By
Dr Sashi Acharya M.D.,Ph.D.
Shiva Hospital, Birganj Nepal
Heart is one of the vital organ of our body, once it starts damage it can detoriate even after regular medical check up, so patients should be very conscious about the protection of their heart. Professionals' warning about bad cholesterol is to be considered very honestly and sincerely.
Few words about cholesterol, lipoproteins : Cholesterol is a kind of fat which is present in our body. In blood it contains in the particles known as lipoproteins. The total cholesterol contains all the cholesterol found in various lipoproteins. Among them triglycerides, low density lipoproteins ( HDL) are of great clinical importance.
LDL is bad cholesterol, bad because it has tendency to damage heart, likewise HDL is good cholesterol, good because it protects heart. If we want to live longer, healthier and happier life we have to stay away with bad cholesterol. Even the highly educated people are found less conscious of their own heart problem and try to escape the grip of professionals' directives' keeping the blood vessels free from plaques made by cholesterol.
High blood cholesterol is one of the major risk factor of coronary heart disease (CHD). The higher your blood cholesterol level, the greater your risk for CHD. The desirable level for total cholesterol level is below 200 mg/dl, see Table 1.
Triglyceride: This is also a form of fat. High levels are thought to be linked with increased risk of CHD. Various triglyceride levels and category are given in table-2. Normal triglyceride levels are less than 150 mg/dl. Very high triglyceride levels are greater than 500 mg/dl
Total cholesterol level |
Less than 200 mg/dl | 200-239 mg/dl | 240 mg/dl & above | ||
Category |
Desirable | Borderline High | High |
Triglyceride level |
Less than 150 mg/dl | 150-199 mg/dl | 200 -499 mg/dl | 500 mg/dl | |
Category |
Desirable | Borderline High | High level | Very High level |
LDL cholesterol level |
Less than 100 mg/dl | 100-129 mg/dl | 130 -159 mg/dl | 160- 189 mg/dl | 190 mg/dl & above |
Category |
Optimal | Above Optimal | Borderline High | High level | Very High level |
| If you have | If you Are in category | your LDL Goal |
| Heart disease , Diabetes or risk score more than 20% | I Highest Risk | < 100 mg/ dl | 2 or more risk factors and risk score 10-20% or less than 20% | II Next Highest Risk | <130 mg/dl |
| O or 1 risk factor < 10% | III low to moderate risk | < 160 mg/dl |
The Lipoprotein :
Low Density Lipoprotein(LDL) :- is the main source of cholesterol and constitutes about 50-70% of total cholesterol and directly correlated with risk of Heart disease . In normal healthy people LDL level should be less than 130 mg/dL. National cholesterol Education programme ( NCEP) guidelines recommend to keep the level of LDL below 100 mg/dl, for the patients who have high risk for CHD or who has had heart attack . see table 3& 4 .
The higher the level of LDL, the higher the risk for CHD. If there is increased amount of LDL in the blood it combines with WBC of blood forming plaques in the arterial walls which helps to get narrowed the arterial walls reducing blood circulation and nutrition in the particular organ, the heart if in the case of coronary arteries ( arteries of heart ) and ultimately leads to CHD ( coronary Heart Disease )
High Density Lipoprotein (HDL) or Good Cholesterol :
HDL is the good cholesterol, good because it removes LDL from blood vessels thus protecting the blood vessels from narrowing and preventing plaque formation . So people with low HDL are at high risk for CHD. HDL cholesterol constitutes about 20- 30% of total cholesterol and thus inversely correlated with CHD.
Both LDL and HDL levels are useful in assessing, monitoring and treatment for patients with cardiovascular diseases . It is recommended to keep the value of HDL level 40 or above 40 mg/dl.
Equally important are the factors that affect the cholesterol level in our blood. Cholesterol level in the blood is determined partly by inheritance and partly by the following factors . :
· Diet
· Weight
· Physical Activity
· Age
· Gender
· Smoking
Diet :
Excessive intake of carbohydrates increases LDL level. Likewise saturated fats are harmful to our heart if taken more than recommended. American Heart Association suggests that total daily fat intake should be less than 30% of total calories . Saturated fats should be only 8- 10% and monosaturated or unsaturated fats should be above 15% of total calories . Saturated fats increase cholesterol levels. Food low in saturated fat such as poultry products ( chicken, ostrich ), fish oil reduce Triglyceride levels. So fish, chicken containing low fat, low cholesterol are better recommended . Liver,Organ meats , egg yolks and full fat dairy products are less recommended .
