High cholesterol is a risk factor for heart disease. A risk factor is a habit, trait, or condition that increases your risk of having a heart attack. There are two types of risk factors: those that can be modi-fied and those that can't. Risk factors that cannot be modified are gender, family history, and age. High cholesterol is a modifiable risk factor. In other words, by using a proactive approach, you can reverse it.
Well over 100 million Americans about 17 percent of the popula-tion have moderate to high cholesterol levels. Of these, more than 37 million have cholesterol levels that place them at high risk of developing heart disease. But the fact remains, not all cholesterol is bad.
Your body needs cholesterol. It is manufactured primarily in the liver from fragments of proteins, fats, and carbohydrates. Cholesterol is abso-lutely critical to the:
- Production of vitamin D, an important nutrient that helps prevent many illnesses
- Formation of sex hormones such as estrogen, testosterone, and progesterone
- Production of bile acids that help us digest food
- Formation and maintenance of various cell membranes, specifically in the brain and central nervous system.
If cholesterol is so important, then why is it considered so dangerous? Because when there is too much, it can encourage plaque buildup. The body makes as much cholesterol as needed. Unfortunately, cholesterol has become a key "ingredient" of the typical American diet. In addition, medications, genetics, lack of exercise, and many other factors can cause an individual to have too much cholesterol. The first step to controlling cholesterol is to test cholesterol levels.
Having high cholesterol will not produce symptoms. Therefore, the only way to determine if you have high cholesterol is by having your doctor check your cholesterol levels. It is absolutely critical to properly detect and diagnose high cholesterol. Current guidelines from the American Heart Association (AHA) and others recommend that everyone have a baseline cholesterol test before age 20 and then every five years thereafter.
One of the most common ways to determine cholesterol levels is with a simple blood test. The test measures cholesterol and triglycerides that are circulating in your blood. Triglycerides are a type of fat in the blood. Similar to cholesterol, if triglycerides become elevated, you may be at an increased risk of heart disease. To get the most accurate cholesterol test result, do not eat or drink anything for nine to 12 hours prior to the blood test. This includes beverages such as coffee, tea, or soda. Only drink water.
However, some patients with high cholesterol never develop heart dis-ease, while others have normal cholesterol levels and have heart attacks early in life. It has been recognized that the only accurate way to gauge your level of plaque build-up is a test called a heart scan. This CAT scan allows direct visualization of the coronary arteries and detects plaque years or de-cades before the buildup becomes severe enough to cause a heart attack or blockages that require surgery or stents to open. This CAT scan, also known as a calcium scan or cardiac CT, only exposes the person to a small radia-tion dose (the equivalent of a woman getting a mammogram or a child getting dental X-rays) and does not require needles, injections, or dye. This scan has been shown to detect risk of heart disease better than carotid tests, C-reactive protein (a measure of inflammation in the blood) and exercise tests (treadmill or nuclear testing). This noninvasive test is poised to change the way we look at adults' risk for heart disease and is recommended by the AHA and American College of Cardiology, along with the National Cholesterol Education Panel, as a preeminent method to detect patients at increased risk of heart attacks in the next few years.
Keep in mind that some drugs can either increase or decrease your to-tal cholesterol levels. Be sure to inform your doctor of all drugs and/or dietary supplements you may be taking. Some drugs can interfere with cholesterol test results. These include:
- Anabolic steroids
- Beta blockers
- Birth control pills
- MAO inhibitors
The blood cholesterol test measures both low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol. The reason both types are important is because only LDL cholesterol is bad. HDL cholesterol is considered "good" because it transports excess cholesterol to the liver for metabolism and elimination from the body. The reason LDL cholesterol is considered bad is because it sticks more easily to the arterial wall and can build up as plaque.
Your total cholesterol should be less than 200 mg/dl, and your LDL should be less than 130 mg/dl. Your HDL should be greater than 40 mg/dl. You have high cholesterol if your total cholesterol is 240 mg/dl or higher. An LDL of more than 160 mg/dl and an HDL below 40 mg/dl are considered high risk. For more information, refer to the chart on this page. Newer data suggests that lower targets (LDL less than 100 mg/dl) may be more appropriate for people who have either suffered a heart at-tack or are at very high risk of experiencing heart problems.
Testing for inflammation is thought to be helpful in identifying risk. However, this type of testing (i.e., C-reactive protein or CRP testing) has not been shown to be a reliable predictor because anything can elevate inflammation levels, including infections, arthritis, and cancer. Thus, el-evations of these proteins are more often not related to heart disease and are not useful as measures of risk or to track progression of heart disease.
