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MONDAY, Nov. 12, 2018 (American Heart Association) – With the release of new guidelines for treating and managing cholesterol, there is no question about the changes in the update, but about cholesterol itself.
Most people know that high cholesterol is bad. But there is a bigger picture involved when determining what is considered too high. Put another way, the same number would be in the normal range for one person but considered high for another.
The only way to know your cholesterol situation, and more importantly, what to do about it? This is important because poorly managed cholesterol could lead to heart attack, stroke and other major health problems.
Here are the basics needed to understand, treat and manage cholesterol.
What is cholesterol?
"First of all, it's important to understand that cholesterol is itself not a bad thing," said Dr. Robert Eckel, director of the Lipid Clinic at the University of Colorado Hospital. "Cholesterol is an important part of the body, but it is important that we carry it."
Cholesterol is a substance of the body uses to build cells. The liver makes all the cholesterol the body needs. However, dietary cholesterol the kind of food and some drinks such as milk cholesterol into the bloodstream.
Cholesterol is carried in the blood in the form of high-density lipoproteins (HDL) – the "good" kind – and low-density lipoproteins (LDL) – the "bad" kind. And that's where treatment is emphasized.
The bad kind of cholesterol can be collected in the artery walls, which causes stiffness and narrowing. This is atherosclerosis, which can be the basis of a heart attack or stroke.
Good cholesterol helps by removing the bad, which is not easy to do. HDL can only help in the fight, not win it.
"It's important that we do this," said Eckel, who was part of the team that created cholesterol guidelines from the American Heart Association, American College of Cardiology and other health organizations in 2013. Those guidelines were updated Saturday.
The total cholesterol figure is based on HDL, LDL and a third factor: triglycerides. Triglycerides not only circulate in blood but are the most common type of fat in the body. A high triglyceride level combined with high LDL or low HDL cholesterol is linked to those fatty acids that increase the risk of heart attack and stroke.
What do cholesterol numbers mean?
Cholesterol numbers mean different things for each person's situation.
"There is a lot of room for the fact that someone in their 40s and 50s LDL cholesterol may be slightly elevated," Eckel said. .
Dr. Scott M. Grundy, chairman of the committee for the new cholesterol guidelines, notes that when working with their patients, they should consider a person's "risk-enhancing factors" such as family history, kidney disease or other personal scenarios.
"These are important," said Grundy, a professor of internal medicine at the University of Texas Southwestern Medical Center and Veterans Affairs Medical Center in Dallas. "Patients should be aware of these issues and determine how to think about them with their doctor."
How is elevated or high cholesterol treated?
Treatment comes in two forms: lifestyle changes and medication.
"We always want people to start with making lifestyle changes," Eckel said. "Lonely eating, eating, eating, eating, eating, eating and eating vegetables, vegetables, lean meat, fish and nuts."
If that sounds like a plan for losing excess weight and keeping it off, that's exactly the point. A healthy body weight helps reduce LDL levels and helps people with normal cholesterol levels stay that way.
Sometimes, diet and exercise alone are enough to get numbers into the comfort zone. Sometimes, they're not. For those people, the next option is usually taking a cholesterol-lowering medication called a statin.
"This is a very well-proven, evidence-based option," Eckel said. "A lot of clinical trials strongly support taking statins."
The type of statin and dosage can vary from person to person. In some cases, doctors may prescribe other or additional medications that are not statins, such as ezetimibe or a PCSK9 inhibitor.
"The neat thing about cholesterol-lowering plans is that you can see changes quite quickly," Eckel said, noting that cholesterol levels can be improved within the context of dietary changes or medications.
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