DEAR DR. GOTT: Although I’ve had high LDL and cholesterol readings for nearly 30 years and resisted taking statins, when I had an SCA caused by cardiomyopathy (a dilated left ventricle) the hospital’s cath lab reported that my arteries were “beautifully clear”.
I had heard that some of us are lucky (or blessed) to have bodies that don’t respond to high cholesterol by forming plaque, that the cholesterol in our bodies somehow doesn’t stick to artery walls. Short of having a camera running through the arteries, how can someone find out how seriously to take the usual advice about getting one’s LDL below a certain number?
DEAR READER: SCA (sudden cardiac arrest), without almost immediate intervention, can result in death no matter what age a patient may be. Ventricular fibrillation, arrhythmias, specific diseases or conditions such as coronary artery disease, extreme physical stress, some inherited disorders, and structural changes within the heart can all cause the condition. Your heart can react adversely to major blood loss, extremely low blood levels of potassium or magnesium, intense physical activity or exercise and a lack of oxygen, causing it to shut down. In your instance, it was a dilated left ventricle, a well-known precursor of ventricular dysfunction in both men and women who have not had an MI (myocardial infarction, aka heart attack). Known possible causes of your cardiomyopathy include hypertension, bacterial infections, viruses, certain cancer medications, long-term alcohol or illicit drug use, toxic metal exposure to include mercury and cobalt, and more. Risk factors that may have contributed include diabetes, thyroid disease, an immune system disorder, hemachromatosis, hypertension, and a host of other possibilities.
From my perspective, the fact that you have clear arteries is fantastic, but it isn’t the determining factor here. You and your cardiologist should work together to take every precaution with regard to exercise, control of other medical conditions, determining necessary lifestyle modifications and controlling cholesterol levels (that he or she will likely prefer well below the normal range) to assure the SCA doesn‘t occur again. Is an implantable defibrillator to be considered? Are cardiac meds, in addition to those to lower your cholesterol, appropriate?
There are methods of lowering your LDL while increasing your HDL such as diet and life style modifications, as well as some medication. There are a number of statin drugs available on the market that can reduce LDL production by almost 70%. That being said, statins have a bad reputation for causing muscle damage and spasms. Dietary change such as reducing your intake of red meat, cheese and egg consumption, as well as cutting back on foods high in saturated fats are very important, however they don’t have the impact that statin drugs do. If you prefer not to take a statin drug, begin by considering niacin, plant sterols and stanols, or a soluble fiber supplement. A bile acid sequestrant such as colesevelam, cholestyramine or colestipol comes in pill or powder form and can decrease your LDL by up to 20%. If you lead a sedentary lifestyle, exercise and weight reduction, if appropriate, will lower your LDL level. Limit saturated fats from your diet and avoid trans fats at all costs. Partially hydrogenated vegetable oils have been found to be the source of almost 75% of trans fatty acids in the American diet according to the AHA. Discontinue smoking and keep your alcohol intake modest. The practice has been proven to decrease LDL levels.
Supplements worth exploring include niacin, plant sterols and soluble fiber supplements. Niacin is known to cause flushing in some individuals but it can raise HDL levels by up to 35% and lower LDL levels by about 20%. The flushing can be counteracted by taking an antihistamine such as Benadryl 15 minutes prior to ingesting the niacin. Plant sterols are found in fortified foods such as margarine and orange juice and are also available over-the-counter in tablet form. Two grams are believed to lower LDL by about 15%. Soluble fiber, found naturally in oats, nuts, psyllium husk, and Metamucil, can reduce LDL levels. Readers are warned of red yeast rice that may work; however, the product contains naturally occuring lovastatin, the active ingredient in Mevacor, which is a prescription statin.
Ask your cardiologist what numbers he considers acceptable. If necessary, request a referral to a dietician, fitness center or other facility that can get you where you want to be.
Readers who would like related information can order my Health Reports “Understanding Cholesterol” and “Coronary Artery Disease” by sending $2 US dollars for each report in a US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title(s) when writing or print out an order form from my website www.AskDrGottMD.com.