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October 2, 2007 > Keep Cholesterol in Check and Enjoy Better Health

Keep Cholesterol in Check and Enjoy Better Health

Cardiologist Shares Wisdom of Keeping the Heart Healthy, Avoiding Risks

Cholesterol is the enemy, right? In fact, it is an essential element of our cellular make-up, but in excess amounts, it serves as a risk factor for a number of disease processes, including the number one killer in the United States, heart disease.
Cholesterol Education Month offers a good opportunity to learn more about the role cholesterol plays in overall health and how taking the proper steps can prevent many conditions affected by high cholesterol.
"Cholesterol is a constituent of all the cell walls; therefore it's absolutely essential to maintain the structure of our cells," explains Washington Hospital Medical Staff cardiologist Dr. Jeffrey Carlson. "The problem is when we get too much of it. The body can't store cholesterol the way it does fat, and the only place it can find to store it is in the walls of the arteries."
When cholesterol accumulates, especially in the arteries around the heart, it increases the chances for both heart attack and stroke. The human body produces a certain amount of cholesterol naturally, but cholesterol is also introduced through the foods we eat that contain animal products, such as meat and eggs.
According to Dr. Carlson, a single egg contains approximately the same amount of cholesterol that the body produces daily. And if a person is taking in more cholesterol than his or her body can process, it will begin to build up in the arterial walls, potentially reducing the amount of space blood has to move through the arteries to feed the body with oxygen rich blood.
Making the right changes
Many patients can manage their cholesterol levels quite easily through what the American Heart Association (AHA) calls "TLC" - not tender loving care - but therapeutic lifestyle changes, which can include modifying the diet, implementing an exercise routine and quitting smoking. For those without a genetic predisposition to high cholesterol, a diet low in cholesterol and saturated fats can make great strides in helping them maintain the appropriate cholesterol levels.
For others, a genetic predisposition to high cholesterol may make it difficult for them to process even the cholesterol their bodies produce naturally. Those with a family history of high cholesterol may need the help of various medications that have been developed in recent years to either prevent the body from producing excess cholesterol or prevent it from reabsorbing cholesterol produced in the liver.
To better manage cholesterol, it is important to understand that it is actually made up of different components, including low-density lipoproteins (LDL), known as the "bad" cholesterol, and high-density lipoprotein (HDL), known as the "good" cholesterol, as well as triglycerides, the chemical form in which most fat exists in food as well as in the body.
Dr. Carlson says it's helpful to think of LDL as the "trash" and HDL as the "trash collector. HDL helps the body remove LDL from the bloodstream and from blood vessels and dispose of it from the liver. Exercise is an effective way to increase body's HDL. The HDL then can transport the bad cholesterol to the liver and away from important arteries, notes Dr. Carlson.
Controlling cholesterol after a heart attack or stroke
For people who have already had a cardiac event, such as a heart attack or stroke, a priority for their physician will be to get their cholesterol under control as fast as possible.
"If you've already had an event, we will try to drive down your cholesterol as quickly and as low as possible using medications," Dr. Carlson says. "With the medication, the physician will talk about making all the other lifestyle changes, but our first goal is to assure that his patient is as protected as much as possible. The sooner you begin to make the changes after an event, the better the outcome for the patient, especially since the biggest risk factor for a cardiac event is having had a previous event like a heart attack, stroke, or peripheral vascular disease."
When it comes to cholesterol, typically the first point of contact for patients is their primary care physician, not the cardiologist, Dr. Carlson says. For those that have a family history of heart disease or high cholesterol, he recommends undergoing a simple cholesterol screening to determine if they have a tendency toward high cholesterol stemming from either diet or genetics.
Cholesterol and other disease processes
Cholesterol, Dr. Carlson emphasizes, is closely linked to several different disease processes, such as hypertension and diabetes, in addition to heart disease. For patients diagnosed with diabetes, they must manage not only their blood sugar, but also their cholesterol levels.
"I think the mindset that most of us in the field have taken is that a person with diabetes has to be treated as though they've already had a heart attack," he says. "Similarly, if you have a patient with high blood pressure, cholesterol takes on a very different significance. Patients with these types of comorbidities are what we call 'heart attack equivalent patients'. They haven't had an event but they have the same risk as if they already had a heart attack or stroke."
The good news is that patients are becoming savvier about cholesterol and related issues, Dr. Carlson says. And for many patients, taking action early on, such as making the therapeutic lifestyle changes recommended by the American Heart Association and having their cholesterol levels and blood pressure screened, can help reduce the chances of suffering a cardiac event later in life.

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