The Lowdown on Bad Cholesterol

Experts see gains in ever-decreasing levels, with even 'normal' people benefiting from statins

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HealthDay Reporter

FRIDAY, Sept. 30, 2005 (HealthDay News) -- Your cholesterol levels are well within the "safe" zone, much lower than the 200 milligrams per deciliter mark at which your chances of a heart attack or stroke increase.

That means you can keep living as you have been, same old habits and diet and activities.

Right? Not so fast.

Some doctors now say that even people with "normal" cholesterol can lower their risk of heart attack if they start eating right, exercising, or even taking cholesterol-busting statin drugs.

"We've been studying how low you can take 'bad' cholesterol and still see a benefit," said Dr. John C. LaRosa, president of the SUNY (State University of New York) Downstate Medical Center in Brooklyn. "The answer is you can take it much lower than naturally occurs in a Western population."

Cholesterol is a soft, waxy substance found in the bloodstream and in all your body's cells, according to the American Heart Association. It's essential to have some cholesterol, as it is used to produce cell membranes and some hormones, and serves other needed bodily functions.

But if there's too much cholesterol in your blood, it can begin sticking to the walls of arteries and veins. These plaque deposits can block blood flow to the heart or brain, leading to heart disease, heart attack or stroke.

The goal is to lower your low-density lipoprotein (LDL) cholesterol, which is the bad kind that clogs blood vessels.

"We call it the bad cholesterol because it's being delivered to the cells from your liver," LaRosa said. "If you're delivering more cholesterol than your tissues can use, some of it tends to find itself in places where it shouldn't be, including the blood vessel walls."

On the other hand, "good" cholesterol -- high-density lipoprotein (HDL) cholesterol -- tends to carry cholesterol away from the arteries and back to the liver, where it is passed from the body. High HDL levels are considered a good thing.

An estimated 106.9 million American adults have total blood cholesterol values in the "borderline high risk" range of 200 milligrams per deciliter and higher, according to the American Heart Association. Of these, about 37.7 million people have levels of 240 or above, the level at which doctors recommend immediate lifestyle changes and a prescription to statins.

People with total cholesterol over 240 have double the risk of heart disease, compared to those who keep their cholesterol under 200, the American Heart Association says.

Studies have shown that statins are extremely effective, reducing LDL levels by 25 percent to 35 percent.

The drugs also have proven themselves to be relatively risk-free, LaRosa said. "These are very safe drugs, these statins, and very effective," he said. "They're safer than aspirin, for example."

Accordingly, doctors now are prescribing them to a wider range of people.

Individuals with "high-risk" profiles -- smokers, those with cardiovascular disease, people with poorly controlled high blood pressure -- might find themselves on statins even though their LDL levels are around 100 milligrams per deciliter.

And some doctors believe statins should be made available to anyone who can't make the diet and lifestyle changes necessary to keep their LDL levels down, even if they currently are in the safe zone.

"Cholesterol should be kept under control quite rigorously, rather than leaving it to chance," said Dr. David J.A. Jenkins, a professor in the department of nutritional sciences at the University of Toronto. "It may be easier to take a pill in the evening, rather than go for a run in the morning."

That doesn't mean that Jenkins and others are advocating the use of drugs over a healthy lifestyle.

The doctor noted that eating well and exercising can provide other benefits, including a reduction in the risk of diabetes and cancer.

The lifestyle changes that can make a big difference in your cholesterol levels include:

  • Reducing the amount of saturated fat and cholesterol in your diet.
  • Losing weight if you're overweight, which can reduce your LDL cholesterol and boost your HDL cholesterol.
  • Devoting at least 30 minutes a day to exercise.

"No one who is promoting medications would do so responsibly unless they were equally vigorous in promoting diet and lifestyle change," Jenkins said. "If they do make major changes in their diet and lifestyle, they can have achievement in a range of health issues. We shouldn't give up on this."

More information

To learn more about cholesterol, visit the American Heart Association.

SOURCES: David J.A. Jenkins, M.D., professor, department of nutritional sciences, University of Toronto; John C. LaRosa, M.D., president, SUNY (State University of New York) Downstate Medical Center, Brooklyn, N.Y.; American Heart Association

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