If your cholesterol is high, your doctor may recommend a cholesterol-lowering prescription drug. These drugs are known as statins, and they are currently the only FDA-approved prescription drugs for reducing LDL cholesterol. Some of the most popular brands of statin drugs include Lipitor, Crestor, Zocor, and Mevacor. Statins can be effective in certain cases because they block a substance that the body needs to make cho-lesterol. Some of these drugs may also help your body reabsorb accumu-lated cholesterol to help prevent plaque buildup.
Because these drugs have side effects, before considering taking a statin, ask yourself these two questions:
- What are all your risk factors for heart disease in addition to high cholesterol?
- What exactly are the side effects of the prescription being recom-mended?
Remember, high cholesterol is just one factor that puts you at risk of developing heart disease or having a heart attack. If high cholesterol is your only risk factor, you may want to try other means to lower your cho-lesterol before taking a prescription medication. Chapters Three and Four provide information about a natural approach to keeping cholesterol lev-els in check. If you have a healthy diet, are physically active, and have tried dietary supplements, then a statin drug may be indicated in some cases. Unless they don't tolerate these drugs, some patients need to be on statins. These include people with diabetes, those with known coronary disease (including heart attack, stroke, or bypass surgery), and individuals with very high risk of having a heart attack (such as those with a positive heart scan). In clinical studies, statin drugs have been shown to reduce the risk of all-cause death (improved survival) when taken by patients at high risk. The American Diabetes Association recommends statins for all diabetic persons over the age of 40. Also, almost everyone who is at risk for heart disease should be taking a low dose (81 mg per day) of aspirin, as this has also been shown to lower cardiovascular risk by about one-third. This means that the combination of aspirin and a statin reduces chances of heart attack, stroke, and cardiac death by over 50 percent.
Discuss all of your options with your doctor. If you are already taking a statin, do not discontinue taking it without first consulting with your doctor. You should never discontinue taking any prescription medication without your doctor's knowledge.
Weigh the decision to take a statin very carefully because taking a statin drug is most likely a lifelong commitment. Even if your cholesterol comes down, you'll likely have to stay on your statin medication indefinitely because there is a good chance your cholesterol will go back up once you discontinue the medication. In some cases, making significant diet and lifestyle changes may help you discontinue your medication completely. But again, you need to discuss these options with your doctor. The side effects of statin drugs include:
- Muscle and joint aches and pains
- Liver damage
- Deficiency of coenzyme Q10 (CoQ10)
Depletion of CoQ10 is concerning because CoQ10 is so important to optimal heart function. For individuals who are taking statins, I rec-ommend a minimum dosage of 60 mg of CoQ10 daily. I recommend a product called Kyolic Formula 110 because it combines CoQ10 with aged garlic extract. I'll provide more information about aged garlic extract and CoQ10 in Chapter Three.
Perhaps the most concerning side effects of statins are liver and kidney damage. These drugs can cause an increase in liver enzymes, so a liver test should be done periodically while statins are being used. Increased liver enzymes can lead to permanent liver damage. In some cases, statins cause muscle cells to break down and release a protein that can damage the kidneys. Taking certain drugs and drinking alcohol in excess can magnify these side effects.
Statin drugs have become big business. In 2007, according to CBS News, the most commonly prescribed cholesterol-lowering drug, Lipitor, had annual sales in excess of $12 billion. While these drugs have saved many lives, such widespread use may not be necessary. A targeted approach that employs statins for certain individuals such as those with atherosclero-sis on a calcium scan, diabetes, or known heart disease is the best way to use these drugs.The most effective natural approach to lowering cholesterol and keeping homocysteine levels in check begins with diet and lifestyle.
As for homocysteine drugs, the FDA has approved betaine (brand name Cystadane) for lowering homocysteine levels. In addition to Cys-tadane, doctors often also recommend taking a dietary supplement that contains vitamins B6, B12, and folic acid (also known as folate). Accord-ing to the National Institutes of Health (NIH), betaine has side effects, some serious, including:
- Behavior changes
- Loss of consciousness
If you are taking this drug, tell your doctor if you experience any of the previously listed side effects. Also, if you are pregnant or plan on becom-ing pregnant, you should avoid Cystadane.
The most effective natural approach to lowering cholesterol and keep-ing homocysteine levels in check begins with diet and lifestyle. Many pres-tigious medical journals, including the Journal of the American Medical As-sociation (JAMA), report that drug therapy should be recommended only after dietary modifications have been proven unsuccessful and high risk factors are not present.