High Cholesterol

What do you think of the new statin guidelines?

DEAR DOCTOR K: My doctor never recommended statins to me, but he says there are new guidelines, and thinks that I should now start taking one. What do you think of the new statin guidelines?

DEAR READER: The new guidelines make a lot of sense, because we've learned that statins have more effects on the body than just lowering cholesterol. Statins were developed after a Nobel Prize-winning discovery in the 1970s revealed how the body makes cholesterol. Most of the cholesterol in our body is made by our body, not consumed in our food. Statins slow the production of LDL ("bad") cholesterol by the body.

Should I stop taking niacin to raise my HDL cholesterol?

DEAR DOCTOR K: For years I've taken niacin to raise my HDL cholesterol. Now my doctor wants me to stop. Why?

DEAR READER: When we talk about cholesterol, we're generally referring to low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol. LDL is also known as "bad" cholesterol. When there is more LDL than necessary in the bloodstream, the LDL cholesterol burrows inside blood vessel walls. It slowly forms plaques of atherosclerosis. When those plaques rupture and block blood flow, they cause heart attacks and strokes.

Should I request advanced cholesterol testing?

DEAR DOCTOR K: Should I request "advanced" cholesterol testing at my next checkup?

DEAR READER: A standard cholesterol test, or lipid profile, measures levels of HDL, LDL, total cholesterol and triglycerides in the blood. So-called "advanced" cholesterol testing is a more detailed version of this test. Cholesterol is a waxy, yellowish fat. It travels through your bloodstream in tiny, protein-covered particles called lipoproteins. These particles contain cholesterol and triglycerides, a type of fat.

Does my high HDL cancel out concerns about my high LDL cholesterol?

DEAR DOCTOR K: I am 71 years old. My LDL cholesterol is 160, but my HDL is 122. Does my high HDL cancel out concerns about my high LDL cholesterol?

DEAR READER: I can't give you a definite answer for a simple reason: There are very few people like you. Therefore, there are few studies of people like you. Here's what we know. For the vast majority of people, the higher your LDL ("bad") cholesterol, the greater your risk of heart disease. In contrast, the higher your HDL ("good") cholesterol, the lower your risk.

What do I need to do to lower my cholesterol?

DEAR DOCTOR K: My cholesterol has always been fine, but recently it's started to rise, though not high enough for medication. What do I need to do?

DEAR READER: There are several ways you can lower your cholesterol besides taking medicine. They involve cholesterol-friendly lifestyle changes: dietary modifications and regular exercise. Start with your diet. First, let's consider fats. The types of fat you eat are as important as the amounts you eat. Most animal and dairy fats are full of unhealthy saturated fats, which raise cholesterol levels.

Can you explain how high cholesterol causes a heart attack or stroke?

DEAR DOCTOR K: Can you explain how high cholesterol causes a heart attack or stroke?

DEAR READER: Cholesterol is a type of fat that travels in the bloodstream. Our bodies need some cholesterol to survive. But high levels of cholesterol in the blood -- particularly low-density lipoprotein (LDL) cholesterol, or "bad" cholesterol -- increase your risk of cardiovascular disease.

What foods should I eat to help lower my cholesterol?

DEAR DOCTOR K: I know lots of foods raise cholesterol levels. But are there any foods that lower cholesterol?

DEAR READER: Indeed there are. But before talking about them, it's worth saying a few words about foods that raise your cholesterol. Except for a very few people who inherit genes that cause them to have high cholesterol, most of us who have had a "cholesterol problem" (which includes me) do it to ourselves by the foods we eat.

Is high HDL cholesterol good?

DEAR DOCTOR K: For years my doctor has been telling me about the benefits of high levels of HDL cholesterol. Now I read that high HDL may not protect against heart disease after all. Is "good" cholesterol still good for you?

DEAR READER: The HDL cholesterol story is a cautionary tale. It demonstrates once again that even the most persuasive theories about what should make us healthy need to be put to the test. It has been solidly established that people who have high levels of LDL (bad) cholesterol have a higher risk of developing heart disease. Moreover, it has been solidly established that treatments that lower LDL cholesterol reduce the risk of developing heart disease.

How can I lower my triglyceride level?

DEAR DOCTOR K: I recently had my cholesterol checked, and it turns out I have high triglyceride levels. Why are high triglycerides dangerous? What can I do about it?

DEAR READER: What's often called a "cholesterol test" really measures three different kinds of cholesterol and one other type of fat, triglycerides. Most people have heard of the three types of cholesterol: LDL ("bad") cholesterol, HDL ("good") cholesterol and total cholesterol. But not as many have heard of triglycerides.

What is metabolic syndrome?

DEAR DOCTOR K: A friend recently told me about a condition called metabolic syndrome. What is it? And what can I do if I have it?

DEAR READER: Metabolic syndrome may be the most common condition you've never heard of. Many of my patients have it; nearly 50 million Americans have it -- and many of them don't know it. Metabolic syndrome is dangerous. If you have it, you have a much higher risk of stroke or a heart attack, and of developing diabetes, kidney and liver disease.