I often read about individuals with ideal cholesteral readings having plugged arteries and others with reading through the roof that have no problems. Is their a way to actually examine the condition of our arteries to see if we are the type that needs to actually treat high cholesteral?
While you can do tests such as a coronary CT that can show the amount of blockage in the arteries (by calculating the amount of calcium) or even a cardiac catheterization to directly look at the diameter of the arteries, this does not always correlate directly to outcome. What you have to understand is that the risk of heart attack and death is not directly related to the amount of blockage. You can have 90% blockage in an artery that remains stable for years and causes some pain with extreme exertion but will never completely block the artery, and you can have an artery that is only 30% blocked but the plaque can suddenly rupture, completely block the artery and cause sudden death. Current research into which people have so-called unstable plaques is ongoing. Endovascular ultrasound may be able to help but studies are preliminary. A protein called c-reactive protein may correlated with unstable plaques, but again this research is preliminary.There is a lot of research going on about this. One of the newer subjects is looking at the size of the LDL or bad cholesterol particles. People who have smaller, denser LDL have a higher risk of heart attack. Others are looking at the total number of particles (smaller particles mean more total particles)
IMHO, the best course of action at this time is to look both at the cholesterol and at other risks that we know cause heart attacks and strokes to be more likely, such as high blood pressure, diabetes, smoking, and family history. Certainly, if you have symptoms of stable blockage, such as pain with exercise that should be treated. Otherwise, the most recent recommendations are to calculate the cardiac risk based on our best current knowledge and treat aggressively those at higher risk clinically.
These things tend to run in families, so talk to your doctor about your family history.
My maternal grandfather had heart disease (among other things), so my doctor opted to treat my high cholesterol pretty aggressively. If you can tolerate statins, they may help with cholesterol levels–with them, my total serum cholesterol went from the low 200s to 125 (as of my last physical).
My plan to not die seems to be going ok so far.
I have a little concern with statins, I have seen some people just melt away when they started taking them. My cholesteral is about 140 but I am a smoker. Family history is excellent in this area. One of my Dr’s says just watch my diet and the other Dr. says he wants it at 100 or lower.
Latest AHA/ACC joint recommendation on statins is to treat if:
1)You have known heart disease
2)You have known diabetes
3)Baseline LDL > 190
4)10 year cardiac risk > 7.5%
This does not take into account family history, but if you don’t have a family history, or any of the others, you can calculate your risk here.
What if your statin drug is keeping your cholesterol levels where the doctor wants to see them, even if you still eat high cholesterol foods? Should you still cut out the yummy, yummy steak and camembert?
At what point does blockage cause symptoms? I don’t know the math but I thought people could have something like 70% blockage with no symptoms.
Do you know what all factors play a role in unstable blockages? I’ve heard that in studies people who get angioplasties, stents or bypass surgery do no better for MI than people who don’t because these treatments do not really do anything for blockages in people prone to them. Plaque still breaks off and blocks arteries with those treatments.
I’ve heard oxidation of LDL is a risk factor in things like MI, but don’t know how you account for it or compensate.
What about low grade systemic inflammation? Is CRP an effective way to test for it, and if it is high what is the correlation and how do you treat it?