Do you want to know your cholesterol? Your kids?

In My Humble Opinion
1

Assume yourself to be an apparently healthy adult with decent nutrition and exercise habits. Okay,a strong family history of high cholesterol diabetes, and heart disease … but asymptomatic yourself. Do you want to know your cholesterol? Have I, a 52 year old male with a BMI about 24 (normal), eating a very healthy diet, exercising very regularly and somewhat intensely, been well served by having been on a statin for over a decade for modestly high cholesterol that was refractory to exercising at marathon training levels and healthy eating? For years I thought I was but recent articles have me questioning that conclusion. Mind you it works for the numbers, I went from LDL of 130 and HDL of 30 to LDL and HDL both in the 60s. But have I done that much good for my long term health, enough good to offset the risks of side effects and the cost? Not asking for advice, I have my plan already; just using myself as an illustrative case.

And now kids are advised to be screened universally (using non-HDL cholesterol as the number to follow) at age 11 and again at 17. Without doubt we will identify a population with elevated numbers, some of whom are obese, some not, some of whom who eat healthily, some who do not. But those who are obese and those who have unhealthy habits should be guided on how to change those habits no matter what their lipid panel is, being screened does not seem to result in better changes (heck getting a good result may even falsely inform them that their bad habits are okay because their numbers are good), and of those with good habits what good does identifying it do? A very small number may, according to guidelines, have numbers high enough to suggest pharmacological intervention if diet and exercise fails, but the evidence that such has more benefits than harm is currently non-existant.

Do you, as a parent, want to know anyway? Do you as an adult want to know for yourself?

2

Your first sentence, “Assume yourself to be an apparently healthy adult with decent nutrition and exercise habits,” doesn’t necessarily jibe with how you then go about describing yourself: “eating a very healthy diet, exercising very regularly and somewhat intensely”.

I’d wager that typical people, by and large, believe that they’re taking better care of themselves than they actually are. “I have decent nutrition and exercise habits”, in many cases, probably actually means, “I have good intentions, but I don’t really walk the walk.” For them, it’s probably worth knowing their cholesterol levels (especially if they have family history of heart disease).

3

We had health screenings at work, and cholesterol was one of the things they looked at. I scored 165, with an HDL of 100.

The nurse was all “Good job!” but I didn’t feel any pride in it. I’ve never worried about my cholesterol–I would have preferred they had looked at some other indicator of health. And I have no idea why my HDL is that high. Two years ago, when we had our last screening, it was at 64. My diet hasn’t changed all that much, so that makes me think it’s really not measuring anything that I have control over. Or maybe it means that there is so much variability between the blood samples they use for the test that the numbers are meaningless.

Maybe one day I will care about it, but not now.

4

My total cholesterol was around 325, now it’s around 165. My triglycerides were similarly skewed and are now in range. I can’t help but think that it’s a good thing and I will continue to have it checked into the future. So yes, I do want to know my numbers until and if somebody shows that it’s bullshit.

5

I had my cholesterol checked and the total was 95 including the good, bad and indifferent. And I have a high fat diet, most of which fat is coming from almonds and walnuts. So I plan to keep doing the same things and never consider cholesterol again.

6

I have no kids. I know my cholesterol levels. (Always excellent.)

7

I prefer information over ignorance. Cholesterol is not a problem for me now - but it was inching up in the past few years. That fact helped me decide it was time to lose a few pounds to avoid having to listen to my doctor tell me to take meds. I lost about 10 pounds - and my cholesterol came right back down to “normal” range.

I wouldn’t have my kid checked unless it was a family issue (it’s not) - but I would advise her to start having it checked once she reaches adulthood (maybe mid 20’s) - it’s good to know your baseline when you are fairly young and in good health, to compare it to what is happening as you get older.

8

Is there now evidence that childhood cholestoral levels are indicative of anything? I don’t recall hearing about a lot of 11 years old having heart attacks. On the other hand, at 17 there may be an indication of a lifelong problem. Currently, 56, I’m getting myself in better shape after getting the first high cholesterol readings in my life. I’ve been pretty inactive for the past couple of years and my PCP agreed that was a likely reason for it. But I knew I had to get more active and improve my physical condition anyway without knowing my cholesterol levels. I’m also waiting for the straight story on cholesterol levels because the studies of people who lowered cholesterol levels weren’t matching up to predicted results (I haven’t been watching this closely). I’m also generally suspicious of any claims regarding cholesterol since there’s a myth about cholesterol consumption affecting cholesterol levels like we have pig, chicken, and cow cholesterol clogging our veins.

