Cholesterol Archive

The overall message on "bad" LDL cholesterol is much the same as it has been: Lower is better and how low your level should be depends on your cardiovascular risk factors.

But the standard for what low LDL means keeps on getting lower. While  an LDL level under 70 is still the usual goal for people at the highest risk for cardiovascular disease perhaps that is still too high.

Cholesterol-lowering statins seem to have long-lasting benefits against heart disease, according to a 20-year follow-up of a landmark Scottish study.

In the original study, published in 1995, more than 6,500 middle-aged men with high levels of harmful LDL cholesterol took either 40 milligrams of pravastatin (Pravachol) or a placebo daily for an average of nearly five years. For the follow-up, published in the March 15 Circulation, researchers used electronic medical records to analyze health-related events among the same men over the following two decades. They also tracked the men's use of statins after the original study ended. After five years, more than a third of the men in both groups were taking statins, but no further data on statin use was available after that.

Q. I know I need to keep my LDL (bad) cholesterol low and my HDL (good) cholesterol high, but can HDL ever be too high?

A. For high-density lipoprotein (HDL) levels, it does appear that the higher, the better—at least to a point. But you should also think about how you achieve that level. HDL is known as the "good" cholesterol particle because it functions to clear cholesterol from the arteries and deliver it back to the liver. Higher HDL levels are associated with a lower risk of heart disease. HDL levels lower than 40 milligrams per deciliter (mg/dL) are considered worrisome, and levels higher than 60 mg/dL are considered excellent.

Although uncommon, this genetic condition is responsible for most heart attacks that occur at a young age.

Very high LDL cholesterol levels usually result from dozens of genetic mutations that each raise LDL by a little bit.
Image: jarun011/Thinkstock

About one in 250 people has a genetic mutation that causes dangerously high cholesterol levels. Known as familial hypercholesterolemia, or FH, this condition can raise levels of harmful LDL cholesterol as high as 350 milligrams per deciliter (mg/dL)—more than three times higher than the desirable level of less than 100 mg/dL.

The FDA has withdrawn its approval for two older cholesterol-lowering medications, niacin and fenofibrate, for use in combination with a statin. Several large clinical trials found no heart-related benefits from the drugs. 

Statins can lower heart disease risk dramatically, but certain cautions apply.

Nearly a quarter of all adults over age 40 take medication to treat high cholesterol, and most often, it’s a statin drug. However, with such widespread use, especially among people who may have other cardiovascular risk factors, an un-wanted interaction between a statin and another medication can occur. For this reason, the American Heart Association recently issued a statement to help doctors better navigate medication choices for their patients.

What is a drug interaction?

The term “drug interaction” is somewhat misleading. Typically, drugs do not chemically react with each other in the body. Instead, a drug, supplement, or food may affect how long a medication stays in the body, often by stimulating or inhibiting the production of specific enzymes in the liver or intestine (see “The truth about grapefruit juice”).

Research we're watching

Whether you carry extra fat in your belly (an apple shape) or your thighs (a pear shape), slimming down can help your heart, according to a new study.

Previous research found that while belly fat was clearly linked to a higher risk of heart problems, in comparison, fat in the thighs and backside seemed to be associated with less heart disease risk. But an analysis of seven weight-loss studies including a total of 399 people (mostly women) challenges that latter claim.

News briefs

 Image: © jenifoto/Getty Images

Avoiding animal products and eating a plant-based diet is a great way to keep type 2 diabetes under control, according to a study published Oct. 30, 2018, in BMJ Open Diabetes Research & Care. Researchers reviewed 11 studies (most of them randomized controlled trials, the gold standard in research) that included more than 400 mostly middle-aged people with type 2 diabetes. The average length of each study was about six months. People who followed a plant-based diet experienced significant improvements in blood sugar control, emotional health, quality of life, weight loss, and cholesterol levels, compared with people who did not follow plant-based diets. Some people who ate a plant-based diet were even able to reduce or eliminate their medications for diabetes control and high blood pressure. If you'd like to try the diet at home, focus on lots of vegetables, legumes (a must for protein and fiber), fruits, seeds, whole grains, and nuts. But don't stop taking any medications without talking to your doctor first.