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.
Illustration: NY Times News Service
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.
These are the measures that have been found to work, based on randomized, controlled clinical trials, the gold standard of clinical research.
* Alcohol: Consuming one or two drinks a day can lower LDLs by 4mg to 10mg. Red wine is considered most effective. For those who cannot drink alcohol, purple grape juice may be a reasonable, albeit less effective, substitute.
* Exercise: Aerobic exercise, like brisk walking, jogging, cycling and lap swimming, can reduce LDLs by 3mg to 16mg and raise the good HDLs. Consistency is important. Aerobic activities should be performed at least five times a week for maximum benefit.
* Weight loss: When achieved through diet and exercise, weight loss can reduce LDL levels by as much as 42mg. When achieved through drug therapy, weight loss has been associated with an LDL drop of 10 to 31mg.
* Yoga and tai chi: These forms of exercise, which are accessible to just about everyone who can walk, even the elderly, have reduced LDLs by 20mg to 26mg when done for 12 to 14 weeks.
THE RIGHT STUFF
About 85 percent of the cholesterol in your blood is made in your body. The remaining 15 percent comes from food. But by reducing dietary sources of saturated fats and cholesterol and increasing consumption of cholesterol-fighting foods and drink, you can usually lower the amount of harmful cholesterol in your blood. My college roommate, for example, recently adopted a mostly vegetarian-and-fish diet, minus cheese but with occasional meat and chicken, and lowered her total cholesterol from 240mg to 160mg.
There are exceptions, of course, and I happen to be one of them. Still, I intend to continue to follow a heart-healthy diet, because that will enhance the effectiveness of the medication I'm taking.
Start by switching to low-fat and nonfat dairy products, like skim milk and, if you can stand it, fat-free cheese. Substitute sorbet, sherbet or fruit ices for ice cream, or choose ice milk or ice cream with half the fat.
For protein, choose fish and shellfish, poultry without the skin and lean meats, all prepared with low-fat recipes. Eat more dried beans and peas (cooked, of course), soy products like tofu, and nuts like walnuts and almonds. Grains should be mostly or entirely whole - 100 percent whole wheat bread and cereals made from whole wheat or oats, brown rice, bulgur and the like. Oats and oatmeal are rich in soluble fiber, which lowers cholesterol.
Pile on the vegetables and fruits. Especially helpful are those high in fiber like Brussels sprouts, cabbage, spinach, carrots, blueberries, oranges and apples.
Cook with canola or olive oil, and use margarine made from plant stanols.
And enjoy a glass of wine with dinner.
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