(February 19, 2009 - Insidermedicine) In this video, Dr. Lori Mosca, MD, MPh, PhD, author of "Heart to Heart: A Personal Plan for Creating a Heart-Healthy Family," discusses what she would do if she was noted to have abnormal cholesterol on a routine blood test. Dr. Mosca is Professor of Medicine and the Director of Preventive Cardiology at NewYork-Presbyterian Hospital/Columbia University Medical Center, and also the Director of the Columbia Center for Heart Disease Prevention.
At the American Heart Association's Scientific Sessions in New Orleans, we caught up with Dr. Lori Mosca, who is a Professor of Medicine and Director of Cardiology at New York's Presbyterian Hospital Columbia University Medical Center. Dr. Mosca is also the Director of the Columbia Center For Heart Disease Prevention and author of "Heart To Heart: A Personal Plan for Creating a Heart Healthy Family"
What is cholesterol?
Dr. Mosca: Cholesterol is important; it’s actually in every cell in our body. Its a waxy fat like substance that is important for the function of cells but unfortunately when our cholesterol levels become too high then we can develop a serious condition called coronary heart disease. There are different types of cholesterol, the good cholesterol, called HDL Cholesterol; the way you can remember that is that "H" is for "healthy", we want it higher. And the bad cholesterol LDL cholesterol, "L" is for lousy we want it lower.
The bad cholesterol builds up in the arteries in our body, which can cause blockages and a heart attack. The good cholesterol, HDL cholesterol, actually takes cholesterol away from the arteries so that the body can eliminate it. It’s well established that cholesterol is one of the most important risk factors that we have for heart disease. And also a low level of the good cholesterol is an important risk factor for heart disease.
If I were concerned about my cholesterol, what can I expect when going to my doctor?
Dr. Mosca: It is very important that if we are concerned about our cholesterol levels that we go visit our doctor and bring our family history with us. It is very important that if there is a family history of heart disease or a family pattern of cholesterol abnormalities, these can help the doctor make a diagnosis as to what the problem is. There are both genetic factors and also environmental factors that can cause abnormalities in our cholesterol. Certain other conditions that we might have can predispose to cholesterol problems such as an abnormal thyroid. So it is very important that we see our doctor, get a good physical examination, history, and blood work to determine whether or not we need to take further action to reduce our cholesterol levels.
If you have a high level of blood cholesterol, total cholesterol, LDL cholesterol, low HDL cholesterol, or elevated triglycerides, your doctor might recommend for you, depending on your age and your other risk factors, having further diagnostic testing to be sure that you don't have an existing heart disease that you are unaware of. Your doctor might recommend a stress test or other types of technology that we have to determine whether or not there is already plaque build up in your body.
How is cholesterol treated?
Dr. Mosca: Almost certainly every doctor is going to recommend lifestyle as the primary approach to improving your cholesterol profile. Then depending on your particular age, your other risk factors, and your family history your doctor might also recommend medications. The lower we go with LDL cholesterol the better. We certainly recommend that all of our patients try to reduce their LDL cholesterol through diet, exercise, and stopping smoking. Those are the most important measures.
Among some individuals that are still at increased risk of heart disease you should talk to your doctor about whether or not medications will be helpful to you. In particular the statin therapy has been shown to be beneficial in some populations. HDL cholesterol is very powerful risk factor for heart disease. Especially among women and the elderly. When we see levels less than 40 in men and less than 50 in women, this is really a red flag that we need to do something about our HDL cholesterol.
Fortunately there is a lot we can do with lifestyle. Losing weight is one of the best ways that we can raise our HDL cholesterol level. When we have belly fat, fat deposited in our waistline, this tends to lower our HDL level. Also smoking lowers HDL so that by stopping smoking or even cutting back smoking this can help to raise the level as well. Certain things in our diet can be very helpful. Something called monounsaturated fatty acids, when we are eating more of those instead of saturated fats we can also increase our HDL levels. These are commonly found in certain olive oils, peanuts and certain other nuts are very high in monounsaturated fatty acids. It’s less common to put a patient on medications to raise HDL cholesterol because we don't really have as much research in this area. But occasionally in the high-risk patient this will be recommended.
If I had abnormal cholesterol on routine blood work...
Dr. Mosca: If I was noted to have abnormal cholesterol on routine blood work, I would be certain to discuss with my doctor my family history, my personal history, other conditions that could cause abnormalities in blood cholesterol levels. I would make certain that I discussed with my doctor what levels should I be aiming for and how best can I get there. What is the right exercise program for me what is the best diet for me? If I smoke how can I get help to stop. And then most importantly after I have tried all of those lifestyle maneuvers I would ask my doctor "should I take medications to control my blood cholesterol?" Because we know that blood cholesterol is one of the most powerful and common risk factors for heart disease. But blood cholesterol is also a preventable risk factor for heart disease.