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Cholesterol Elevation: A Risky Situation

By Jock Simon, M.D., Attending Physician at 75th St. & 126th St. Medical, Ocean Pines Medical & Doctors Weight Control & Wellness centers, Ocean City, MD.

Doctors disagree about the age at which people should start routine cholesterol screening and also about how aggressively patients with high values should be treated. The National Cholesterol Education Project(NCEP) of the National Heart, Lung and Blood Institute recommends you get a cholesterol test once you reach age 20, even though at that age, you're still at low risk. One reason is that cholesterol measurements taken while you're still young have been shown to predict your risk of heart disease later in life. It stands to reason that the more you know up front, the better you'll be able to avoid heart disease by changing your diet, getting more exercise or, if necessary, seeking the proper treatment.

The American College of Physicians (ACP), however, recently issued updated guidelines recommending that you not get tested until age 35. The ACP reasons that if you're at low risk anyway, getting tested young makes it more likely that you'll be given cholesterol-lowering drugs before you really need them.

It has been my practice among my patients to have cholesterol screening performed on a yearly basis for all patients above the age of 20. By not doing so, you deny yourself a valid predictor of coronary artery disease. Find a physician who orders a full cholesterol profile. This gives you a measure of your total cholesterol and total triglycerides, as well as measurements of the high (HDL) and low(LDL)-density lipoproteins.

The average American diet today is fatter than ever. Obesity is now prevalent in epidemic proportions. Just over the last decade, the average American has put on 11 pounds per person. Cholesterol and triglycerides are fat substances in the body. They do not dissolve in water, thus cannot travel unaided in the bloodstream. They are carried by molecules which are called lipoproteins. The HDLs("good") are believed to take cholesterol away from arterial cells back to the liver for reprocessing and removal. The LDLs("bad") are believed to be responsible for depositing cholesterol in the arterial wall. Elevated serum concentrations of triglycerides appear to be an independent risk factor for cardiovascular disease in both men and women, but direct evidence of clinical benefit from triglyceride reduction is lacking.

According to the American Heart Association, if you have had a heart attack and your LDL number is below 100, your risk of a repeat attack is very low. Drug therapy should be considered if you've been placed on a cholesterol-lowering diet and your LDLs still measure 100 to 130. Drugs are mandatory for LDL values above 130.

If you have never had a heart attack, but have high cholesterol, an LDL of 160 or more means you should consider drug therapy; even then, dieting and exercise should be utilized as first-step therapeutic modalities. If you can't lower your LDL in this manner or if you have other risk factors, such as elevated blood pressure or smoking, then it would be wise to look into cholesterol-lowering drugs.

The goal is to have every person who is at risk for the development of coronary artery disease on a cholesterol-lowering program. You may not realize it, but there are many choices you can make and actions you can take to guarantee better health for your heart.

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