Cholesterol: the New Approach to Managing Your Cholesterol Levels

I am 72 years of age and have a family history of heart disease in both of my parents. I have been very concerned about heart health and my cholesterol level. This blog is intended to discuss the new numbers and what you need to know about using medication to lower your cholesterol levels.

More than a quarter of Americans older than 40 are taking a statin, a number that could rise to 46 percent of people aged 40 to 75 under the newest prescription guidelines, especially now that almost all statins are available as inexpensive generics. A recent study showed that prescribing statins under the new guidelines could cut in half the number of people who develop clinical evidence of cardiovascular disease.

Because statins are cheap, as well as effective and safe for most people, doctors often prescribe them for otherwise healthy patients with elevated cholesterol, even if they have no other cardiovascular risk factors. Yet many who could benefit — including people with established heart disease and serious risk factors like smoking, diabetes and high blood pressure — who are not on a statin for reasons that include reluctance to take daily medication, and concern about possible or actual side effects.

While best known for their ability to lower serum cholesterol, statins also reduce artery-damaging inflammation that can result in a life-threatening blood clot. By lowering cholesterol, statins also appear to stabilize plaque, artery deposits that can break loose and cause a heart attack or stroke. And they may cleanse arteries of plaque that has not yet become calcified.
Instead of striving for a target level of, say, under 200 for total cholesterol and under 100 for LDL, the new guidelines, put forth by the American College of Cardiology and American Heart Association, focus on four main groups who could be helped by statins.
1. People who have cardiovascular disease, including those who have had a heart attack, stroke, peripheral artery disease, transient ischemic attack or surgery to open or replace coronary arteries.
2. People with very high levels of LDL cholesterol, 190 milligrams or above.
3. People with an LDL level from 70 to 189 milligrams who also have diabetes, a serious cardiovascular risk.
4. People with an LDL level above 100 who, based on other risks like smoking, being overweight or high blood pressure, face a 7.5 percent or higher risk of having a heart attack within 10 years.
Gone are the recommended LDL(low density lipoprotein)- and non-HDL(high density lipoprogein)–cholesterol targets, specifically those that ask physicians to treat patients with cardiovascular disease to less than 100 mg/dL or the optional goal of less than 70 mg/dL. According to the expert panel, there is simply no evidence from randomized, controlled clinical trials to support treatment to a specific target. As a result, the new guidelines make no recommendations for specific LDL-cholesterol or non-HDL targets for the primary and secondary prevention of atherosclerotic cardiovascular disease.

Bottom Line: The new guidelines identify four groups of primary- and secondary-prevention patients in whom physicians should focus their efforts to reduce cardiovascular disease events. And in these four patient groups, the new guidelines make recommendations regarding the appropriate dose of statin therapy in order to achieve relative reductions in LDL.

More FAQs From My Patients

I have a high cholesterol level. Is there anything I can do to lower the cholesterol level besides medications, i.e., statins?
Yes, there are cholesterol lowering foods that are effective and have absolutely no side effects. These include:
Soluble fiber of 25gms each day is helpful and good for the colon as well. Good sources of soluble fiber include legumes such as peas and beans; cereal grains such as oats and barley and vegetables and fruits such as carrots, apples, and dried plums (prunes).
Nuts to the rescue. Although nuts are high in fat, the fats are predominantly monounsaturated and polyunsaturated, which are known to decrease LDL cholesterol levels or bad cholesterol. By eating a daily helping of nuts — about 2.4 ounces — results in an average 5% reduction in total cholesterol concentration. Nuts that will help lower LDL cholesterol levels include almonds, walnuts, peanuts, pecans, macadamias and pistachios.
Plant sterols and stanols, plant compounds that are structurally similar to cholesterol, partially block the absorption of cholesterol from the small intestine. They lower levels of LDL cholesterol without adversely affecting high-density lipoprotein (HDL or “good”) cholesterol levels. Plant sterols and stanols, plant compounds that are structurally similar to cholesterol, partially block the absorption of cholesterol from the small intestine. They lower levels of LDL cholesterol without adversely affecting high-density lipoprotein (HDL or “good”) cholesterol levels.
So you can begin by decreasing your consumption of red meat, butter, and high cholesterol containing seafood such as crayfish (heaven forbid!) shrimp and lobster and try these other non-medical options. If these do not work, then talk to your doctor about medication.

I am thinking of having a vasectomy. Is there any risk of erectile dysfunction or impotence?
No, you have nothing to worry about. A vasectomy ONLY prevents the sperm from entering into the ejaculate or seminal fluid. It does not affect the testosterone level or the ability to engage in sexual intimacy. If your erections are good before the vasectomy, they will remain just like they were prior to the vasectomy. So it is safe to proceed with the “prime cut”!

I am a man 78 years of age. Do I need to have a PSA test for prostate cancer?
No, the American Cancer Society and the American Urological Association do not recommend screening for prostate cancer with the PSA test in men more than 75 years. Cancer screening tests — including the prostate-specific antigen (PSA) test to look for signs of prostate cancer — can be a good idea in younger men between 50-75 but not in men over age 75. A normal PSA test, combined with a digital rectal exam, can help reassure you that it’s unlikely you have prostate cancer. But getting a PSA test for prostate cancer is not be necessary for men 75 and older.

I am 40 years of age and ate some red beets. My urine turned red. Is that normal after consuming red beets?
Usually red urine after red beet consumption is a result of a pigment, betalain, in the red beets and is nothing to worry about. However, if the red persists more than 24 hours after consuming the beets, then it is important to see your physician and have a urine examination. When the red color persists, this is referred to as hematuria. Hematuria is a clinical term referring to the presence of blood, specifically red blood cells, in the urine. Whether this blood is visible only under a microscope or present in quantities sufficient to be seen with the naked eye, hematuria is a sign that something is causing abnormal bleeding in the patient’s genitourinary tract. For more information on hematuria, please go to my website: http://neilbaum.com/articles/hematuria-blood-in-the-urine