So basically I’m interested, but it’s not driving my life so much as general health concerns.

9

Chefguy, it certainly is not bullshit. And if knowing your numbers motivated you to engage in behavior changes that improved them, then you are a data point in favor of screening.

TP, there is evidence that lipid levels just before puberty track quite well with adult levels (better than once puberty hits and changing hormones skew things), and evidence that the process of atherosclerosis begins in childhood.

The question, for both kids in general and for relatively lower risk adults, is if knowing the number results in any meaningful intervention that have positive impacts on long term outcomes.

An obese kid, a kid with crappy nutrition habits? They should change those habits no matter what the test shows. I fear that a normal number may do more to demotivate those changes than an abnormal number will do to motivate them. And pharmacologic intervention is advised only for the very highest and even then with little solid evidence to show it has long term positive impacts.

A kid with good habits already? What good have we done to identify their bad lipids early? “Okay, keep up with your great exercise and nutrition habits and just know that you are despite that still at risk of earlier heart disease because your parents gave you crappy genes. So don’t let up. Enjoy your day!”

My hope is that at 11 the parents are still in charge enough that a high number can get everyone on board taking nutrition and exercise habit formation seriously. But a child with normal numbers should have that happen as well.

So parents, do you think you’d respond to a high number by getting more serious? Do you think that maybe a good number would make you feel less anxious about the fact that you do a lot of fast food in your house and be less likely to listen to the advice about change? Or will you do the same thing no matter what the result shows?

10

No. Cholesterol is a necessary part of your body chemistry, which your liver makes to maintain the level which is normal for you. Reducing dietary cholesterol rarely reduces blood cholesterol levels by more than 5-10%, because your body just makes more. Statins artificially reduce cholesterol, but don’t make a significant difference in reducing heart attacks. Something like 1 in 400 less with statins, IIRC.

11

To what do you attribute the reduction in your cholesterol levels?

12

My knowledge, which may be all sorts of wrong, is that an elevated cholesterol level is a risk factor for cardiovascular disease (including heart attacks) IF the patient has a co-morbidity like obesity, high abdominal circumference, diabetes or hypertension. So if I don’t have any of those, I don’t really give two figs about my cholesterol levels.

In reality, I’m obese, so yes, I do care, and I have found out, and I’m trying to change it through diet, [del]exercise[/del] (yeah, right, who am I fooling?), 7+g of psyllium based fiber per day, oatmeal as often as I can stand it and more red yeast rice than you can shake a panda bear at. If it doesn’t come down satisfactorily in 6 months, I’ll take the damn statin.

My kids are both slim, and if my daughter keeps after her father’s shape, she’ll be fine. My son is shaped more like me except for being a boy, and he may battle his weight as he ages. If he becomes obese or develops HTN or DMII, I’d suggest to him that he get his cholesterol tested, sure. But I see no reason to test him now. What’s it going to change? “Don’t get fat, kid.” Well, sure, but there are plenty of reasons not to get fat! I certainly wouldn’t suggest prophylactic statins for a teenager with no risk factors except hypercholesterolemia, and I’d suggest he get another opinion if his doctor recommended them at this point.

So I guess to answer your question, if I haven’t already: if my kid had another risk factor, yes, knowing s/he *also *had high cholesterol might motivate me to do more in terms of intervention. If my kid didn’t have another risk factor, I wouldn’t care about the cholesterol number. So I guess I’m not in favor of routine screening, but testing chol levels in an obese, hypertensive or diabetic kid makes sense.

13

I’m 44 and have never had my cholesterol checked. In my case, I don’t see the point. I’m healthy, not overweight, and I lift weights and run throughout the week. If I had high cholesterol, what could I possibly do about it?

14

Take a statin?

(Me: Relatively healthy, not overweight, eat an ovo-lacto vegetarian diet, barely exercise = awesome cholesterol/triglyceride levels.)

15

Given my family history; AFAIK, the only heart problems back to my grandparents was atrial fibrillation in one of my grandmothers, and that isn’t due to CVD; this is with a ~50% prevalence of overweight, if not obesity (not including myself; I am also more active/get more exercise than most of my family; my mother in particular literally spends all day on the computer playing Farmville and such) and a high meat diet (which I personally think has nothing to do with CVD; if anything, the nastiest foods I see are mostly made with refined bleached flour, sugar and partially hydrogenated vegetable oil, all vegan, or at least no direct meat products), it doesn’t make much sense to get a cholesterol test.

