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Dr. Winni Loesch: Risk factors play heavily in terms of cholesterol

I can recall a time when it was uncommon to know one’s cholesterol level, much less the breakdown of lipoproteins like low-density lipoproteins (LDL), also known as the “bad” cholesterol, and high-density lipoproteins (HDL), or the “good” cholesterol, and triglycerides.

Nowadays, cholesterol levels are bantered about during mahjong games, fishing trips and neighborhood socials. A competitive spirit enters into these conversations with some bragging about their LDL of 80, others moaning about being unable to score an HDL higher than 30 and a quiet few preferring a “don’t ask, don’t tell” philosophy because they are too confused by it all.

What many people don’t realize is that this is not football or soccer, and the goal line of optimal LDL level is not the same for everyone. It varies based on one’s risk factors.



Know your risk

The basic principle that underlies and guides cholesterol-lowering intervention is that the intensity of treatment is directly related to the degree of risk for coronary heart disease (CHD). So, your youngish neighbor who is making a comeback from a mild heart attack last year belongs to the highest risk category; he already has CHD. His doctor has advised him to drop his LDL level to 100 at least, optimally less than 70. On the other hand, your sister claims that she’s in a low risk category and is not worried about her LDL level of 130.




It is important for you to first know your risk category. Risk factors for CHD are elevated LDL, tobacco smoking, hypertension (a blood pressure greater than 140/90 or on medication for hypertension), low HDL (blood pressure 40) family history of premature CHD (less than 55 for men, or 65 for women in first degree relative) and age (men 45 and older, women over 55). If more than two risk factors are present, you should learn your 10 year risk of developing CHD, based on criteria from the Framingham study.

The objective of the Framingham Heart Study was to identify the common factors or characteristics that contribute to cardiovascular disease by following its development over a long period of time (since 1948) in a large group of participants who had not yet developed overt symptoms of CVD or suffered a heart attack or stroke.

High risk people have CHD or CHD equivalent (diabetes mellitus or greater than 20 percent 10-year risk by Framingham criteria for CHD risk): LDL goal less than 100 (optimal is less than 70). Intermediate risk is more than two risk factors and under a 20 percent 10- year risk of CHD: LDL goal less than 130. People with fewer than two risks are in the low risk category: LDL goal less than160. There, so now the playing field is no longer level; the discussion needs to include a focus on risk factors and that’s great! Why?

Because you may be able to lower your risk category before your doctor reaches for the pad to write you a prescription for a cholesterol-lowering medication. (However, this may be the best first thing to do while you work on lowering your risk factors.) TLC is not only what you hopefully received as a child from your parents. It stands for Therapeutic Lifestyle Changes and for this part of the game (of life), the ball is in your court.

What you can do

Although you’ve probably heard these recommendations before, they bear repeating:

Stop smoking. Engage in moderate intensity physical activity for greater than 30 minutes on at least five days of the week. Maintain a healthy body weight (BMI less than 25). Limit your saturated fat and Trans fatty acids. Consume (safe) oily fish regularly or take 2000 to 4000 mg of fish oil supplement daily. Eat your fruits and vegetables (rich in important nutrients and antioxidants ” between four -to-13 servings or two to 6.5 cups per day). Use sufficient fiber containing grain products, legumes and/or nuts. (25-30grams/day).

But of course, changing behavior is REALLY hard for us. It requires incredible motivation, planning and effort to break old patterns and establish new ones. Easier to ignore or deny that these changes are necessary. Some folks would much rather take relatively expensive medicine(s) with potential adverse side effects than assume responsibility for their health and make changes in their lifestyle.

Having been a doc for more than 25 years, I have a litany of excuses from patients (and myself) to justify why this is not quite possible to do. I also have a long list of folks who experienced “adverse cardiovascular events” while they were in denial about all this. How about we all get a grip and quit denying or “trying” and “just do it”?

ooo

Winni Loesch M. D., FASFP may be reached at Amethyst Medical Group, an integrative/ functional family medical group, at 123 Margaret Lane, Suite C2 in Grass Valley by calling ( 530) 2712331 or by fax ( 530) 271-2338.

Relevant Web sites

http://hp2010.nhlbihin.net/atpiii/calculator.asp

(for 10-year risk calculator)

http://www.nhlbi.nih.gov/guidelines/cholesterol/atglance.htm

for Adult Treatment Panel III (ATP III) – to be covered more next article

http://www.lipid.org/clinical/tlc/1000001.php

“Innovative Approaches to Comprehensive Cardiovascular Disease Risk Reduction: Focus on Therapeutic Lifestyle Changes”

http://www.lipid.org/clinical/tlc/1000002.php

“Exercise Determinants of Weight Loss”

http://www.fruitsandveggiesmorematters.org

“Fruits & Veggies More Matters”

” Compiled by Dr. Winni Loesch


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