Page 11 - Valley Life & Health

THE MORNING CALL SATURDAY, APRIL 27, 2019 11
HDL CHOLESTEROL
Continued from page 10

following a thorough evaluation of the individual’s Gangar tells her patients to think of their calo-
medical condition and personal concerns. More often ries like cash: “If your cash is spent, you don’t have
than not, however, statins are prescribed as a form any credit.” In a world where there are so many
of prevention and because that individual is a cardiac cultural differences and different palates – not to
risk – not because they have already experienced mention every individual’s taste buds and prefer-
a heart-related event. Statin therapy can be high, ences being different – it’s important that we don’t
moderate, or low intensity. cut out the foods we want to indulge in, but that
“When you put someone on a moderate- they fit inside of our calorie budget for the day and
intensity statin, like pravastatin, lovastatin or for the week.
low-dose rosuvastatin and atorvastatin, they can “I will never tell a person ‘don’t eat that’. That’s
decrease cholesterol levels by up to 45 percent, and why I’m not into any particular type of diet,” she
even more when used in conjunction with lifestyle stresses. “I’m more about lifestyle changes. You
changes. They can also decrease cardiovascular need to do things you can incorporate easily into
mortality when the 10 year calculated ASCVD risk your life – not something you will do for 10 days
is more than 10% at baseline,” Dr. Gangar says, “if and then forget about.”
we can bring a person’s low-density lipoproteiny lipoprototeieinn
levels to less than 100.” Does stress play a role?Does stresess pl
So, what are the LDL and HDL cholesterolchchololesterol Stress can have various effects on the body,Stress cann ha
ranges and differences? Less than 100 mg/dL (mil-00 mg/dL (mil- and one of these is that it may increase cholesterolanand one of thehese
ligrams per deciliter) is the optimal LDL measure-LDLDL measure-e- levels. This happens because when the body faceslelevevels. This hapap
ment, while 100-129 mg/dL is near optimal or aboveopoptimal or aaboveve Photo courtesy of Steward Medical Group’s Easton Hospital stress, certain physiological reactions take place,streressss, certain phph
optimal. Anything over 130 is considered high, whileered high,h, whilele Jinal Gangar, MD, MPH at Steward Medical Group’s including changes in hormone levels and compo-includuding changege
190 and above is considered very high.igh. Easton Hospital. nents in the blood. The thing about stress, however,nentnts in the blolo
For HDL, less than 40 mg/dL is a major risk fac-aa major risksk fac-- is that it is usually responsible for a short-term raiseis tthahat it is usuaua
tor for heart disease. 40-59 mg/dL is better, while 60s better, whwhilile 6060 – not a long-term raise – in cholesterol levels.–– not a long-terer
A
mg/dL is considered protective against heart disease,instst heart diseaeasese, According to Dr. Gangar, there are four thingsccordidingng tto Dr. GaGangngarar, ththere are four things When a person is dealing with stress, their bodyWhen a pepe
that will actually increase a person’s HDL: exercise;at willl actualallyly increase aa pepersrsonon’s’s HHDLDL:: exexercicise;
and is subject to gender differences. An HDL ofAnAn HDL of th automatically prepares their heart and other organsautomaticallyy pr
less than 50 for females and less than 40 for malesan 400 for males qu for a high-energy, fight-or-flight response. Their bodyfor a hihighgh-energ
quitting smoking; increasing fruits and nuts in the dietitting smokiking; increasing fruits and nuts in the diet
increases cardiovascular risk. several times a week; and bringing your body massseveral times a week; and brbriningiging your bobodydy mass will react in certain ways depending on whether thatwill react in cert
“When do we start treating someone with index (BMI) within optimal range. These four actions stressor is dealt with immediately or handled over
elevated cholesterol?” asks Dr. Gangar. “Let’s say will also provide overall health benefit. a longer period of time. Regardless, when dealing
someone’s LDL is 190. I would definitely put them “They don’t need to come to me for that – with stress, the body releases the hormone cortisol
on a moderate intensity statin, irrespective of if that’s what I want to encourage. We should all be – which causes the body to release glucose and fatty
their HDL is at 60. Or, say a patient has an LDL of doing these four things. Those are the things that acids to the muscles and blood for use as energy.
170, and this person also has a low HDL. I’m more are in our hands,” says Gangar. “This is a part of These hormone levels will remain high until the
inclined to put them on a statin than to wait and primary prevention.” person resolves the stressful situation – which is
watch. Individualized calculations of ASCVD risk is It is widely understood that being overweight why the cholesterol threat could be either short
an optimal approach for patients between 40-70 puts you at a greater risk for heart disease. People or long-term.
years of age.” who are overweight are not only more likely to “When steroids are released into your body, they
Statins can also increase mortality benefits in a have lower HDL and higher LDL levels, but also high independently reduce your HDL and increase your
way that lifestyle changes – such as diet and exer- blood pressure, pre-diabetes, or sleep apnea. LDL. That’s how stress plays a role,” explains Dr. Gan-
cise –clearly cannot, as seen in recent clinical trials. One may make the argument that you rely on visual gar. “It’s hard to prove this in any studies because it’s
Watching a patient’s progress after lifestyle modifica- appearance to know how much of a dietary change such a subjective thing. It’s a very subjective assessment
tions sometimes helps decide the need to be on a you need. But the truth is, many wait until it’s well and it can only be translated into a research study. But
cholesterol modifying agent like statin. past time to make that change before actually plan- if somebody has to explain the physiology, it’s probably
“If someone has high LDL and low HDL, they ning a course of action. At that point, the idea of related to cortisol and anabolic steroid release.”
will definitely benefit by optimizing their risk by weight loss is a daunting challenge.
following diet, exercise and other lifestyle changes” At-risk patients also need to realize that bringing A minimalistic approach
Dr. Gangar says. “I would try three to six months of their BMI down isn’t about a number on a scale. No research is foolproof, which is why physicians
lifestyle changes, and if the LDL stays persistently Because BMI is calculated from an individual’s weight, practice evidence-based medicine that is current. For
elevated, I would put them on a statin.” which includes both muscle and fat, some individuals high cholesterol and for all conditions affecting the
With the ASCVD Risk Calculator, Gangar says may have a high BMI but not a high percentage of human body, there are usually a set of guidelines to
that a risk of 7.5 to 10 percent is acceptable, but body fat. People with a BMI of 30 or higher should go by for what to change and how to do it.
any number higher than that should also lead to the concentrate on improving overall body composition. For optimal heart health and good cholesterol,
patient being prescribed a statin. “The bottom line is that every food turns to Dr. Gangar suggests a minimalistic approach.
calories. It’s all about simple mathematics – 3500 “Read the current guidelines, but keep in mind
Increasing your HDL and improving calories translates into one pound, and if you’re able that guidelines can change,” Gangar cautions. “We
your lifestyle to cut down 3500 calories in your week’s course, do advocate more for losing weight, diet and exer-
Medications like niacin, fenofibrate, and gem- you will lose one pound per week,” says Gangar. “I’ve cise. But if research says that you could live longer
fibrozil have been used for years and have suc- experimented with this on a few of my patients. One with a statin, would you take that, or would you just
cessfully increased HDL but have not been able to was in the pre-diabetic range, so I put her on calorie focus on your lifestyle? That’s what people should
reproduce the mortality benefit that is shown by counting. Three months later, she had lost 20 pounds, remember – that those two things are in their hands,
statins. Also, concurrent use of stations and fibrates and the pre-diabetes was gone. That’s how much and that you should focus on both your good choles-
increases risk of myalgias. protection losing weight gives you.” terol and bad cholesterol.”