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High Cholesterol

Question: What Lifestyle Modifications improve Cholesterol Levels?

Answer:

Diet

Currently, there is much controversy over the best balance of carbohydrates, fats, and protein. A number of dietary approaches for improving the heart are available:

• The American Heart Association (AHA) Guidelines
• The Mediterranean Diet,
• Very low-fat diets, particularly the Ornish Program.
• The Dietary Approaches to Stop Hypertension (DASH) diet has been designed specifically to help people reduce blood pressure.
• The Atkins diet severely restricts carbohydrates and substitutes protein.

Exercise

Inactivity is one of the four major risk factors for coronary artery disease, on par with smoking, unhealthy cholesterol, and high blood pressure. In fact, studies suggest that people who change their diet in order to control cholesterol are successful in actually lowering their risk for heart disease only when they also follow a regular aerobic exercise program.

The following are some observations on the effects of exercise on coronary artery disease.

• People who maintain an active lifestyle have a 45% lower risk of developing heart disease than do sedentary people. Even moderate exercise reduces the risk of heart attack.
• Some studies suggest that for the greatest heart protection, it is not the duration of the exercise that counts but the total daily amount of energy expended.
• Burning at least 250 calories a day (the equivalent of about 45 minutes of brisk walking or 25 minutes of jogging) seems to confer the greatest protection against coronary artery disease, particularly by raising HDL (the so-called good cholesterol) levels. (It may take up to a year of sustained exercise for HDL levels to show significant improvement, but in terms of raising HDL levels, more is better.)
• Aerobic exercise also appears to open up the blood vessels and, in combination with a healthy diet, may improve blood-clotting factors.
• Resistance (weight) training offers a complementary benefit by reducing LDL (the so-called bad cholesterol) levels.
• Exercises that train and strengthen the chest muscles may prove to be very important for patients with angina.

Quitting Smoking

Cigarette smoking lowers HDL-cholesterol levels and is directly responsible for approximately 20% of all deaths from heart disease. The importance of breaking this habit cannot be emphasized enough.

Alcohol

The effects of alcohol on heart disease vary depending on consumption. Evidence now suggests that light to moderate alcohol consumption (one or two drinks a day) protects the heart. The benefits are strongest in people at high risk for heart disease and may be fairly small in those at low risk. Light to moderate alcohol intake may even reduce the risk of sudden cardiac death and also protect against coronary heart disease in people with adult-onset diabetes.

On the negative side, moderate consumption of alcohol, equal to or less than one drink a day, may produce a slight increase in the risk for breast cancer in women. Large amounts of alcohol can raise blood pressure, trigger irregular heartbeats, and damage the heart muscle. Binge drinkers have a significantly higher risk for a cardiac emergency. Pregnant women or those at risk for alcohol abuse should not drink alcohol.

Question: What  are the Drug Therapies and the Other Treatments for Unhealthy Levels of Cholesterol?

Answer: Experts now recommend that drug treatments be tailored for raising or lowering specific lipids, depending on the patient's blood lipid picture:

• Three types of drugs, statins, resins, and probucol, target LDL. Statins have other benefits as well and are now the first choice for most people who require lipid-lowering therapy.
• Two others, fibrates and nicotinic acid, also lower triglycerides and increase HDL. [See Table Below.]

Considerations for Women. Some evidence has suggested that cholesterol-lowering agents do not provide the same benefits to women as they do to men. However, recent studies are finding that they are also life saving in women, although perhaps not to the same degree as they are in men.

Considerations for Children. Certain children over seven or eight years old with unhealthy cholesterol levels (LDL over 190 mg dl) may benefit from medications, particularly if they have a strong family history of heart disease. In such cases, the following may be helpful:

• Bile-acid binding agents may be a good choice, assuming the child has normal triglyceride levels. A multiple vitamin with folic acid and iron supplements may be needed in such cases.
• Nicotinic acid is an option for young people with high triglycerides.
• Statins may be used in adolescent boys, but their effect on pregnancy is not known so young women should avoid them.

Long-term safety of any cholesterol-lowering agents in children has not been tested.

Patients should discuss all options thoroughly with their physicians. Combinations are often used for patients with severe cholesterol profiles. The physician should periodically monitor the patient in order to check the drug's effectiveness and possible toxicity. It remains important, even when taking drugs, to maintain a healthy lifestyle.

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