DEAR DR. GOTT: I am a 71-year-old female in good health. I take 40 milligrams of diltiazem, and my blood pressure is under good control. A recent blood test revealed my cholesterol to be 286, my HDL 82, LDL 188 and triglycerides 81. My doctor prescribed 40 milligrams lovastatin, but I would prefer not to take this medication. My total cholesterol has been 200 or higher since I was 40, and my HDL has been over 80. May I have your opinion?
DEAR READER: High-cholesterol levels in the blood are considered to be a major risk factor in the development of coronary-artery disease, heart attack and stroke. When cholesterol accumulates in the walls of the arteries and combines with cellular debris, plaque forms, impairing the flow of blood. Eventually, clots may form, the arteries become blocked, and problems occur.
There are two primary types of cholesterol — good and bad. The good is known as the HDL (high-density lipoproteins), and the bad is LDL (low-density lipoproteins). According to the American Heart Association, total cholesterol of under 200 is desirable and puts a person at a substantially lower risk for heart disease. Levels between 200 and 239 are borderline, signifying a person has twice the risk than someone below 200. HDL levels for men lower than 40 and 50 for women signify a major risk factor for heart disease. Levels of 60 and higher are extremely good, with lower probability of heart disease. LDL readings lower than 100 are optimal. Triglyceride levels vary according to age and gender. Levels under 150 are considered to be normal. Levels beyond that are borderline to high.
While your total cholesterol is higher than the recommended figure, your HDL is exceptionally good. Your LDL puts you in a borderline-high bracket. Because extenuating factors such as family history come into play, your primary-care physician or cardiologist should make the decision as to the appropriate level for optimal health.
If diet is to blame, this is relatively simple to modify. Cut out iced cream, butter and other high-fat foods. Reduce your consumption of cheese, eggs and whole milk. Stay away from tropical oils in cookies and pastries. If inactivity is to blame, speak with your physician about a program of exercise. If heredity comes into play, then you may be doing all you can without outside assistance. A number of over-the-counter cholesterol-reducing products are available. Ask whether a trial might be appropriate.
If your physician has given you a statin drug to inhibit your liver’s natural production of cholesterol and you are opposed, make another appointment to discuss the matter. I don’t blame you for expressing concern. There has been a lot of controversy surrounding the side effects of statin drugs. Get answers, and be guided by what he or she says. Ultimately, the decision should be yours.
To provide related information, I am sending you a copy of my Health Report “Understanding Cholesterol.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.
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