Cholesterol Archive

Q. I'm 80, and I exercise or bike for an hour and a half almost every day and eat a healthy diet. I recently had a blood lipid assessment, and my HDL was 70 and my LDL was 42. But my internist wrote me saying that my LDL was too low and that I should cut my dose of atorvastatin from 40 mg to 20 mg a day. I also take 2,000 mg of niacin daily. Is there general agreement that one's LDL should not go below a certain point? Is mine too low?

A. First, let me say that you are doing great. Most people even half your age aren't as physically active, and your cholesterol levels are impressive. An HDL level of 70 milligrams per deciliter (mg/dL) is above the 60 mg/dL threshold where the "good" cholesterol seems to afford some protection against heart disease and stroke. Your LDL of 42 mg/dL is comfortably in the optimal range for "bad" cholesterol, which is 100 mg/dL or less.

Raising HDL with niacin takes a back seat to lowering LDL with statins.

Doctors often encourage people with heart disease or at risk for it to attain high-density lipoprotein (HDL) cholesterol levels above 40 milligrams per deciliter (mg/dL). Levels lower than that, the thinking goes, diminish this "good" cholesterol's power to protect the heart and arteries. But the importance of raising HDL may be declining, especially for people with rock-bottom levels of low-density lipoprotein (LDL) cholesterol.

Q. Can eggs be part of a balanced, heart-healthy diet?

A. Eggs are handy, inexpensive sources of protein. They also contain healthful fats, folic acid, and essential vitamins.

Wire-mesh stents were invented to prop open heart arteries that balloon angioplasty had just cleared of cholesterol-laden plaque. Coating them with drugs helped fix an early problem: cells from the artery wall surrounding the stent sometimes grew over and around the stent and clogged the space through which blood flows.

But without a protective coating of artery-wall cells, a stent is an attractive surface for blood-clot formation. If such a clot is large enough, it can trigger a heart attack. This is called stent thrombosis.

Diet, exercise, and drugs can lower the bad and raise the good.

Cholesterol comes in two basic forms. Low-density lipoprotein (LDL), or "bad" cholesterol, contributes to clogged arteries. High-density lipoprotein (HDL), or "good" cholesterol, keeps the bad stuff from accumulating. So your LDL number should be low and your HDL number should be high.

Q. After a heart attack six years ago, I went on Lipitor (atorvastatin) because my doctor said it was proven to reduce the risk of a second heart attack in high-risk people like me. Three years ago, I switched to a generic (simvastatin) to save money. Now that Lipitor is going generic, should I switch back? And can I be assured that the generic version will be as effective as brand-name Lipitor at preventing a second heart attack?

A. The statins are a great class of drugs, and I don't think there is any reason to switch from one statin to another as long as you are reaching your LDL cholesterol goal and are not having side effects.

Q. I come from a long line of family members with heart disease. Right now, my HDL is 62 mg/dL [milligrams per deciliter], and my LDL is 115 mg/dL. My doctor isn't worried about my LDL, but shouldn't I shoot for an LDL level under 100 mg/dL?

A. First, your HDL is terrific, and is probably the envy of many of your friends (if you sit around comparing lipid profiles). Based on these numbers, you don't have a high-risk lipid profile. Assuming that you don't currently have a personal history suggestive of coronary artery disease — like having angina (chest pain with exercise or stress) or having had a heart attack — an LDL-lowering medication such as a statin is not something I'd suggest if you were my patient. I don't think the potential for side effects and the cost of the medication are worth whatever small gain you might achieve from driving your LDL lower.

The hidden burden of high blood pressure

Cordero A, Bertomeu-Gonzalez V, Moreno-Arribas J, Agudo P, Lopez-Palop R, Masia MD, Miralles B, Mateo I, Quiles J, Bertomeu-Martinez V. Burden of systemic hypertension in patients admitted to cardiology hospitalization units. American Journal of Cardiology, published online Aug. 24, 2011.

Can a hospital stay make you anemic?

Salisbury AC, Amin AP, Reid KJ, Wang TY, Masoudi FA, Chan PS, Alexander KP, Bach RG, Spertus JA, Kosiborod M. Hospital-acquired anemia and in-hospital mortality in patients with acute myocardial infarction. American Heart Journal 2011; 162:300-309 e3.

It's high time to retire the low-fat diet as the default approach for lowering cholesterol. Better options? A Mediterranean-type diet or one that includes a "portfolio" of cholesterol-lowering foods. Both convincingly beat low-fat diets in head-to-head trials. Both also focus on foods and what you should eat rather than on nutrients you need to avoid.

In six trials that included 2,650 overweight men and women, those assigned to a Mediterranean-type diet lost more weight and had bigger improvements in cholesterol, blood pressure, blood sugar, and markers of inflammation like C-reactive protein (American Journal of Medicine, September 2011). A report from the developers of the so-called portfolio diet showed that it lowered harmful LDL cholesterol by 13%, compared with just 3% for a low-fat diet (Journal of the American Medical Association, Aug. 24–31, 2011).

Many of the studies described in the Harvard Heart Letter last only a few years. That's why one covering four decades caught our attention.

Finnish researchers who followed more than 3,000 men for almost 40 years found that those with the lowest total cholesterol levels (154 mg/dL or less), measured when they were 30 to 45 years old, lived on average more than five years longer than men with the highest midlife cholesterol levels (greater than 347 mg/dL). Those with lower midlife cholesterol levels also functioned better physically in old age than their high-cholesterol counterparts (American Journal of Cardiology, Sept. 1, 2011).