Cholesterol Is Key to Understanding Heart Attack Risk

By Magdy Danial, M.D.

More and more of my patients are taking an active role in their health care, and I think that’s a very encouraging sign. I get a lot of questions about cholesterol: How important is it? How often should I be tested? What do all the numbers mean?

When patients take an active interest in their health care, it’s always a good sign, and I try to encourage that interest and knowledge by educating them about the importance of certain key indicators of health.

One of the most important indicators of health is cholesterol—a soft, waxy substance found in the bloodstream. Cholesterol is actually a vital component and used by our bodies to support many important functions.

What I explain to my patients is that there is both good and bad cholesterol. Too much of the bad or too little of the good can lead to serious health problems such as the build up of fatty deposits —or plaque—in the arteries, a process that can lead to atherosclerosis, heart attack and stroke.


Cholesterol and Heart Disease Risk
While there are several different numbers that one can look at when measuring cholesterol and determining the risk it poses, I like to start most patients with the Total Cholesterol test. Patients like the test because it is a simple test that can be done without fasting. I like the Total Cholesterol test because it basically gives me a clue as to where the patient is overall, and then I can start looking at more detailed cholesterol profiles if needed.

Total Cholesterol is very important to know because of the direct correlation between high cholesterol levels and atherosclerosis. Too much cholesterol overall in the blood is a major risk factor for coronary heart disease (which leads to heart attacks) and for stroke, the number one and number three killers in the U.S., accounting for more than 800,000 deaths each year.

Diagnosing and Treating
A patient’s Total Cholesterol score should be less than 200. If it is higher than 200, then I usually test for more detailed cholesterol levels that include low density lipoproteins (LDL or bad cholesterol), high density lipoproteins (HDL or good cholesterol) and triglycerides (another type fat in the bloodstream). Results of these additional tests can help me explain a patient’s overall situation and in determining how to treat the high cholesterol levels. Most doctors will then take into account other risk factors such as age, family history, smoking and high blood pressure to determine overall risk of heart attack and stroke.

When it comes to dealing with high cholesterol, my goal is to lower cholesterol levels enough to reduce the risk of developing heart disease or having a heart attack or stroke. Together with your doctor, you’ll determine the best course of action, but typical measures to help lower bad cholesterol levels may include sticking to a diet low in saturated fat and cholesterol, and high in soluble fiber. Losing weight if you are overweight can also help lower LDL, and regular physical activity can help lower LDL as well as raise HDL.

Prevention
Current guidelines recommend that men and women 20 years and older undergo cholesterol screening every five years, so I always encourage my patients to get tested and to start as early as possible. If Total Cholesterol is high, blood samples should be obtained after fasting and tested for Total Cholesterol, LDL cholesterol, HDL cholesterol and triglycerides.

I am encouraged by the increasing number of patients I see who want to take a proactive role in their own health. However, if there were one thing I could change about how people approach their health, I think it would be how they eat. The process of atherosclerosis starts very early in life, and the effect of bad habits such as too much junk food and lack of exercise can start to show up at a very young age. I always start out with this simple advice when talking to my patients: check food and product labels, eat a balanced diet, eat less fat, more fiber and get plenty of exercise—and start early.

Many patients I see today are quite adept at gathering information from the Internet, and I often direct them to reputable Web sites such as the Centers for Disease Control at www.cdc.gov, eMedicine at www.emedicine.com, and the American Heart Association at www.americanheart.org. And one of the easiest answers I can give when it comes to questions about risk of heart attack and stroke is: take a simple but important test called Total Cholesterol.