What is cholesterol and how does it contribute to one’s overall health? It may seem like a simple question and answer but it is not. In fact, what we know about cholesterol is ever evolving (much like medicine in general). We are always learning, and that’s okay! Throughout this article I will reference the ACC/AHA cholesterol management guidelines published at the end of 2018. What we do know is “cholesterol and it’s lipoprotein carriers are related to atherosclerotic cardiovascular disease (ASCVD)”.

We go to the doctor, they check our cholesterol (lipid panel) through blood work. Lipid panels have been around for a while. A basic panel is typically covered by insurance. And what does it include?

1. LDL- low density lipoprotein and what many of us know as “bad” cholesterol
2. HDL- high density lipoprotein and what many of us know as “good” cholesterol
3. Triglycerides
4. Total cholesterol- a simple calculation of LDL + HDL +1/5 triglycerides

Perhaps your primary care provider (PCP) says your LDL is >100 or total cholesterol >200 so let’s start a medication. Pause, there are so many factors to consider here! I am not saying your PCP is “wrong”, but this can be an educated discussion with your provider.

There are other important lipoproteins to consider such as VLDL (very low density lipoprotein), apolipoprotein B (ApoB) and lipoprotein (a) (Lp(a)). One might consider an advanced lipid profile (often referred to as “cardiac IQ”) if they have a family history of early heart disease, elevated LDL and/or triglycerides, or if you are curious. Please note these tests are not covered by insurance and you will likely have to pay out of pocket.

How can we decrease our cholesterol?

In some cases, hypercholesterolemia (high cholesterol) is genetic, so pharmacologic therapy may be indicated. In other cases, lifestyle modifications may be enough. This is patient specific and should be discussed with your primary care physician and pertinent specialists. There are two main categories when considering treatment of hypercholesterolemia, which I will touch on below.

A. Secondary Prevention (those with a history of ASVCD, i.e. stroke, heart attack, angina, TIA, etc)- Medication is a MUST here.

B. Primary Prevention (no history of ASVCD)

1. Lifestyle Modifications

Decrease adipose tissue (aka fat). How do we do that? Through diet and exercise. Often times, hearing the word “diet” we think of restricting intake, decreasing fats and carbohydrates, etc. But I simply mean what you ingest. Humans are meant to have a variety of fruits, vegetables, proteins, carbohydrates, AND fats. What kind of fat consumed is important. Steer clear of saturated or trans fats. Try this: At each meal incorporate protein, carbs, and veggies. Consider adding a low-fat dairy product, like cheese. And for dessert, a fruit or yogurt with fruit. For snacks, reach for nuts, veggies, fruits, and veer from those packaged, processed products. Always be sure to review your labels. Many yogurts have unnecessary added sugars.

Remember food and movement are medicine.

2. Drug Therapy

Perhaps you fall into a category where medication is indicated. Not to fear, there are many effective and well tolerated options out there. I am a clinical pharmacist, so I have a lot to say on this section in my next post!

See you then.

Lindsey, PharmD, BCPS