Since the biggest cause of death in the US is cardiovascular disease, unless
you want to die of a heart attack at 50 (for a man and 60 for a woman) being
squarely in the middle of the "normal range" is not such a good
thing.
Cholesterol is the basic building block for hundreds of chemicals and
indispensible for life. It's so important that without it we'd die.
Ever heard of someone dying of "low cholesterol"? Me neither. It just can't
happen. It was thought that humans were poor producers of cholesterol and
primarily relied on dietary intake. Now we know that's wrong. Adults need
about 800-900 mg per day to make our bodies function. Even with the average
bad American diet we only eat 20% of our cholesterol and make the other
80%. Therefore, cholesterol is almost always due to genetic overproduction,
not dietary intake.
OK, lets talk about good and bad, cholesterol that is.
Cholesterol and fat aren't water soluble, so they are transported in blood
by large protein molecules. While there are multiple sub-types, to simplify,
there is good (HDL) and bad (LDL) cholesterol. Of the 2, it's best to have
less bad (LDL) than more good (HDL). The current medicines mainly lower
LDL, which is why tey are so effective at reducing heart disease.
That segues into the discussion of what is a healthy LDL level.
Basically, it varies depending on other factors and family history. While
deposition of cholesterol and fats in the lining of blood vessels is the
fundamental injury that causes atherosclerosis, other diseases can speed up
deposition. Therefore, the absence or presence of diabetes, smoking,
hypertension and family history have to be included in the decision making
process. If you are young, healthy and have no family history of heart
disease then you can tolerate higher levels. If you're older and have
hypertension, diabetes or smoke even 'normal' levels can be fatal.
Now for some numbers. When we are born our LDL is 30-40 (with
a total cholesterol about 80) and this MORE than enough for a newborn baby
with 20 times an adult's metabolism to satisfy all requirements for growth.
Aboriginal hunter-gatherers run LDLs of 50-80 and never die of heart disease
and rarely have diabetes, hypertension or cancer. Therefore, most credible
experts feel 65-70 is the most LDL we can tolerate long term. However, the
average US adult has an LDL of 135, meaning it takes a 50% reduction in LDL
to get LDL to a biologically
normal level. Since diet only contributes 20% rarely is it effective and
drugs are usually necessary.
Wait, can't I just adopt the Hunter-Gatherer lifestyle and avoid
taking medicine? You can, but it's not fun. You have to walk 10-14
miles a day, eat twigs, roots, bugs & worms, have multiple vitamin
deficiencies, get diarrhea from bad water 2-3 times a month for the rest of
your life, chronically weigh 15% below your ideal body weight, and all the
while avoid dying from some infection because you're so malnourished. If you
can do all that, your LDL will be 50-60.
Drug treatment - Most cholesterol lowering drugs are in the "statin"
family and only differ in potency. They primarily lower LDL but also
modestly lower triglycerides and raise HDL. Each new drug has been better
than the prior one. Zocor was the first that came close to the 50%
reduction for the average adult. It's now generic and is good for 45% in
most people. Lipitor 50%, Crestor 55% and Vytorin 60% have followed.
If patients have any of the following I recommend checking cholesterol:
A history of heart attack or stroke in your family.
Any one over 40, male or female.
If you have hypertension, diabetes or smoke.
Men with erectile dysfunction.
Post-menopausal women.
Dr. John Launius - Lakepointe Urgent Care - Lewisville
