Cholesterol Archive

Ask the doctor

Q. After a year of taking a statin, my LDL cholesterol measurement is 50 mg/dL, which seems awfully low. Is there any downside to a very low LDL?

A. Based on what we currently know, a low-density lipoprotein (LDL) level of 50 mg/dL appears to be reasonably safe, especially when attained naturally. Studies of people who've already had a heart attack suggest that lowering LDL to about 50 mg/dL provides further protection against recurrent cardiovascular events versus reaching a level of around 70 mg/dL. In studies lasting up to seven years or so, these lower LDL levels appeared to be well tolerated.

But if you are healthy, deciding if these commonly prescribed drugs are right for you is a personal choice.

A study in JAMA Internal Medicine may help to explain the controversial connection between cholesterol-lowering medications and memory loss. Researchers scrutinized health records of more than 11 million people who saw their primary care doctors from 1987 to 2013. They compared reports of memory problems by three groups of people:

• 483,000 who were prescribed a statin to lower their cholesterol

• 26,000 who were given another type of cholesterol-lowering drug (not a statin) to lower cholesterol, such as a fibrate or niacin

• 483,000 who didn't take any cholesterol drug.

People who took any kind of cholesterol drug—a statin or some other type—were nearly four times more likely to report memory loss right after starting on the drug, compared with people who didn't take any kind of cholesterol drug.

A novel class of drugs has the potential to pick up the slack where other cholesterol medications leave off.

The latest guidelines used to determine who should take a cholesterol-lowering statin to prevent heart disease appear to be more accurate and cost-efficient than the previous guidelines. That’s according to two studies led by Harvard researchers, both published in this week’s Journal of the American Medical Association. The new guidelines, published in 2013 by the American College of Cardiology and the American Heart Association, recommend a statin for men and women between the ages of 40 and 75 who have a 7.5% or higher risk of having a heart attack or stroke over the next 10 years. The JAMA studies show that the new guidelines provide a more accurate assessment of who would benefit from a statin and who wouldn’t, and are more cost-effective than the older guidelines. Statins aren’t a cure-all. Eating a healthier diet, exercising often, and not smoking will go a long way to preventing heart attack and stroke.

High levels of these fatty particles in the blood means you may need to step up healthy lifestyle changes.

High cholesterol is a key culprit in the development of cardiovascular disease, the leading cause of death in the United States and many other developed countries. We know that lowering cholesterol helps prevent heart attacks and strokes. But an unanswered question remains: how low should you go? New research published online today in The New England Journal of Medicine suggests that lower is better. In a large clinical trial, participants who took a cholesterol-lowering statin plus ezetimibe, a different type of cholesterol-lowering drug, had lower levels of harmful LDL cholesterol and experienced fewer heart attacks and strokes than participants taking a statin alone. The new findings provide a strong rationale for using ezetimibe when a statin alone isn’t enough.

Q. I just got diagnosed with diabetes and my doctor said I am at risk for heart disease. Why?

A. Diabetes is considered to be an extremely strong risk factor for heart disease. One reason is that people with diabetes are also more likely to have other conditions that raise their odds of heart disease, such as obesity, high blood pressure, or elevated LDL cholesterol. Also, those factors seem to have more of a detrimental effect on people who have diabetes compared with those who don't.

Experts still advise getting regular blood lipid tests.

In late 2013, when the new national guidelines on managing cholesterol were released, many people wondered how the change would affect blood cholesterol testing. Also known as a lipid profile or lipid panel, the cholesterol test measures several different types of fats (lipids) in your bloodstream.

Adding an avocado a day to a healthy diet may lower harmful LDL cholesterol levels, according to a study in the Journal of the American Heart Association. Forty-five overweight or obese volunteers followed three different cholesterol-lowering diets, each for five weeks. One diet had 24% of calories from fat; the other two were 34% fat, one of which included an avocado per day. While participants were on the avocado diet, their LDL levels dropped an average of 13.5 points—nearly twice as much as when they were on the other two diets.

Hass avocados (the type used in the study) have bumpy, greenish-black skin. The creamy flesh is rich in monounsaturated fats, which help lower LDL cholesterol when swapped for saturated fat. But other compounds in avocados, such as fiber and plant sterols, may also contribute to their healthful benefits, say the authors. Avocados can be sliced into salads, spread on sandwiches, or mashed to make guacamole. Just be sure to go easy on the high-calorie, salty corn chips often served with the latter.