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Health & Exercise Forum

The Truth About Managing Cholesterol: Part 1 of 3

Feb 21, 2011

Dr. Mackarey's Health & Exercise ForumGuest Contributor: David FitzPatrick, MD

February is American Heart Month! This month is dedicated to raising awareness of heart disease across the country. Heart disease strikes more men than women; but among women, it is the leading cause of death. The purpose of the next three columns is to dispel the myths that surround the topic of cholesterol and heart disease and provide accurate information that may help you protect your heart.

Personal Story

I share my personal story about my genetically high cholesterol, not to brag that I took control of my life and became a fanatic, but rather to illustrate two truths about high cholesterol. One: if you are the “Average Joe” with high cholesterol associated with too little activity and too much weight, you can take steps to resolve the problem. Two: if you, like me, have “genetically high” cholesterol, you can exercise and diet endlessly, but you will likely need a statin to truly control your problem. In either case, the ultimate goal is to prevent atherosclerosis (the build-up of plaque in arteries, caused by excess cholesterol), which leads to heart attack and stroke.

It has been almost 20 years since the traumatic day that I discovered I had high cholesterol. I was in my mid-thirties, and was working at a health fair when I decided to visit the booth labeled “cholesterol screening.” Little did I know that the information I would receive at this booth would change my life. The blood test revealed that my blood cholesterol level was almost 300 mg/dL—I was in shock. Concerned, I then visited my family physician, Peter Cognetti, MD, for follow-up. A 12-hour fasting blood test found similar results: 280 mg/dL.

It turns out I have a strong family history for this problem, and I needed to take corrective action immediately. I was hesitant to take medication because I was young, healthy, and determined to “beat it.” I became a vegetarian and ate limited portions of fish containing omega-3, such as salmon, mackerel and sardines. I did not eat meat or dairy. I increased my running workouts from 30 minutes, 2-3 times per week to 45-60 minutes 5-6 days per week. I trained for, and ran, marathons, and I took vitamins and supplements including fish oil and vitamin E. In three months I lost 10 pounds (150 to 140), and my total cholesterol went from 280 to 170. For 8 years I was able to control my cholesterol in this manner. However, once I reached my mid forties, the numbers crept up (210 – 220) in spite of maintaining my rigid program. My physician informed me that cholesterol levels increase with age, and I needed to strongly consider taking a statin medication. I agreed to take the minimum dose and maintain my program. After three months, the statin, in combination with my strict diet and exercise regimen, lowered my total cholesterol from 220 to 167 and increased my HDL from 32 to 52.

What is Cholesterol

Cholesterol is a fat substance that is present in all parts of the body. While it is needed for normal cellular functions, when too much is present in your blood, it can deposit in the walls of your arteries. This contributes to plaque (atherosclerosis) and can accumulate to narrow or eventually block the artery wall. Therefore, high levels of cholesterol in the blood can increase your risk of heart disease.

Cholesterol comes from two sources: your body and your food. 75-percent of the cholesterol in your blood comes from your liver and other cells in the body. The remaining 25-percent comes from the foods you eat. Cholesterol is found only in animal products. High cholesterol shows no signs or symptoms, but can be detected by a blood test.

High cholesterol is also called hypercholesterolemia, hyperlipidemia or dyslipidemia.

The two most commonly measured forms of cholesterol particles are high density lipoprotein (HDL) and low density lipoprotein (LDL). LDL is the “bad cholesterol,” because it accumulates in the walls of your arteries. HDL is considered to be “good cholesterol,” because it reverses cholesterol deposition in your arteries. Men with HDL levels lower than 40mg/dL (50mg/dL for women) have been shown to have a greater risk of heart disease. Age, family history, smoking and high blood pressure are additional risk factors that, when combined with high LDL and low HDL cholesterol, dramatically increase the risk of heart disease.

Total Cholesterol Ranges:

  • At or Less Than 200 mg/dL –    Good Minimim at 200
    • Very Good < 200 (lower risk of coronary heart disease)
  • At or Greater Than 200-239 – Borderline High
  • At or Greater Than 240 mg/dL – High (two times the risk of coronary heart disease)

HDL Ranges:

  • At or Less Than 40 mg/dL –      Bad Minimim at 40 for men (50 for women)
    • Very Bad < 40 (50 for women)
    • (higher risk of coronary heart disease)
  • At 50 – Borderline Good
  • At or Greater Than 60 mg/dL – High (lower risk of coronary heart disease)

LDL Ranges:

  • Less Than 100 mg/dL – Optimal (lower risk of coronary heart disease)
  • 100 -120 mg/dL– Near Optimal
  • 130 – 159 mg/dL – Borderline High
  • 160 – 189 mg/dL – High (higher risk of coronary heart disease)
  • 190 mg/dL or Above – Very High (higher risk of coronary heart disease significantly)

NOTE: Updated National Cholesterol Treatment Goals Are Expected Some Time in 2011.

Sources: MedlinePlus, Prevention Magazine, UpToDate

Guest Contributor: David FitzPatrick, MD, Cardiologist, Great Valley Cardiology, Scranton, PA.

Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next Week: Part II: Top Ten Ways to Lower Your Cholesterol

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: