All About Cholesterol

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More Crucial Info

The Scoop on Triglycerides

What's ideal: Below 100

Triglycerides are the third part of the cholesterol equation. They are basically fats -- from foods you've eaten or made by the liver -- carried through the bloodstream to be stored in your tissues. A high level increases your risk of coronary artery disease and diabetes. While some guidelines say 150 is normal, Dr. Roizen says that's too high and you should aim for under 100. "Too often 'normal' means heart disease," he says. The triglycerides number really reflects what you've been eating lately. To get the most accurate reading, eat as you normally do in the week or so before you get your cholesterol tested. Don't cut out lots of fat in an attempt to fool the test, because it won't help you assess your real risks. Dr. Andersen says your level also has a genetic component, and sometimes very thin, seemingly healthy women can have a very high triglyceride level.

What Moves the Needle

Triglycerides respond very strongly to dietary changes, says Dr. Roizen. Reducing those simple carbs that quickly turn to sugar (and hit your waistline) is most helpful. Cutting animal fat and increasing exercise can help, too. Although moderate alcohol intake can help raise your HDL, which is good, it will also raise your triglycerides, which is bad. If your triglycerides are high, Dr. Andersen says reducing your alcohol consumption is important.

What's this ratio I'm hearing about?

Lab results may include a ratio that's calculated by dividing your HDL level into your total cholesterol number. If you have a total cholesterol of 200 and an HDL of 50, that's 200/50, or a ratio of 4:1. While many guidelines say the ideal ratio is 3.5:1, Dr. Roizen says an optimal number is unknown and may be more like 2:1. Assessing your actual numbers is more important, according to the American Heart Association. Dr. Andersen says that although people are talking about their ratio now, most experts have moved past it. "I never look at ratio anymore," she says. If you have a high enough HDL you can get a deceptively good ratio. Say you have an HDL of 65, which is good, and a total level of 235. Your ratio would be an acceptable 2.6:1, yet you could still have an LDL of 158 or 170, which is too high. "I wouldn't ignore those LDL numbers," says Dr. Andersen. "You want your LDL as low as possible."

How Plaque Can Become a Heart Attack

At first plaque looks like chicken fat, says Dr. Andersen. As it grows it can obstruct blood flow and cause patients to say things like, "Every time I walk up the stairs now I get chest pain." Worse, as the blood is pounding over this fatty plaque, the plaque can get inflamed and then rupture, which causes a blood clot to form in an attempt to heal the rupture. The clot can then grow or break away and cause a blockage and thus the need for angioplasty (where a balloon is inflated via a catheter to widen the blocked artery), stents (a metal mesh tube that is inserted after the blocked artery is opened by angioplasty), or bypass surgery (where a vein from the leg or other part of the body is surgically routed around the blockage). If the blockage totally stops blood flow to your heart (as in the image, left), you'll have a heart attack -- even if you've never had symptoms before. Dr. Andersen says a 49-year-old patient of hers who was a marathon runner had a heart attack from just the tiniest bit of fatty plaque. "We can't predict when plaque is going to rupture. Sometimes the first symptom of heart disease is death, and that's why we have to practice prevention."

Who Should Take Statins?

Many women can improve their numbers and decrease their risk of heart attack with exercise, weight loss, and eating right. But sometimes willpower is not enough, or despite your best efforts, your stubborn genetics keep your numbers in the red zone. That's when your doctor might suggest you go on a statin. These drugs inhibit an enzyme that controls cholesterol production in the liver. Most statins can lower your LDL significantly and certain ones may raise HDL, too. Statins also have an anti-inflammatory effect that may be as important as their effects on cholesterol for preventing heart disease.

Still, women are less likely to take statins than men, despite being just as much at risk, said a 2008 study from Rush University Medical Center. "In general in this country, we underestimate the risks in women and don't treat them as aggressively as we should," says Dr. Andersen. "And once a woman is diagnosed with heart disease, she is more likely to die from it than a man is." Deaths due to heart disease are continuing to increase in young women, which makes prevention more important than ever. "These are lifesaving drugs that are extraordinarily safe," she says. "I know there's a lot of mistrust about prescription drugs, but these medicines have been used successfully for decades and we've found that women on statins are living longer, with fewer strokes and heart attacks."

Continued on page 3:  Marnie Nussbaum, MD


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