Thursday, September 23, 2010

6.(8-9) Risk Factors and Secrets of Low Cholesterol

Physician's Notebooks 6 - - See Homepage
  This section contains risk factors and on cholesterol and fats. Scroll down for that.     
8. Risk Factor (RF) of Heart Disease, Update 13 December 2018
Knowing a Risk Factor for a disease, you can live healthily longer by avoiding or modifying it. Even if it is not modifiable, knowing you have it makes you vigilant to detect a disease you are at risk for. Having one RF gives motivation to avoid other. A study 50+ years shows the 6 big RF's for Myocardial Infarction Heart Attack:
Of them all,  Tobacco Smoking is worst for dying badly; its stopping  or never starting is easier than lowering cholesterol, BP or weight; and gives cash bonus of the money every smoker pays to buy an early, prolonged and unpleasant dying.
      High Blood Pressure is Chapter 10 in this Notebook.
Keep LDL cholesterol and BP normal for healthy longevity and see the next chapter 9.
Overweight according to book l'arnin' means Body Mass Index (BMI is body mass divided by the square of body height)25. It ups risk of high LDL cholesterol, high BP & Diabetes; and increases work of heart, speeding its normal wear and tear. Especially if one already has heart disease, having a high BMI with failing heart will bring death closer.
Diabetes is often preventable by avoiding high BMI. Its bad effect on heart and circulation is prevented by keeping blood glucose normal. See chapter 13.
Lack of exercise (Chapter 12), tense personality, high homocysteine blood test, vitamin or mineral deficiency, and metal ion toxicity make up lesser risk list. Recently the CRP blood test's increasing positive number adds to the list. 
In lowering Risk Factors (RF), your aim should be long, healthy life. Lowering RF will prolong your healthy life and give you more pleasure in living, not over a day, a week, a month but years and decades. Your lapsing from behavior that healthily modifies or avoids RF should immediately bring on the unhappy feeling you are speeding your premature death.
9. Cholesterol, the Lipid Profile and Your Life
The Cholesterol and lipid profile blood tests are reported in U.S.A. and Japan as milligram per deciliter (mg%) blood serum. In rest of world, it is milliMoles per Liter (mM/L). Those that follow are bare number and should be understood as mg%. (In brackets converted to mM/L) The Lipid Profile refers to total cholesterol (TC), and to LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C) and Triglyceride (TG). Best to have the blood test sample drawn at 9 to 10 AM after overnight fast with normal water intake, without exercise in morning.
   If the TC and LDL-C are healthy range and you are not gaining weight, one test a year is OK in my (Dr E. Stim) opinion, assuming no other Risk Factor or sign or symptom of Coronary Artery Disease (CAD).
   The high TC (most accurately high LDL cholesterol) is a major risk for CAD and also for brain stroke, Alzheimer's Disease and eye cataract.
   Three factors normally determine the TC: the Cholesterol made in liver from glucose, the cholesterol in your food, and that excreted into intestine and lost in toilet bowl.
   Blood glucose not used immediately to provide energy for exercise and metabolism is a source of Cholesterol; so losing weight if overweight, upping exercise and going low on sugars and starches will lower the TC. One might eat no cholesterol but if too many calories, you get high TC. However, food is an important source of cholesterol so avoid or reduce red meat, fat, egg-yellow which is high in cholesterol; and prefer fat-free, low-cholesterol, and polyunsaturated fatty acid (PUFA) in food. Favor high-fiber food because fiber will bond with Cholesterol in intestine and prevent its being absorbed through intestine wall into blood. Vegetable and fruit also have sitosterol, a natural cholesterol-lowering substance with similar chemical structure to cholesterol. Its molecule ‘fools’ the intestinal absorptive cell into accepting it as if it were a cholesterol molecule and then the sitosterol blocks the absorptive pore like an oversize golf ball stuck in normal size hole. So eat fruit and vegetable daily.
   Cholesterol is carried in blood in lipoprotein fractions, the most important of which are LDL (low-density lipoprotein) and HDL, each differing in lipoprotein carrier. The LDL is responsible for CAD risk while the HDL is opposite, the higher the HDL the lower the risk. The other lipid test, triglyceride (TG), gives another test in CAD risk. (Eating too many bananas ups the triglycerides) Best is to aim for an LDL 60 (1.6 mM/L) or lower. A high LDL calls for a Statin medication. If the LDL is very high after diet modification one should check secondary cause or genetic condition.
Total Cholesterol from 130 to 275 (3.3 to 7.1 mM/L) is usually lowered by diet and drug; but anything >275 (7.1 mM/L) suggests genetic cause. First, use healthy eating to lower your TC but if diet alone no good, a Statin should be added. In practice it is rarely possible to get TC below 100. As for HDL, Higher is better. Moderate alcohol intake raises HDL. (But in old age alcohol may promote cerebral atrophy) Even with good TC and LDL, strive to keep the HDL above 50 (1.3 mM/L). The highest HDL I have seen, 94, (2.5 mM/L) was in a person taking high dose Omega-3 Fish Oil tablets. I started taking a daily 1200 mg Fish Oil cap with 360 mg Omega-3 and on that dose noted a modest effect to elevate HDL to 60 (1.6 mM/L) and after stopping I noted a modest drop to 53 (1.4 mM/L). So it seems Omega-3 fish oil may be good if you need to up your HDL.
Beyond Genetics, the lipid profile is influenced by enzyme systems in the body due to different genes. It is another way of saying that 2 persons who eat the same, take the same medicines and take in the same calories may have different lipid numbers due to differences in inherited enzyme levels.

Reduce BMI to <25 (as low as you can get it to limit of 17), avoid cholesterol and saturated fat in food (no red meat or eggs, prefer poultry and favor sea food); drink only low-fat milk, avoid rich dessert and use cottonseed or other high PUFA vegetable oils. Read the food label for cholesterol and PUFA. 
Low-Cholesterol Statin Drug has advantage for healthy longevity. The older Statins: lovastatin, pravastatin or simvastatin, are effective and safe in wide range of dose. Muscle pain may be bothersome with the newer atorvastatin, fluvastatin or cerivastatin especially when any of the latter is combined with gemfibrozil. Liver toxicity is only with too high dose or previous liver damage or disease. Statins come as scored pill easy to cut in half.
   The argument in favor of taking a Statin every day for life, with even low TC, is the data showing there is no lower good-health limit for TC or LDL-C. The lower the TC or LDL-C, the lower is disease of heart, brain, kidney. Especially studies of genetic conditions that give very low TC <100 (<2.6 mM/L) and show extreme longevity.
  I take Pravastatin for several years now. I started 10 mg a day and recently I may take up to 3 tabs a day, or 30 mg depending on how much meat in my meals. I note no bad effects. The alternative lower-cholesterol meds - fibrates and high dose niacin are not as safe and effective at the Statins.
END NOTE: Lipid profile testing should start just after birth. Since blood sampling a child is a problem, advantage should be taken of the newborn hospitalization. Approx 5% of children have TC>200 (>5.2 mM/L) and are at risk for early CAD. They should take a daily Statin pediatric dose. Especially with children on a Statin it is important to monitor for side effect by checking liver and muscle enzyme levels at intervals.
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