Cholesterol by the Numbers

Every body has cholesterol; the waxy, fat-like substance is found in all of the body’s cells and is a building block in the making of hormones and digestive substances. The problem with cholesterol is that there can be too much of it, circulating through the blood stream and building up plaque in arteries. This process leads to hardening and narrowing of the coronary arteries and an increased risk of coronary artery disease and stroke.

To some extent, plaque build-up is a common consequence of the aging process. It need not be inevitable. With a balanced diet, a healthy lifestyle and medication, when indicated, most people can reduce their risk of arteriosclerosis, hardening of the arteries.

For the general population, guidelines recommend keeping LDL at the ideal level of under 100 mg/dl. Davide DeBellis, M.D., a practitioner in Premier’s Internal Medicine Division, prefers to take a cautious approach to cholesterol management. “Unless a patient presents with extremely high test numbers or confirmed cardiovascular disease, I do not believe the disease should be treated with a drug right away,” he says. “We know that plaque build-up takes decades to develop. I have found that a person who really wants to make the effort can, with some attention to diet and exercise, lower his LDL by 20 points.”

People with a family history of heart disease, a personal history of heart attack, stroke or transient ischemic attacks or other risk factors, such as smoking, hypertension or diabetes, are advised to strive for an LDL of 70 mg/dl. For most of these patients, statins, a class of drugs that lowers cholesterol levels, will be prescribed along with a lifestyle prescription.

Dr. DeBellis offers these recommendations for cholesterol control:

18-35: “If you have not had a baseline fasting lipid profile by age 25, you absolutely should,” Dr. DeBellis says.

36-50: “By this age, people have started to accumulate plaque in the arteries,” Dr. DeBellis says. An annual fasting lipid profile that can be compared to earlier tests helps determine the rate at which cholesterol is rising. “

51-75: “In addition to continued annual fasting lipid profiles, if you have not established a relationship with a primary care provider you should do so,” Dr. DeBellis says. I believe cholesterol management for women is as important as management in men; heart disease is also the #1 killer of women. Sometimes beginning drug based lipid therapy is more difficult in women of childbearing age. For them, diet and exercise is even more important than in men. Drug therapy should be reserved only for the most abnormal lipids with the most risk factors in women of childbearing age.

“Hardening of the arteries is extremely common throughout the American population,” Dr. DeBellis says. “But with regular screenings and careful management of their cholesterol we can help our patients reduce their risk of heart attack or stroke.”