cholesterol

RECENT POSTS

Project Louise: What To Do About Cholesterol?

(Wikimedia Commons)

(Wikimedia Commons)

One of my original goals for this project was: “Lower my cholesterol and triglycerides.” I’ve been doing some serious thinking about that lately, along with a bit of research, and I’d like to share the results with you.

The serious thinking started last spring, when I ran across the current controversy about the risks of statins in postmenopausal women.

A growing number of physicians and researchers are arguing that, for some women like me, the risks of taking statins to lower cholesterol may outweigh the potential benefits. And the risks are scary: muscle pain (and, more rarely, permanent muscle damage), kidney and liver issues and – yikes! – increased risk of diabetes. Aside from being my own biggest fear, diabetes also, ironically, increases the risk of heart disease, the very thing statins are meant to prevent.

All this gave me pause, because my doctor had prescribed a statin a while ago, and my argument to the nurse practitioner (whom I actually see more often than the doctor) that I didn’t really want to take it had been met with a firm insistence that I should. Based on my numbers, she said – total cholesterol around 350, with an HDL (“good” cholesterol) of around 60 – there was no question.

So I took it for about a month, but I felt tired and achy – maybe just because of life in general, but the achiness felt worse than usual. So when I saw the new studies, I thought, “You know what? I’m just going to stop.”

And I did, and I felt better. But I’ve been avoiding going back to the nurse practitioner to tell her. All of which strikes me as the behavior of a naughty child, rather than a mature adult.

So, as a mature adult, this week I sought another opinion. My editor, Carey Goldberg, suggested I talk with Dr. Vikas Saini, a cardiovascular specialist and the president of the Lown Institute. He’s known for promoting the cause of “right care,” or “avoiding avoidable care” – that is, for arguing that modern medical practice too often overtreats patients, with frequently expensive and sometimes disastrous results. This seems self-evident to me, though it has been enough to create huge controversy in some circles.

In any case, I called Dr. Saini and talked with him about statins, in both general and personal terms. After noting that statins have become a fairly polarizing issue in the medical community, he asked a few questions about my personal and family history.

Dr. Vikas Saini

Dr. Vikas Saini

I gave him my numbers, which he agreed create a slightly increased risk – on paper, anyway. But when I told him that both my grandmothers had high cholesterol but lived into their 90s (and neither died of heart disease), and that neither of my parents, who also had high cholesterol, died of heart disease, either, he said that this history “makes me very, very suspicious of any attempt to paint your high cholesterol as a risk factor. It doesn’t add up.”

Well, hurrah. So I’m not being stupid to stop taking the statin?

“I don’t think that’s stupid at all,” Saini said. “I personally wouldn’t do much of anything except check your numbers.”

And, of course, keep increasing my commitment to exercise – “at least get it up to three times a week” – and eat your basic Mediterranean diet with plenty of olive oil, and work on stress reduction. All these factors, he noted, clearly help prevent heart disease. Continue reading

WSJ: Everything You Need To Know About New Cholesterol Guidelines

It’s so very disconcerting when deeply entrenched health wisdom is suddenly flipped on its head. But that’s the way it often goes in this arena.

The Comedian/flickr

The Comedian/flickr

So, with such widespread confusion over the new guidelines on cholesterol and statins, cholesterol-lowering drugs, I was relieved to see that veteran health reporter (and my former colleague) Ron Winslow at The Wall Street Journal offered a just-the-facts-ma’am Q & A on exactly what you need to know about the new guidelines. It’s got everything from LDLs to the new risk calculator — which was down when I checked this morning. (What’s going on with all the bugs in our critcal health care sites??)

Here’s a snippet from Winslow:

The new tack recommended by the American Heart Association and the American College of Cardiology is to prescribe moderate to high doses of cholesterol-lowering drugs called statins to patients who fall into one of four risk groups regardless of their LDL status. Here is a look at the implications:

Q. Why get rid of the LDL targets?

A. The targets lack strong scientific evidence. The expert panel that developed the guidelines concluded that by focusing on an individual patient’s overall risk rather than a relatively arbitrary set of LDL targets, the strategy to prevent heart attacks and strokes will be more effective and more personally tailored to the needs and preferences of each patient.

Q. What should patients do in response?

A. Patients already on cholesterol-lowering medication should ask their doctors at their next appointment whether they are on the most appropriate therapy to reduce their heart-attack and stroke risk, says Neil Stone, a cardiologist at Northwestern University who headed the panel that wrote the cholesterol guideline.

For people not on cholesterol drugs, a new risk calculator is available online. If you have a 7.5% chance of having a heart attack over the next 10 years, you are a candidate for treatment with a statin no matter your LDL level under the new guidelines.

Q. I have no heart problems and my LDL was 90 in a recent cholesterol test. Is it possible I should be on a statin anyway? Continue reading

Higher Levels Of ‘Good’ Cholesterol Not Necessarily So Great For The Heart

Re-thinking the benefits of good cholesterol (The Broad Institute)

It seemed to make perfect sense. If HDL cholesterol is good, then higher levels of HDL are better, right? Alas, no, according to a potentially game-changing study published in the medical journal The Lancet. As things tend to go in medicine, it’s far more complicated.

Researchers at The Broad Institute and Massachusetts General Hospital found that people with higher genetic levels of the good cholesterol HDL don’t necessarily have more protection or a lower risk of heart disease.

Here’s the Broad’s video explainer.

And the crux of the findings are summarized in this news release:

What they found was surprising. Individuals who carried a particular variation in a gene called endothelial lipase had HDL levels that were elevated about 6mg/dl, or 10% — a change expected to decrease heart attack risk by about 13%. However, these individuals showed no difference in their risk of heart disease compared to people without the variant. Continue reading