Tue, Aug 28, 2007 - Page 16 News List

Cholesterol: Under control

A healthy lifestyle is the best way to achieve safe cholesterol levels, but for some, drugs may still be necessary

By JANE E. BRODY  /  NY TIMES NEWS SERVICE

Illustration: NY Times News Service

Last December, a routine non-fasting blood test revealed that my total cholesterol level, which had long wavered between 190 and 205mg/dl of blood serum, was now 222 and flagged as "high" by the laboratory's computer. A heart-healthy reading should be under 200.

The high-density lipoproteins (HDL), the so-called good cholesterol that protects against heart disease, were also high at 69, so that was good. My triglycerides, at 95, were well within the normal range of zero to 149. The very low-density lipoproteins (VLDL), also a potentially harmful form, measured 19, again within the normal range of 5 to 49.

But the low-density lipoproteins (LDL), the bad guys that deposit plaque on artery walls, were 134 – "high" since they should be under 100 if I want to maintain a healthy cardiovascular system.

PREEMPTIVE MEASURES

My doctor wasn't too concerned because my blood pressure is low, I eat a healthful diet and I exercise every day for 60 to 90 minutes and run up and down scores of steps. Still, I decided to cut out cheese, lose a few pounds and return in three months for another test, this time after an all-night fast.

So in early March, three pounds lighter and taking a daily supplement of plant stanols, which are supposed to lower cholesterol, I had a second test. But now my total cholesterol had risen to 236 and the LDLs were up to 159.

Still, my doctor was not as alarmed as I was. My father and his father and his father's brother had heart attacks in their 50s, and my father and grandfather died of their second attacks at 71. I was 65. Were my days going to be numbered by a surprise coronary or stroke? Not if I could help it.

Now it was time to further limit red meat (though I never ate it often and always lean), stick to low-fat ice cream, eat even more fish, increase my fiber intake and add fish oils to my growing list of supplements. But the latest test, in early June, was even more of a shock: total cholesterol, 248, and LDLs, 171.

My doctor's conclusion: "Your body is spewing out cholesterol and nothing you do to your diet is likely to stop it." I was not inclined to become a total vegetarian to see if that would help. The time had come to try a statin, one of the miraculously effective cholesterol-lowering drugs.

STEPS TO TAKE

By studying the effects of statins in thousands of people who already had heart disease or were likely to develop it, researchers finally proved that lowering total and LDL cholesterol in people at risk was both health-saving and life-saving. I'll know by fall if the low-dose statin I now take nightly will do the trick, or if I'll need a higher dose.

High LDL cholesterol is an independent risk factor for coronary heart disease, and lowering it by 60mg can reduce coronary events like heart attacks, angina and sudden death by 50 percent after only two years, experts from Oregon Health and Sciences University wrote recently in The Journal of Family Practice.

The Oregon specialists, Dr. Elizabeth Powers, Dr. John Saultz and Andrew Hamilton, recommended that doctors start with lifestyle modifications when a patient has high LDLs. And Dr. Vincent Lo of French Camp, California, suggested that the patient's culture, preferences and practical issues like cost and availability be considered. Not everyone can afford to join a gym, and a traveling salesman may have a hard time sticking to a low-fat, calorie-controlled diet.

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