Cholesterol Archive

Your primary care provider should help you control risks for heart disease and refer you to a cardiologist if needed.

Any primary care provider you see—a doctor, nurse practitioner, or physician's assistant—should offer detailed advice on how to lessen your odds of cardiovascular disease, which is responsible for one in three deaths in the United States. However, some people need more specialized care for their hearts.

"I see or hear from a lot of people who have very common problems, like high cholesterol and high blood pressure, who think they need to see a cardiologist," says Dr. Patrick O'Gara, a cardiologist at Harvard-affiliated Brigham and Women's Hospital. For many people, a primary care physician can effectively manage those problems. But if you have specific concerns, talk to your doctor about whether more specialized care might be beneficial, says Dr. O'Gara.

Research we're watching

Walnuts are loaded with folate, vitamin E, and lots of good fats. Although they are also high in calories, they don't seem to contribute to weight gain. Researchers at Yale University Prevention Research Center wanted to determine if eating walnuts daily could help people at risk for diabetes control their cholesterol and blood sugar.

The researchers randomly assigned 112 people ages 25 to 75—70% of whom were women—to two groups. People in both groups were given 2 ounces of walnuts to eat daily. They were told to eat whatever else they wanted but to keep a record of what they ate. One group was also told to eat 366 fewer calories from other food to compensate for the calories added by the walnuts. Both groups ate the walnuts for six months, and their customary diet without walnuts for another six months.

Ask the doctor

Q I have a relative who had a total cholesterol value of 155, yet he still had a heart attack with 90% blockage in one artery. How could that happen?

A I understand your confusion, considering how doctors have long focused on the importance of having an optimal total cholesterol level (less than 200 milligrams per deciliter or mg/dL) as a way to lower the chance of having a heart attack. It's actually the harmful LDL cholesterol value that's most important in terms of this risk. However, a person with a total cholesterol level of 155 mg/dL probably has an LDL level under 100 mg/dL, which is currently considered a reasonable target for avoiding heart disease.

Image: iStock

Cholesterol in the foods you eat generally has little effect on levels in your bloodstream. But your overall diet does.

Cholesterol has a bad reputation, thanks to its well-known role in promoting heart disease. Excess cholesterol in the bloodstream is a key contributor to artery-clogging plaque, which can accumulate and set the stage for a heart attack. But if you're like many people, you might not understand cholesterol's other key functions—or the connection between the cholesterol you eat and that in your bloodstream.

These potent medications are for hard-to-manage cases of high cholesterol—not replacements for the tried-and-true statins.

Q. My doctor used to check my liver function once a year after I started taking a statin drug to lower my cholesterol, but he doesn't anymore. Why not?

A. Your doctor appears to be following the latest recommendations from the American Heart Association and the FDA. When statin medications were first approved, doctors did periodic blood tests to check for liver injury. Three decades later, it is clear that serious liver injury from statins is a rare side effect and that routine blood testing does not help identify people at risk for statin-related liver problems. Therefore, routine monitoring is not a good use of money and time.

Ask the doctor

Q. After a year of taking a statin, my LDL cholesterol measurement is 50 mg/dL, which seems awfully low. Is there any downside to a very low LDL?

A. Based on what we currently know, a low-density lipoprotein (LDL) level of 50 mg/dL appears to be reasonably safe, especially when attained naturally. Studies of people who've already had a heart attack suggest that lowering LDL to about 50 mg/dL provides further protection against recurrent cardiovascular events versus reaching a level of around 70 mg/dL. In studies lasting up to seven years or so, these lower LDL levels appeared to be well tolerated.

But if you are healthy, deciding if these commonly prescribed drugs are right for you is a personal choice.

A study in JAMA Internal Medicine may help to explain the controversial connection between cholesterol-lowering medications and memory loss. Researchers scrutinized health records of more than 11 million people who saw their primary care doctors from 1987 to 2013. They compared reports of memory problems by three groups of people:

• 483,000 who were prescribed a statin to lower their cholesterol

• 26,000 who were given another type of cholesterol-lowering drug (not a statin) to lower cholesterol, such as a fibrate or niacin

• 483,000 who didn't take any cholesterol drug.

People who took any kind of cholesterol drug—a statin or some other type—were nearly four times more likely to report memory loss right after starting on the drug, compared with people who didn't take any kind of cholesterol drug.

A novel class of drugs has the potential to pick up the slack where other cholesterol medications leave off.