by Judy Stringer
By now, most of us have heard that there is “good” and “bad” cholesterol. Understanding the differences between “good” and “bad,” however, and how measured levels of one or the other – or both – affect our overall cardiovascular health can be confusing. Summa Health System Interventional Cardiologist Dr. Justin Dunn shed some light on types of cholesterol and treatments for patients with unhealthy cholesterol levels.
What is the difference between good, bad and total cholesterol?
“Total cholesterol is a number that includes all different types of cholesterol. That is one number we look at for identifying the risk of a cardiovascular event like a heart attack or stroke, but the number that really dominates the guidelines on how we manage cholesterol is LDL, which is low-density lipoprotein, sometimes called ‘bad’ cholesterol. LDL is a protein that carries cholesterol into the bloodstream and contributes to cholesterol buildup in the body.
“HDL, high-density lipoprotein or ‘good’ cholesterol, is a type of protein that carries cholesterol away from the bloodstream and can sometimes actually clean some of the cholesterol out of the bloodstream.
“With treatment, generally speaking, lowering your bad cholesterol is the goal. Studies that have looked at ways to raise good cholesterol through medications have found that even when you are successful at raising HDL, there is not a big change in cardiovascular outcomes. When we get that bad cholesterol down, however, we do see a big improvement in cardiovascular outcomes.”
What are some ways to lower bad cholesterol?
“There are two big buckets when we talk about risk factors for cardiovascular disease. Non-modifiable risk factors would be things like age and genetic, things you can’t do anything about. Modifiable factors – things you can change – include physical inactivity and a poor diet, as well as lack of control of diabetes and high blood pressure.
“We recommend to all patients who need to lower their cholesterol aggressive exercise and a diet low in saturated fats and high in fresh fruits, vegetables and lean proteins. That is the first step for all patients. If a patient needs medication for lowering their cholesterol, the first medication to be reached for in almost every circumstance is a statin.”
What are statins? How do they work?
“Statins are HMG-CoA reductase inhibitors. They help inhibit the process of releasing cholesterol into your bloodstream.”
Who should take them?
“If you have identified cardiovascular disease – for instance, you had a stroke or heart attack – you should be on a high-intensity statin, regardless of your cholesterol levels. If you have extremely high LDL, you should be on a statin medication, even if you have not had a cardiovascular event. If you are 75 and have diabetes, you should probably be on some kind of statin medication. If you are 75 and you don’t have diabetes, then we do a risk calculation where we plug in numbers like your blood pressure, age and cholesterol levels and we say based on your numbers your risk of having an adverse cardiovascular event is the next 10 years is this percentage. If that is above 20 percent, you should be on a statin. If it is less than 5 percent, you probably don’t need to be on a statin. Between 5 and 20 percent, you should have a discussion with your doctor about risk factors and other tests.”
What are the side effects?
“There can be muscle aches. Statins may cause very mild muscle breakdown in certain circumstances, but it is rare. Inflammation of the liver is also a very rare side effect. In general, statins are very well-tolerated.”
Is the use of statins widely supported by the medical community?
“In my opinion, other than diet and exercise, statins are the best way to prevent a second arteriosclerotic cardiovascular event, such as a heart attack or stroke, and probably the best way to prevent a first arteriosclerotic cardiovascular event.” ∞