DEAR READERS: In yesterday's column I began to answer a reader's question as to what I thought about the new statin guidelines. Today, I finish my necessarily long-winded answer. Statin drugs have (at least) two powerful effects. They lower blood levels of LDL cholesterol (so-called "bad" cholesterol). They also fight inflammation. Old guidelines said doctors should prescribe statins for people whose LDL cholesterol levels were high. New guidelines say that doctors should prescribe statins to people who are at high risk for heart disease, even if their LDL cholesterol levels are not high. These guidelines are controversial.
DEAR DOCTOR K: My doctor put me on a statin in 2013 because the guidelines that came out that year said I should be on them. Are the new guidelines really better than the ones they replaced?
DEAR READER: I'm sorry you asked that question, because any answer I give will be criticized by some of my colleagues on the faculty of Harvard Medical School. This is a very controversial area, and my colleagues all have strong opinions -- just not the same one.
DEAR DOCTOR K: My cholesterol is high and my doctor wants me to go on a statin. I'd like to avoid medication. Do any supplements effectively lower cholesterol?
DEAR READER: Statin drugs lower LDL (or "bad") cholesterol and also reduce inflammation. Together, these effects lower your risk of heart attack. Various herbs and supplements have been touted for their ability to improve cholesterol levels. There is one general caveat you should consider. New drugs are tested by the FDA for their safety, effectiveness and purity.
DEAR DOCTOR K: I have high cholesterol, but I can't tolerate statins. Are there any new treatments for lowering cholesterol?
DEAR READER: I assume you're taking statins because your low-density lipoprotein (LDL) cholesterol (so-called "bad" cholesterol) is high. If so, that does increase your risk of having a heart attack or stroke. Lowering LDL cholesterol reduces that risk. Some people can bring down their cholesterol levels with diet and exercise alone. But many people need medication to get to their target levels.
DEAR DOCTOR K: Does the amount of cholesterol you eat affect the cholesterol levels in your blood?
DEAR READER: I'm glad you asked this question, because I think doctors and the news media have not made it clear. For decades, doctors and food scientists have warned against the dangers of eating foods high in cholesterol. That seemed to make sense. First, high blood levels of so-called "bad" (LDL) cholesterol definitely are bad for your health. Second, it seems logical that the more cholesterol you take into your body when you eat, the higher the cholesterol in your blood. But there's growing agreement among nutrition scientists that cholesterol in food has little effect on cholesterol in the bloodstream.
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.
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.
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.
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.
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.