Saturday, December 16, 2017 7:24

Are You At Risk Of Heart Disease If Your Cholesterol Level Is Normal?

Posted by on Monday, December 7, 2009, 15:10
This news item was posted in Cholesterol category and has 0 Comments so far.

You may have had your level of blood cholesterol measured as less than 200 mg/dl, the top of the range deemed desirable by the Adult Treatment Panel of the National Institutes of Health.

If so, your risk of coronary heart disease will depend on the presence of other factors, including certain inherited blood lipid problems. Or you may be the one person in five with known coronary heart

disease who has a cholesterol level less than 200 mg/dl. If so, this  will help you understand why you developed coronary heart disease despite a desirable blood cholesterol level.

What is your family history? If your blood cholesterol level is less than 200 mg/dl but you have a positive family history of premature (less than age ~) coronary heart disease, you should obtain a complete

lipid profile. That is, following an overnight fast, you should have a blood test that measures your levels of total cholesterol, triglyceride, and HDL cholesterol.

If your triglyceride level is high (250—500 mg/dl) or very high (over 500 mg/dl), you have probably inherited one of the blood triglyceride problems. It is the combination of a positive family history of

premature coronary heart disease and a blood triglyceride problem that places you in this category.

If your HDL cholesterol level is less than ~ mg/dl, it is too low. A low HDL level combined with a positive family history of premature coronary heart disease may indicate that you carry a gene for hypoHDL, a condition discussed below. When the HDL cholesterol is too low, bad things can happen even when the blood cholesterol is less than 200 mg/dl. For example, take the case of a patient, who developed coronary heart disease requiring coronary artery bypass surgery at age 33 despite having a desirable cholesterol level. He smoked two packs of cigarettes a day right up to his bypass operation; his blood pressure was normal.

Nine years later, a repeat heart catherization showed that one of the bypass grafts was completely blocked, and that the blockages in the native coronary arteries had become narrowed further. When I saw him, his blood cholesterol level was 148 mg/dl, his LDL cholesterol 89 mgI dl, and his triglyceride i 8o mg/dl; but his HDL cholesterol was low at 31 mg/dl. After one year of a good low-fat diet, his triglyceride had increased to 234 mg/dl and his HDL cholesterol remained very low at 32 mgI dl.

I couldn’t use nicotinic acid because he was being treated with a medicine to decrease the high acid content of his stomach. I prescribed Lopid to try to lower his triglyceride level and increase his HDL. Before I could check him again, he developed more heart trouble and had to have a second triple-vessel coronary artery bypass, at the age of 45.

When I saw him again, Lopid had lowered his triglyceride to 109, but his HDL remained at 3’ mg/dl, and his LDL/HDL ratio was above 4.0, indicating that he was still in the higher-risk category for coronary heart disease. I knew I had to do something, particularly in view of the second bypass operation. I stopped Lopid and started Mevacor, one pill with dinner, to see if I could lower his LDL cholesterol and improve his LDL/HDL ratio.

This is precisely what happened. On Mevacor, his LDL cholesterol decreased from 132 to 70 mgldl, and his ratio of LDL/HDL fell to 2.0. A repeat coronary angiogram showed that his new bypass grafts were completely open. Further, even if your blood cholesterol level is less than 200 mgldl you are at increased risk of coronary heart disease if you have high blood pressure, smoke cigarettes, are considerably overweight, or have diabetes.

If you have even one of these other risk factors for coronary heart disease, you should have your levels of cholesterol, triglyceride, and HDL cholesterol determined.

What is your lifestyle?Do you eat whatever you want? Is your diet high in calories, total fat, saturated fat, and cholesterol? Do you exercise rarely or never? Are you ten to twenty pounds overweight?

You are certainly not alone, but with such a lifestyle a blood cholesterol level of less than 200 mg/dl is not particularly reassuring. An assessment by your doctor of your levels of triglyceride, HDL cholesterol, and LDL cholesterol will provide further information, and may suggest modifications that will improve your health.


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