Cholesterol Medications Boston MA

Taking Cholesterol to Heart

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By Dennis A. Goodman, MD, FACC

The last time Bonnie went for her annual check-up her doctor warned her to watch her cholesterol. At 240, it hovered well above the normal 200-or-lower range, making her a likely candidate for a heart attack. Instead of filling the prescription he handed her for a cholesterol-lowering statin drug, however, Bonnie sought a second opinion and a more comprehensive blood test. The results showed she did indeed have high cholesterol, but she also had high “good” cholesterol. While her “bad” and total cholesterol levels needed to come down, this new doctor felt Bonnie could lower them with diet and lifestyle changes and supplements. So she consulted a nutritionist who suggested a diet rich in fruits and vegetables, encouraged her to give up red meat, and recommended a manageable exercise program. Her new doctor started her on a vitamin and mineral regimen that included antioxidants and vitamin B complex and plant sterols. Within three months Bonnie’s blood cholesterol levels began to drop and within six, her total cholesterol registered within the normal range, while the “good” kind remained high, and the “bad” cholesterol had decreased.

Everyone knows high cholesterol increases our risk for heart attacks and strokes and that we need to lower it to keep our hearts and blood vessels healthy. What does that mean—Bonnie has “good” and “bad” cholesterol?

Just asking those questions points to the obvious fact that cholesterol plays a complex role in heart health. For starters, it’s a “must-have” substance for survival. Every cell of the body needs this soft, waxy, fat-like substance to help digest fats, strengthen cell membranes, insulate nerves, and make hormones. The liver produces most of it, but the cells lining the small intestine make some too, as do individual cells in the body. While the body creates all it needs—about 1,000 mg a day—we get more from the foods we eat. All foods from animal sources contain cholesterol, with egg yolks and organ meats (like liver and kidney) having the most. Plant-derived foods, on the other hand, never contain cholesterol, even if they are high in fat like avocados and peanut butter.

Like other fats in the body, cholesterol doesn’t dissolve in the blood and so it can’t reach the cells without the help of special carriers called lipoproteins to transport it—primarily low-density lipoproteins (LDL) and high-density lipoproteins (HDL). Although LDL has earned the nickname “bad” cholesterol and HDL has become known as the “good” cholesterol, each one has an important role to play in good heart health. LDL carries cholesterol through the body and deposits it in the cells. HDL transports any cholesterol the cells don’t use to the liver, which eventually processes and eliminates it. This lipoprotein relationship works well as long as the body doesn’t have an overabundance of cholesterol and as long as the ratio between LDL and HDL stays within certain parameters.

When the body does...

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