Advanced Queen's Medical Care
Medical Director
Michael Shirazi MD -- Internal Medicine
Diplomate of American Board of Internal
Medicine
83-06 Queens Blvd, Elmhurst NY 11373
(718) 672-4600
Cholesterol / LDL / HDL / Triglycerides
Why am I concerned about cholesterol levels?
There have been numerous research and relevant studies linking abnormal
cholesterol levels directly and indirectly to atherosclerosis and heart disease
(coronary heart disease). By attaining the cholesterol levels of my patients,
I am able to discuss their relative risks of heart disease based on a
comprehensive lipid panal (ie. cholesterol and other fats).
What are doctors referring to when they speak of cholesterol?
Generally most physician's speak of LDL and HDL. The LDL is a lipoprotein
which is composed of fat and proteins. What LDL does is transport
cholesterol from the liver to the rest of the body. Clogging of the arteries
occurs when LDL deposits cholesterol to the blood vessels. This causes
atherosclerosis which leads to heart attacks, strokes, and peripheral
vascular disease. HDL on the other hand is involved in keeping the
cholesterol away from the blood vessels. So LDL is known as the"bad
cholesterol" and HDL is known as the "good cholesterol."
How do we get high cholesterol?
Cholesterol is a lipid that is only made by animals. Thats right! Please don't
be fooled by gimmicky food labels stating "No Cholesterol". If it's not an
animal product, such as peanut butter, there should never be any
cholesterol unless it was added to the product. So only meats, milk products
(which come from the animal the cow!), eggs (which come from the animal
the chicken)and other animal products have cholesterol. Ok, so you are a
vegetarian, is it possible for you to have high cholesterol levels? Yes! You
are an animal, the human.
Our bodies make cholesterol which is required for the body to work properly.
For example, we need cholesterol to maintain the integrity of our individual
cells. Animals consume other foods and convert this to cholesterol.
Unfortunately, some people produce too much cholesterol leading to
damage, even when they "watch" their diet. Other people may have high
cholesterol levels simply because they consume too much cholesterol in
their diets.
When and how do I treat high cholesterol?
There are different guidelines that doctors use when deciding to start
therapy, but most, including myself adhere to the National Institute of
Health's NCEP reports. These reports discuss patients secondary risk
factors of heart disease such as:
1. Hypertension (High Blood Pressure).
2. Family history of premature heart disease
3. Patient's age
4. Smoking
5. Personal history of heart disease
6. Personal History of Diabetes
7. Low HDL
However, in my practice I also recognize that there are also emerging risk
factors that new research and data link abnormal lipid levels and heart
disease to:
1. Obesity
2. Physical inactivity
3. Athrogenic diets
4. Inflammation
5. Other diseases such as thyroid disease
So, in general my strategy to combat high cholesterol entails all of the
above and incorporates many individualized factors.
There are mainly two ways to lower cholesterol. Diet alone, or diet and
medications. These include the "statins" such as lipitor, zocor, crestor,
pravachol, among others. Other mediations include zetia and a variety of
fibrates and niacin products. Of course there are still other ways.
How to raise HDL?
1. Quit smoking
2. Losing weight (or maintaining a healthy weight)
3. Being physically active for at least 30–60 minutes a day on most all
days of the week
Remarkably some studies suggest that raising HDL (the good cholesterol)
levels by merely 2-3 percent can dramatically reduce the risk of heart
disease. Keep in mind that if your HDL level is 40, raising it to a level of 41
or 42 may have significant benefits.
Here are some general guidelines on where your cholesterol should
be. These are just guidelines and your cholesterol goals are often
individually tailored.
Very High Risk
LDL Target: An LDL of less than 70 is a "therapeutic option" if you fall into
this category.
If you have the presence of established cardiovascular disease and one of
the following:
1. Multiple major risk factors for cardiovascular disease, especially diabetes
2. Severe and poorly controlled risk factors, especially smoking
3. Multiple risk factors for metabolic syndrome, especially high triglycerides
(200 or over) and low HDL (below 40)
4. A history of heart attack or unstable angina.
High Risk
LDL target: An LDL of less than 100 achieved with cholesterol-lowering
medications if lifestyle changes haven't lowered it to this level.
1. A history of heart disease (heart attack, unstable or stable angina, a
heart procedure such as angioplasty or bypass) or one of the following:
2. Diabetes
3. Evidence of diseased blood vessels (peripheral artery disease,blocked
carotid arteries, transient ischemic attacks, etc.)
4. Two or more risk factors for heart disease (cigarette smoking, high blood
pressure, a family history of premature heart disease, age).
An LDL of less than 100 achieved with cholesterol-lowering medications if
lifestyle changes haven't lowered it to this level.
Moderately High Risk
LDL target: An LDL of less than 130, but an option to lower your LDL to less
than 100.
1. Having two or more risk factors for heart disease that create a 10%-20%
chance of having a heart attack in the next 10 years.
Moderate Risk
LDL target: An LDL of less than 130
Having two or more risk factors for heart disease that create less than a
10% chance of having a heart attack in the next 10 years.
Low Risk
LDL target: An LDL of less than 160.
Having one or no risk factors for heart disease
Call to make an appointment so that we can discuss
things in person and perhaps further risk stratify you
for heart disease with a good history and physical,
homocysteine level, cardio CRP level, and an analysis
of your heart with a cutting edge, computerized, real
time EKG that is available at my practice.
links below
for more
information.
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