16

Many years ago as part of a routine blood test for something unrelated, it was revealed that my then teen-aged daughter had high cholesterol. Worse, it was mostly whichever the “bad” one is. Doctor’s recommendations were made and addressed.

The doctor suggested that everyone in the family should be tested, and we were. Here comes the weird part. The one with the best test results was me – overweight and rarely exercising. The doctor said he checked everything over very carefully to be sure they hadn’t mixed up my tests with my daughter’s. My husband’s was none too good. Our other daughter’s was high in total, but most of it was the “good stuff” – she was, and is, a very slim and active person.

My theory was that I inherit my basic metabolism from my mother. My father always thought it was quite unfair that she drank and smoked but had low blood pressure and great cholesterol, whereas he did neither had had high BP and bad cholesterol.

The moral of the story is that sometimes even with a healthy life style you can have problems with this sort of thing. Of course, it doesn’t always mean anything in the long run. My mom died entirely too young of a congenital mitral valve prolapse, unrelated to her blood chemistry, after her second operation for a valve transplant. My dad lived well into his 90s although in earlier times with coronary bypasses unavailable would have gone much earlier.

17

Not really. I was diagnosed with super duper high cholesterol at age 24, not overweight, no high BP, no other co-morbidities. Just fatty blood.

I’ve done all sorts of things, increased exercise, stopped eating all meat, brought chicken back into my diet, taken statins, not taken statins, tried herbal supplements, not tried herbal supplements. Nothing really changes it much. It’s just freakin’ high (generally in the 200-300 range). I, otherwise, couldn’t be healthier.

Doctors want me to take statin drugs. I think I am too young to start on that neverending train, especially given the long-term side effects. I have trouble taking something every day anyway; it’s why I don’t take vitamins or the pill – because I cannot get in the habit of taking a pill or multiple pills every day.

So I try to eat a very low-fat diet, exercise a lot (I’m up to about 8 hours a week of cardio+resistance), and mostly, I just don’t give a shit. Seriously. While just about everyone in my family dies of heart disease, my secret is that 90% of them die after age 80. I would be perfectly content to live to 80. A lot of 'em died with cancer, but not of cancer. I’m gambling on genetics and just not worrying about it. I don’t have kids, and I might feel differently if I did because there would be humans relying on me. However, because there’s only four-legged critters relying on me, and I’ll probably out live them… meh. I can’t be bothered to care about my cholesterol. Now, if I had a bunch of other problems, like high blood pressure as well, then yeah, I’d probably take the statins. But I think I’m one of those people who are genetically predisposed and I see no sense in taking statins for the next 40 years. Fuck that.

18

I don’t want to know. I’m not overweight, I eat a very healthy diet extremely consistently, exercise regularly, and feel great. I’m not going to change my habits, and I’m certainly not going to start taking statins. If it’s high, oh, well. I don’t want to stress about it.

19

When I was in my early 30s–weight perfect, feeling fine–I thought, “I’ve never had my cholesterol checked, probably should.” The doctor called and told me, “Come in right now, and don’t eat anything!”

Turns out my levels were up in the “Orson Welles/I can’t believe you are alive and walking around” range, as I inherited a bum liver from my father, and it does not metabolize properly. Even with meds and proper diet, my cholesterol is still a bit too high. So yes, I am very glad I had it checked.

20

I know my cholesterol numbers and they aren’t as good as the doctor would like, yet I am not willing to take the meds he wants me to take. I dropped one doctor over this already. He was completely fixated on cholesterol numbers, to the point that he couldn’t seem to focus on anything else. I even took the damned pills for a few months. Had to dropped him when I came in with a knee injury and he spent the whole time trying to talk me into upping my Cestor dosage. If he had his way I would take the pills and visit him once a month for blood work until the day I die. A huge expense in both time and money with no beneift for me other than a vague, “it might help lower the chance of a heart attack in some cases.” For the benefits to outweigh the time, expense and side effects of the drugs they would need to actually show some kind of positive effect for me. So far I don’t think they have. It is nice to see the tide turning from the old demand that everyone start taking statins NOW to a more reasoned approach.

I can’t help but feel like the drug companies have done their best to stoke the flames of the fear over cholesterol. Those ads where we see a cross section of an artery with globs of cholesterol sticking to the sides and almost blocking the flow are a horrible form of fear mongering. Fear mongering that is both inaccurate and profitable.