Among the controllable risk factors for heart disease, cholesterol is a primary indicator of cardiovascular health. For many adults, elevated LDL (low-density lipoprotein) is one of the first wake-up calls that lifestyle modification and/or medication is needed to help keep cardiovascular risk in check.
Everyone needs some cholesterol—it’s a natural substance created by the body and derived from food. The amount of cholesterol in our blood depends in part on genetics and in part on diet. While cholesterol helps form cells’ exterior surface, aids in digestion and contributes to hormone production, too much of it can clog arteries, leading to blockages that cause heart attack or stroke.
“It is important for everyone to have a cholesterol screening. When you have this done depends on your cardiovascular risk factors, such as a family history of high cholesterol and/or early heart disease,” says Krista Havlin, clinical lipid specialist with Mercy Lipid Center.
The National Cholesterol Education Program recommends that screening with a lipoprotein panel start at age 20. “How often to repeat this will depend on your results (normal versus abnormal), whether you are prescribed a cholesterol-lowering medication and your complete risk-factor profile,” Havlin says. “In some children and teens with a family history of early heart disease and high cholesterol, early cholesterol screening is advisable. All individuals with diabetes should have their cholesterol monitored at least yearly.”
Recent high-profile news about the use of statin medications to treat high cholesterol does not alter current screening guidelines that have been accepted by the medical establishment for many years. In fact, the report backed by the American Heart Association, which initially indicated that blood cholesterol levels were no longer needed for determining ongoing doses of cholesterol-lowering statin drugs, is controversial among experts. “I’ve read it, and the report won’t change my practice at this point,” says Dr. Glenn Davison, founder and co-director of the Lipid Management Program at St. Luke’s Hospital.
There are different types of cholesterol screening. Many people volunteer for the finger-stick test at health fairs that gives a basic cholesterol reading. However, cholesterol is composed of both low-density lipoprotein (LDL) and high-density lipoprotein (HDL). Both should be monitored to give a more accurate picture of cardiovascular risk. The finger-stick test provides total cholesterol and HDL levels, but more detailed analysis requires a fasting (only water for 12 hours prior to the test) blood test.
“The gold standard is called the ATP III, the Adult Treatment Panel,” explains Davison. This fasting lipid panel should be performed at least every five years. “If a finger-stick test shows that total cholesterol is above 200 or HDL is below 40, then you need to have a fasting lipid test done soon thereafter.”
Interpreting the results is a matter of weighing all risk factors to determine an individual’s overall risk profile. “Risks are based on your LDL, and there are different variables in terms of where you should be,” Davison says. “For example, anyone who is above 130 LDL is considered abnormal. But then how aggressive do you want to be when you get these numbers? So when you talk about interpreting results, you look at LDL and other risk factors, low HDL (less than 40 for men and less than 50 for women) and age.”
Once a patient and physician have assessed all these factors, they may decide that lifestyle modification is adequate or a lipid-lowering statin may be prescribed. “The most common lifestyle interventions today include carbohydrate restriction and daily exercise,” Havlin says. “I always caution my patients to avoid becoming overwhelmed with new diets, pills, drinks, etc. Instead eat like our ancestors did: Close to the earth, foods as whole as possible, with few additives, chemicals or preservatives. Select lean sources of protein that are the product of consciously raised animals.” And, Havlin stresses, exercise regularly.
If you are older than 20, check with your primary-care physician about cholesterol screening. “Everyone should know their cardiovascular risk,” Havlin notes. “This is a progressive disease. With early intervention, lives can be saved.”