stroke or heart attack. Most people are not interested in adding years to the end of their life when they can no longer chew solid food 😉
Good question, I’m glad I asked!
If your diet is already prudent, and you are not morbidly obese, you can probably only hope to improve your cholesterol by 10-15% with dietary modifications. That is the sad truth of it. Cholesterol, unfortunately, is more influenced by genetics than by diet; your liver makes a certain amount every night while you sleep and there is nothing we can do about that (yet!). However, if your cholesterol is not too high, this may be all that is needed!
So what is the solution for the majority of americans?
Better living through chemistry.
Pills may not always be the answer to every medical issue which comes down the road, but in this case, it is easily the best answer. There is a class of medications called “Statins” which have been around in one form or another for about 25 years. The ones we have available today are more potent and have fewer side effects than ever before. Even the lowest dose of Simvastatin (a generic statin which should be very cheap on any insurance plan) will lower your cholesterol 25-35% in about 6 weeks. That is a 25-35% lower yearly risk for stroke or heart attack. Higher doses can lower it up to 50%. Statins have a very low risk profile. They can cause muscle aches in about 15% of patients (which go away when you stop the statin, or often if you merely change to a different one) and can infrequently cause liver inflammation (less than 1%), so you do need to get blood tests a couple times a year to check for that. There is also a very rare, but serious problem called Rhabdomyolysis which occurs in far far less than 1% of patients (i’ve seen it once in almost 20 years of practice) and it comes with terrible muscle pain, so it’s not silent. Stopping the medicine alleviates the problem.
There are some problems that fall into the medical gray-zone where the risks and benefits of treatment make it a hard decision for a doctor to make. For the majority of people, treatment of cholesterol is a slam-dunk proposition. You live longer and better for almost no risk.
So, get your cholesterol checked! The majority of people who will read this blog will have a Northern European gene heritage (your ancestors came from all over northern europe). These genes are awful for Cholesterol, Hypertension and Skin Cancer (but they are great for winning Nobel Prizes!).
Anecdotal Data on Cholesterol is interesting: (anecdotal data is the worst kind of information a patient or physician can have or use. It has no scientific basis and tends to have a lot of bias. “I don’t believe in blood pressure medicine because Aunt Ruth took blood pressure medicine and she died of a heart attack!”). The average LDL cholesterol for a large portion of Africa and Southeast Asia is 40. That’s right 40. Not 140. 40. And these lucky folks die of malaria, AIDS, malnutrition, TB and a whole bunch of other horrible things. But they don’t get much heart disease. Is it their naturally low LDL that is helping them? Perhaps. It’s not their diet. Their risk stays low even when you bring them to a western country (remember, most cholesterol is made in your liver and is determined genetically. Only 20% or so is due to diet). Again, this is anecdotal information, so it has to be taken with a grain of salt, but it sure looks impressive!
Get your cholesterol checked!