When Should You Worry About Cholesterol?

Total cholesterol is calculated by using a formula that includes HDL, LDL, and triglycerides. That makes the overall cholesterol number of limited use to a doctor.
LDL and HDL numbers are far more important than the total cholesterol. In fact, there is a calculation called the Framingham Risk Score which uses HDL and LDL levels, along with other risk factors, and calculates a person’s 10-year risk of having a heart attack. I’ll put a link to this formula in the show notes.

When you get down to it, people don’t die from high cholesterol, they die from heart attacks and strokes. If I knew a person with high cholesterol would stay healthy until they were 90, I wouldn’t bother treating them. That is what makes the Framingham Risk Score useful to me: it focuses on what really matters. It’s not a perfect formula, but it gives a decent idea of risk. My goal as a doctor is to get that 10-year risk as low as possible.

So what does this mean to you? Here are my quick and dirty tips about cholesterol:

Tip # 1 - It’s important to know what your risks are, and since heart attacks are associated with higher LDL and lower HDL, it is good to know these numbers. This is especially important as you get older, as heart attacks get much more frequent as people age.

Tip #2: Don’t Focus on the Total Cholesterol

Knowing your HDL and LDL will allow you to know your real risk. For low-risk people—or people without any risk factors (which I’ll get to in my next tip) the goal is to have an LDL under 160. But that goal changes as the number of risk factors goes up. For people with diabetes, for example, the LDL should be under 70.

As for your HDL level, you want that to be over 40, although over 50 is even better.

Tip #3: Know Your Other Risk Factors

Knowing your risk factors for heart disease —aside from cholesterol-- will tell you how closely you’ll need to monitor your cholesterol.

1. High Cholesterol
2. High Blood Pressure
3. Smoking
4. Diabetes
5. Strong family history of heart disease in your immediate family
6. Advanced age

Additionally, men are generally at higher risk for heart disease than women are.

Tip #4: Do What You Can to Have the Best Cholesterol Possible

There are many things you can do to lower your LDL and raise your HDL. These include:

· Exercising
· Controlling your weight
· Eating right
· Not smoking.

Foods rich in saturated and trans-fats tend to raise the LDL, whereas foods rich in unsaturated fats can actually raise the HDL--the good cholesterol. In general, this means that you should minimize animal fats --- more common in red meats -- but don’t cut back on vegetable fats. Olive and canola oils are rich in the good unsaturated fats, and so are actually good to have. Also avoid “hydrogenated” oils, which are fats that have been turned from unsaturated to saturated fats by food manufacturers. They do this to make its consistency better, but it makes the food much less healthy.

Tip #5: Consider Cholesterol-Lowering Drugs if You are at Increased Risk

I only use medications when I feel the risk of taking them is outweighed by the risk of not taking them. Studies have shown that bringing the LDL down with specific medications in high-risk people lowers the risk of heart disease and death.

Are Cholesterol Drugs Dangerous?

I don’t think they’re dangerous, but they do have significant risks. That’s why I have to have a license to prescribe them, and why they aren’t in the grocery store next to the candied yams. All drugs should be used only when the benefit significantly outweighs the risk. more