Cholesterol: Managing the Good, the Bad - and the Triglycerides

Part 2 of a 2-Part Series on Cholesterol Risks and Management

Managing your cholesterol and triglyceride levels is important because of the major role those lipids (fats) can play in developing cardiovascular disease.

There are two types of cholesterol, which you can remember by associating the “bad’” low-density lipoproteins (LDL) with “least desirable” and the “good” high-density lipoproteins (HDL) with “highly desirable.” LDL cholesterol can be oxidized by the body and damage the lining of your arteries. HDL cholesterol carries blood cholesterol back to the liver where it can be eliminated. High total cholesterol and LDL cholesterol levels along with low HDL cholesterol can increase the risk of cardiovascular disease.

Another form of fat, triglycerides, are stored in fat cells throughout the body. High levels of triglycerides may be genetic or caused by excess consumption of calories, fatty foods, alcohol, non-complex carbohydrates or sugar. People with high levels of triglycerides often have a high LDL level and a low HDL level.

“There are some risk factors for cardiovascular disease that you cannot change, including your age, gender and family history,” says Dr. Lincy Mathew, an internal medicine specialist with Washington Township Medical Foundation. “For most people, however, making lifestyle changes is an effective way to manage your cholesterol levels and help prevent cardiovascular disease. Lifestyle modifications for lowering LDL and raising HDL are the cornerstone of managing cholesterol levels, even if you are on medications.”

Dr. Mathew notes, for example, that smoking can increase the level of LDL and lower the level of HDL.

“The good news is that if you stop smoking, your risk of cardiovascular disease drops substantially within two to three years,” she says. “There are many resources today for helping people to quit smoking, including nicotine gum and patches as well as various oral medications.”

Diabetes can be a risk factor, as well.

“In people with diabetes, the LDL and triglyceride levels are usually high, and the HDL level is usually low,” says Dr. Mathew. “Managing your blood sugar levels can also help you manage your cholesterol levels.”

Another factor is obesity.

“People who are obese also have greater risks for high cholesterol levels and cardiovascular disease,” Dr. Mathew cautions. “For these people, maintaining an optimal body weight is very important. To lose weight and maintain that weight loss, you need to burn more calories than you take in. For most people that means getting regular, moderate exercise every day. It also means eating a healthy diet.”

A registered dietitian and certified diabetes educator at Washington Hospital, Lorie Roffelsen, RD, CDE, explains that proper nutrition can make a major difference in addressing several risk factors for heart disease, including high cholesterol levels. “A healthy diet is one that features eating more plant-based foods and limiting your consumption of foods that are high in saturated fats and trans fats,” she notes.

“Plant-based foods offer more nutrients and fiber, generally are lower in calories and do not contain cholesterol,” she explains. “The main concern with eating foods of animal origin is saturated fat content. Significant research points to saturated fat, rather than dietary cholesterol, as the main culprit in raising LDL, the ‘bad’ cholesterol, but they often go hand in hand in foods. Fish and skinless chicken breast are lower in saturated fat than red meat. If you still want to eat red meat, a good start is to limit your consumption of it to small portions once or twice a week, and to choose leaner varieties of red meat – such as sirloin instead of ground beef with a high fat content. Smaller portions of meat are good for your budget, as well as for your cholesterol.”

Ms. Roffelsen recommends following dietary guidelines established by the National Institutes of Health’s (NIH) National Cholesterol Education Program and additional guidelines from the American Heart Association.“

The NIH has created a comprehensive program that outlines therapeutic lifestyle changes (TLC), including diet and exercise recommendations,” she says. “Good foods to eat include soluble fiber that binds up dietary cholesterol. Some foods with soluble fiber would include oatmeal, barley, citrus fruits, apples and berries. The soluble fiber acts like a sponge to soak up dietary cholesterol.“

Only a portion of your blood cholesterol level comes from the foods you eat, however,” she adds. “The rest of it is produced in the body by the liver. If you have a history of high cholesterol in your family, your genes may partly determine how much cholesterol your body makes. Modern medications have come a long way in helping to control blood cholesterol levels, including the cholesterol your body makes on its own.”

While Dr. Mathew also prefers to emphasize lifestyle changes as a means of preventing and controlling problems related to high cholesterol, she does urge patients to consult their physician about medications if they still have elevated levels of cholesterol despite changes in their diet, physical activity, blood sugar and weight.

“There are a number of people who would benefit from taking statin medications, which are the only medications proven to decrease cardiovascular events and mortality,” says Dr. Mathew. She notes that the current recommendations from the American College of Cardiology and the American Heart Association as to people who would benefit from statins include:

• People who already have existing cardiovascular disease, including heart attack, stroke, transient ischemic attack and peripheral vascular disease.
• People who have an LDL cholesterol level over 190 mg/dL.
• People with diabetes between age 40 and 75 without proven cardiovascular disease, but with an LDL cholesterol level between 70 and 189 mg/dL.
• People without cardiovascular disease or diabetes, but with an LDL cholesterol between 70 and 189 and additional risk factors such as smoking, high blood pressure or family history of cardiovascular disease that places them at a lifetime risk for cardiovascular disease over 7.5 percent. (See below for information regarding the American Heart Association’s CV Risk Calculator.)

“The LDL cholesterol value is not the only consideration in determining if a patient needs statin medications,” Dr. Mathew stresses. “That decision needs to be individualized for each patient. For example, we would not generally recommend putting women of childbearing age on statins because of the risk of birth defects or miscarriage.

”Statins can produce other undesirable side effects such as muscle aches, elevation of liver enzymes and a slightly higher risk of developing increased levels of blood sugar.“

For patients who have existing cardiovascular disease but do not tolerate statins well, there is another group of medications called bile acid sequestrants, including Welchol, which prevent cholesterol absorption from the gut and prevent bile acid reabsorption,” says Dr. Mathew. “As for lowering triglyceride levels, there are a few medications (such as fenofibrate), but they are very seldom used. Another approach for lowering triglycerides is to use Lovaza, which is a concentrated source of omega-3 fatty acids. The best way to lower triglycerides under most circumstances, however, is to exercise and lower your intake of fatty foods, sugars and alcohol.

“Whenever you consider taking medications, including statins, you need to consult with your physician and balance the potential risks and benefits of the medications,” Dr. Mathew adds. “And you should always, always let your doctor know about all the medications you are taking – including over-the-counter drugs and nutritional supplements – so the doctor can evaluate any possible negative drug interactions.”

Learn More

Part 1 of this series on cholesterol discussed the reasons why people should pay attention to their cholesterol levels to lower their risks for cardiovascular disease. The article explained LDL cholesterol, HDL cholesterol and triglycerides. The article also provided general guidelines for evaluating cholesterol and triglyceride levels, based on guidelines from the National Institutes of Health. That article can be found online in the Tuesday, August 11, edition of the Tri-City Voice newspaper at www.tricityvoice.com or on the Washington Hospital website at www.whhs.com/news.

If you need help finding a personal physician, visit www.whhs.com and click on the link for “Find Your Physician.”

To download a PDF copy of the NIH’s booklet, ”Your Guide to Lowering Your Cholesterol with TLC,” visit www.nih.gov and type Cholesterol Therapeutic Lifestyle Changes in the search box.

For information about cholesterol from the American Heart Association, click here.

To calculate your risk for cardiovascular disease using the American Heart Association’s CV Risk Calculator, click here.