In our Ask a Doc series, we sit down with physicians and other clinical experts across our networks, including at Allegheny Health Network (AHN), for a chat on an important health topic. In this post, Dr. George Gabriel talks with us about cholesterol and heart health.
Hyperlipidemia: It’s a big word… and a big problem. “Hyperlipidemia” means “high cholesterol levels in your bloodstream” or simply “high cholesterol.” About two in five people around the world have high cholesterol levels.
Having high cholesterol can increase your risk of cardiovascular disease the number one cause of death in the world. That’s why it’s important to know if you have high cholesterol, and if you do, to manage your cholesterol levels.
I talked with Dr. George Gabriel, director of clinical cardiology at Allegheny Health Network’s Allegheny General Hospital to learn more about high cholesterol, how it affects your health, and how it’s treated.
Cholesterol is a waxy, fat-like substance that your liver makes, and is also present in foods we eat. Cholesterol is part of every cell in your body, so you need cholesterol.
There are two kinds of cholesterol: HDL (high density lipoprotein) cholesterol, or so-called “good” cholesterol, and LDL (low density lipoprotein) cholesterol, or “bad” cholesterol. LDL cholesterol can build up on the walls of your arteries. HDL cholesterol takes the LDL cholesterol out of your body.
When too much LDL cholesterol builds up in your arteries, it can cause blockages, which can lead to heart attacks and strokes, as well as the need for bypass surgery, stents, and angioplasties to clear those blockages.
Anyone can have high cholesterol. High cholesterol levels can be caused by or associated with:
High cholesterol usually has no obvious signs or symptoms. The best way to know that you have high cholesterol is to have your doctor do a blood test for cholesterol called a lipid panel. This test measures your total cholesterol, HDL cholesterol, LDL cholesterol and triglyceride levels.
High levels of total and LDL cholesterol and low levels of HDL cholesterol are risk factors for cardiovascular disease. However, simply having certain cholesterol numbers is in and of itself only part of your overall risk.
“While there are guidelines for what ‘high cholesterol’ is, everyone’s situation is different. What may be the right cholesterol level for anyone else might not be the right level for you,” says Dr. Gabriel. That’s because while your cholesterol levels do play a significant part in your overall risk, they’re only one part of the picture.
“A study known as the Framingham Heart Study determined what risk factors lead to cardiovascular disease, as well as how best to manage those risk factors,” he adds. “We look at your family history, your other health numbers, such as blood pressure and blood sugar, any other health conditions you may have, like diabetes, and what your lifestyle is like when it comes to diet, physical activity, and tobacco and alcohol use. There’s no ‘one size fits all’ approach.”
According to Dr. Gabriel, it’s important to pay attention to the variables we can control when it comes to high cholesterol. “Keep in mind that although genetics and family history play a big part in your cholesterol levels and heart health as a whole, your diet, exercise, and other health habits also play a part,” he explains. “Think of it like driving your car: Your genes turn the ignition key, but your lifestyle steps on the gas pedal and shifts the gears. So your lifestyle can make a difference for both better and worse.”
Dr. Gabriel explains that “the first line of attack in treating high cholesterol focuses on your lifestyle. We look at your diet and your physical activity levels and help you come up with a plan to eat healthier and get more physical activity. We can also help you quit tobacco and lose weight.”
If lifestyle changes fail to make any significant improvement in your cholesterol levels, your doctor may prescribe medications. Among the most commonly used of these medications are statins. These medications block the enzymes in your liver that are responsible for producing cholesterol.
Statins are extremely effective in lowering cholesterol. But is just taking a statin enough? “Absolutely not,” says Dr. Gabriel. “Statins are most successful when combined with lifestyle changes they don’t make up for an unhealthy lifestyle.”
Many people are reluctant to take statins because they’re worried about side effects. Dr. Gabriel points out that, “although most people don’t have any serious side effects when taking statins, there are some side effects, such as liver, kidney, and muscle problems, to watch out for. That’s why you need to tell your doctor right away if you experience any muscle pain, weakness, or any other side effects, and follow your doctor’s recommendations for any recommended tests to check for any problems, as well as to see how well your treatment plan is working.”
You may also have read about “alternative treatments” for high cholesterol. Here, Dr. Gabriel suggests caution. “As far as alternative treatments are concerned, while it’s always a good idea to eat as few processed foods and get as many nutrients as possible in your diet no matter what your health is like, there isn’t really any scientific evidence that certain supplements, for example, have any significant effects on lowering LDL cholesterol levels.”
One alternative treatment that has received a lot of attention is a traditional Chinese remedy called red yeast rice. “On the one hand, red yeast rice naturally contains some ingredients found in statins, and studies have shown that it can lower LDL cholesterol levels,” Dr. Gabriel says. “But on the other hand, these studies haven’t been done on a large scale, so we don’t have clinical outcomes to show that there are, for example, less heart attacks if you take these supplements. Plus, red yeast rice supplements aren’t FDA-regulated, so what’s out there may not work or may contain harmful ingredients.”
One of the most recent advances in treating high cholesterol is a new class of medications known as PCSK9 inhibitors. By blocking the PCSK9 protein, they improve the effectiveness and longevity of the receptors that your liver produces to clear out excess LDL cholesterol.
“We use PCSK9 inhibitors when your LDL cholesterol is very high, you have a lot of other risk factors for heart disease, and you require more therapy beyond statins,” says Dr. Gabriel. “We also may use them if you’re unable to take statins due to side effects or other reasons. Like any other medication, they too have side effects, and they need to be part of an overall cholesterol management program.”
Looking ahead, doctors and scientists are taking a closer look at the role of genetics in cholesterol levels, and which genetic factors can increase or decrease your cholesterol levels and risk of cardiovascular disease.
“A well-known genetic study was done in a small village called Limone sul Garda outside of Milan, Italy in which several citizens of that village carried a genetic mutation called ApoA-1 that gave them high levels of HDL cholesterol and low levels of LDL cholesterol,” Dr. Gabriel explains. “That study led to research on how to replicate the effect of that mutation, along with gene therapy, as possible treatments. Although current efforts along these lines have failed, they show promise for future treatments.”