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Rethinking cholesterol: Aim even lower

By on April 23, 2018 in Columnist with 0 Comments

Jim BrownBy Jim Brown, M.D.

Last year I had a wake-up call.

I was having some mild breathing issues so my excellent internist ordered a chest X-ray that suggested my right diaphragm was not working the way it should. The next step was some tests with a pulmonologist, and then a cat scan of my chest.

There was no evidence of anything life threatening; however it did show that I had calcifications in my coronary arteries, which I knew is not a good thing to have.

I have never had any cardiac symptoms; I exercise a lot, eat reasonably well, keep my weight and body mass index down and have always had low cholesterol and an excellent HDL (high density lipoprotein) cholesterol level.

I figured at my average pulse rate, my heart has been working very well for me beating an average of 31,536,000 times a year.

I wanted to keep that wonderful pump going as long as possible.

My internist suggested I start a statin drug. I was a little surprised as I thought my cholesterol was excellent. He did point out that my LDL (low density lipoprotein) level was too high — above 100.

Shortly after this I ran into a good friend of mine who is a terrific cardiologist. He said he would look at my cat scan and told me it is not uncommon for men at my age to have some calcifications in the coronary arteries.

He did strongly agree with my internist that I should be taking a statin drug. He mentioned he has been taking a statin for over 20 years with a goal to keep his LDL level below 40.

I have been taking a statin for about two years now with no side effects and have brought my LDL down to a respectable level.

Cholesterol itself is not a bad thing. It is actually extremely important for our health.

It is a fatty substance that occurs naturally in the body and performs several vital functions. It helps make the walls of the cells in our body and is the basic material for many of our hormones including testosterone and estrogen.

It is important in making bile salts that help us absorb and digest fats.

Our body makes the cholesterol we need in our liver.

On the other hand, LDL cholesterol is the so-called “bad” cholesterol, because it is the fat that is associated with the build up of artery clogging plaque. This build up can cause narrowing or blockage, which affects the blood flow to our vital organs, especially to our heart and brain. The result can lead to a heart attack or stroke.

Cardiovascular disease is the number one killer of Americans.

The main issue is not how much a person weighs, but how much body fat they are carrying around. A person might be heavy but be in great condition having little body fat.

Excessive body fat and obesity (having an elevated body mass index or BMI) are associated with higher LDL and lower HDL.

Americans, especially those with large abdomens that contain primarily fat, are way too common. These are also the people who are at a greater risk for developing type two diabetes.

A good site to calculate your own BMI or body mass index is: www.smartbmicalculator.com.

Over the past 20 years as the evidence against LDL cholesterol accumulates, the acceptable or ideal levels are becoming lower and lower.

Whereas a level of 100 was once considered to be acceptable, many cardiologists and internists now are recommending the target level be 50 and no higher than 70. My cardiologist friend’s goal for himself was a level of 40, and that is my goal, too.

Some patients wonder what, if any, are the risks of taking statin drugs.

Statin drugs work by slowing your body’s production of cholesterol. They have been remarkably safe.

Early on, there was some concern about how they might affect the liver, so people getting these drugs had liver function blood tests done to see if there were any problems. This is no longer done because it is considered unnecessary.

About 5 percent of patients on statins complained of muscle pain, soreness or muscle fatigue. This is the same percent of patients with these complaints who were taking a placebo.

Side effect complaints seem more common in people who are taking multiple medications for lowering cholesterol level, and also in those who are female, over age 65, and who have a small body stature, who drink too much alcohol (over one drink for females and two for males), and in anyone with liver or kidney disease.

These are my personal opinions as well as reviews of the literature from nationally recognized experts.

If you have any of these issues or concerns, I strongly recommend you discuss them with your own physician.

Jim Brown, M.D., is a retired gastroenterologist who has practiced for 38 years in the Wenatchee area. He is a former CEO of the Wenatchee Valley Medical Center.

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