Soluble fibers in the Orange , pears and vegetables as sprouts, carrots ,dried peas , beans help to lower LDL level , to lower high triglyceride level and to increase low HDL levels . Highly recommended healthiest cooking oils such as canola , avocado , olive, safflower , sunflower oil and etc. They are free from transfatty acids which are detrimental to our health.
Weight : Avoiding overweight , and loosing weight we can reduce our LDL level , cholesterol and triglyceride level and increase our HDL level .
Physical Activity: Aerobic Exercises like jogging , bicycling have been shown to have good effects on increasing HDL level and reducing LDL levels . American College of Sports Medicine recommends regular physical exercise for at lease 30 minutes daily.
Age and Gender: In women after menopause tends to raise LDL level and increases risk for CHD.
As men and women get older their cholesterol levels rise.
Smoking: Dr. Richard N. Fogoros in one of his article writes that giving up tobacco will result in an increase in HDL levels and this is the only advantage that he can think of that smokers have over non smokers.
Alcohol: Little daily dose of alcohol can significantly increase HDL level, but even in this limit drink one can develop Heart problems . So, definitely we discourage our patients to take alcohol.
Treatment: Drug treatment is to be considered along with therapeutic life style changes (TLC). TLC includes TLC cholesterol lowering diet, physical exercise and weight management only drug treatment is not sufficient without TLC.
Weight reduction and physical exercise are highly recommended to the people with borderline or high triglyceride levels.Drug treatment is recommended for people with very high triglyceride levels. .
Our first goal is however to achieve adequate LDL levels see table 4 and then to treat high total cholesterol level and a low HDL level if indicated. Statin is the drug of choice to treat high LDL level.To treat low HDL level is still difficult . Nicotinic acid in very high dose is found to be useful in raising the HDL level .
The September month 2002 is declared as National cholesterol Education Month by National Heart, Lung and Blood Institute U.S.A. National cholesterol month 2002 continues the them " Know your cholesterol numbers know your risk" Here the update guidelines are given in clinical cholesterol management for healthcare professionals and at the sametime to educate the people about the value of cholesterol, to calculate their risk score for CHD and to protect themselves with CHD as far as possible . Guidelines recommended by National Heart, Lung and Blood Institute U.S.A. are worth noting for the important there steps as fallows::
Step I :
To know major risk factors such as smoking , Hypertension (BP>/ 140 /90 mmHg), Low HDL.( < 40 mg/dl), Family History of early Heart disease ( Heart disease in father or brother before age 55 ; heart disease in mother or sister before age 65 and age ( Men 45 years or older ; women 55 years or older )
Step II :
To find risk score , Risk score means the Chance of having heart attack in the next 10 year, given as a percentage . See table 4 .
Step III:
Knowing your risk factor, medical history and risk score you find in which category you belong. Risk score 10 %means 10, out of 100 people in this category will have a heart attack within 10 years.
As stated in September issue of journal of the American College of
Cardiology , Cardiovascular diseases is taking epidemic characters in India and showed that prevalence of CHD is directly co-related with increased level of total cholesterol, triglycerides and LDL.
We may, therefore, conclude that our goal is to achieve desirable LDL and HDL levels in blood. To achieve the desired positive result, patients themselves ought to be conscious. Without their active participation no professional can help ameliorate the condition of the disease in preventing and combating the very often quoted life threatening heart diseases like heart attacks . It is worth noting that continuous Medical Education has been making valuable contribution .providing many important programmes just to furnish us with the latest informations useful to the professionals to attend with confidence.
Heart Disease has been so common in our country Nepal embracing both rich and poor people. We are required to celebrate one full year as cholesterol Education year just to give precautionary messages to the people of both urban and rural areas
References:
http://www.cholesterol tests. com
http://www.nhlbi.nih.gov/health/bublic/heart/ chol/wyntk.htm
http://www.nhlbi.nih.gov.chd "live healthier, live longer" information on cholesterol lowering
http://heartdisease.about.com/library/weekly
Current medical literature scene : A cipla update on Therapeutics vol16, no3, july sept 2001
https://www.hin.nhlbi.nih.gov/cholmonth/drop-in.htm
http :/www.pponline.co.uk/encyc/0068.htm
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