I gave it my cholesterALL ... But I just got this Plaque
- The main components of cholesterol are your total cholesterol, HDL (good), LDL (bad), and triglycerides. They live in your blood and are always circulating and your body needs a certain amount of them for making hormones and vitamins and cell walls and things like that. The LDL can actually be divided up into various sizes too based on their density, with the low and very low density types being the worst because they take up more space.- If you think of your circulatory system as the halls of a high school, HDL would be the hall monitors and LDL would be the teenagers. In good balance, the hall monitors can keep the kids in line so that the halls look spotless. But as they start getting outnumbered by the teens, their angst starts to take a toll on the walls and floors and they can't be controlled. Graffiti and gum pops up, everyone is crowding around and fights and pranks start popping up. This would be cholesterol plaque in your arteries.
- Blood needs to be flowing continuously through your arteries and so the main ways damage happens in your circulatory system is when the cholesterol forms plaques on the walls of the arteries. It can sometimes break off the wall and plug up a smaller pipe further down the pathway (this would be like a heart attack or a stroke). Sometimes it can cause the walls of the arteries to weaken and swell and burst (this would be an aneurysm). Sometimes the pathways just get narrow enough that blood can't get through adequately (this would be a type of heart attack, or sometimes what's called angina and or poor circulation or a TIA or stroke).
- Who should be tested for cholesterol? Depends on who you are. Generally high risk people (those with diabetes, hypertension, smokers or people with a mom/dad/sibling who had a heart attack or stroke or sudden unexplained death under age 40) should start getting checked around age 25-30 for men and 30-35 for women (because women take longer to develop heart disease, probably due to protective effects from estrogen and, in my opinion from experience, women on average make less of the dumb decisions that guys do related to their health). If you don't have any of those risk factors, we start at 35 for men and 40 for women.
- Cholesterol tests have usually been done while fasting but it turns out for most people this doesn't make much difference so most organizations now say you can do your initial cholesterol test without fasting and then if your total cholesterol is over 250 or your HDL is under 40, repeating it while fasting is a good idea.
- Triglycerides don't mean much anymore unless they're over 500, which is uncommon. Just a matter of more research over the years coming to this conclusion.
- You want your LDL to be under 190 but other than that, we mostly now look at the ratio between HDL and total cholesterol. You want your total cholesterol to be 2-3 times as high as your HDL. If your HDL is much lower than your total cholesterol, that's bad and leads to more plaque buildup.
Club soda didn't work - what else can help?
So what's the whole point of the cholesterol thing? To prevent plaque buildup and the heart, brain and artery diseases that come with it. If you have diabetes, or have already had a heart attack or stroke or aortic aneurysm, you're at high enough risk for having something else bad happen that everyone recommends being on a cholesterol-lowering and cholesterol plaque-stabilizing medication known as a statin permanently.
But if you're otherwise healthy, things are a little trickier. We used to say your LDL needed to be below X at various ages. But now we use cholesterol as part of a bigger picture of risk factors for what's called atherosclerotic cardiovascular disease (a.k.a. Heart/brain/blood vessel problems from cholesterol). The big heart organizations came up with calculators based on various risk factors that can estimate your 10 year risk of having a major cardiovascular event. You can check these out in a few places if you're interested:
American College of Cardiology Risk Estimator
So what helps lower your risk? The website actually has
- Quitting tobacco if you use it
- Getting your blood pressure as close to 120/80 without medications (lifestyle change) or at least under 140/90 for most people on medications
- Aiming for 20-30 minutes of moderate to vigorous exercise every day
- Eating mostly fruits, vegetables and legumes and avoiding processed foods and things with ingredients you can't pronounce
- Alcohol - if you don't drink, don't start. If you do, aim to limit it to one drink a day most days. All that stuff about reservatrol and wine never really panned out - the amount of wine you would have to drink to get an effective dose would knock you out.
- As far as medications and supplements go, for preventing a first heart attack or stroke or cardiac death, think of all of the options as like a seatbelt. How helpful they are depends on what kind of driver you are, where you drive and how long you drive for. If you run red lights and speed, you might be OK for a while but it's only a matter of time before you're probably going to need your seatbelt and probably your airbag.
- Omega 3 fatty acids? Probably helpful. Aiming for a serving of fatty fish twice a week is a good idea and if you don't do that, 1000 mg a day of an omega 3 supplement containing 200-800 mg of EPA and DHA is a reasonable option although a recent analysis showed there was really no benefit in this so you might want to save your money.
- Aspirin a day? Probably not as helpful as we used to think. For people aged 50-59 at higher risk of atherosclerotic cardiovascular disease, an aspirin might be a good idea if you can remember to take it daily. Past that, the benefits start falling off and the risks of mild and major bleeding go up and there's no evidence of benefit over age 70. There's also some data that daily aspirin can prevent colon cancer, but it's not strong enough for us to recommend people do it for that reason, more like a fringe benefit.
- Statins? You might've heard of these by other names: Crestor (rosuvastatin), Lipitor (atorvastatin), simvastatin, Pravachol, etc. They've been called cholesterol medications but they're actually used to prevent heart attacks and strokes so we've started trying to get people to think about them that way. Same deal as the aspirin - if you're at high risk for heart disease, these are helpful. We could talk for a long time about the pros and cons of these but for most people who need them, the benefits far outweigh the drawbacks. The tricky thing is that the benefit is the absence of something bad happening and just like earthquake or flood insurance, can be tough to appreciate when everything is going well. There are tons of blog posts about all the evils of them and while some people do have odd reactions to them, some people have odd reactions ao all sorts of medications, supplements and foods but most of the time, people don't even notice a difference when they take them.
- Some of you may remember niacin being a thing for a while. It was mostly given because it would raise the HDL moreso than anything else out there and the thought was that would prevent heart attacks and strokes. That didn't actually happen though and the effect ended up being like winding the odometer back on your car - the numbers look better but the engine is still the same.