Cholesterol Screening and Heart Disease

Several years ago a good friend of mine (who had no known risk factors for heart disease) had a heart attack. This was such a shock to all of his friends since he had no predisposing risk factors, was not overweight, and exercised regularly. He found out that he had a cholesterol abnormality and this prompted me and several other of his buddies to get our own cholesterol checked. I learned that the most important thing to check is LDL (Low Density Lipoprotein) cholesterol. LDL cholesterol (bad cholesterol) is a fraction of the total cholesterol and is the most important predictor of heart disease. I saw both my mother and father have coronary bypass surgery because of blocked coronary arteries and I knew that I wanted to avoid that if possible.

It is important to know that heart disease is the #1 cause of death in women today. Cancer of the breast gets so much attention and rightfully so. Many health care dollars are spent on research, screening, public awareness, and treatment of breast cancer. By comparison, heart disease, unfortunately, gets far less attention. Many women think that heart disease is more a problem of men and don’t recognize the warning signs. The symptoms of heart pain (angina) sometimes present differently in women than in men. The warning symptoms can be ignored or misdiagnosed as muscle pain or indigestion. While it is true that women seldom have coronary artery disease before age 50 unless they have other risk factors, after age 55 the incidence in women begins to rise and approach that of men. While there are several risk factors that may increase the risk of heart disease (smoking, diabetes, high blood pressure, and family history of heart disease) elevated LDL cholesterol has been shown to be an important independent variable. LDL cholesterol should be obtained on a fasting blood specimen.

Women over the age of 40 should have a "fasting lipid profile" which measures total cholesterol, HDL (High Density Lipoprotein or "good cholesterol"), LDL cholesterol, and triglycerides. In general, women whose LDL cholesterol is >165 even with no additional risk factors, or >130 and who have two or more of the following risk factors should consider taking a drug to lower their cholesterol:

Diabetes
Family history of premature heart disease
Smoking
Age >55
High blood pressure
Low HDL cholesterol
A high HDL cholesterol is good and can actually reduce one’s risk of heart disease. A high triglyceride level, on the other hand, may signal trouble and can interfere with interpretation of the LDL cholesterol number.

I encourage my patients who are at risk to limit their dietary intake of saturated fats and cholesterol and to begin or continue a regular exercise program. Studies show that adherence to a good diet and exercise program can, on the average, result in a 10-15% reduction in LDL cholesterol. Especially in patients who are overweight and sedentary, this is an important first step. But remember that diet and exercise alone will usually account for only a 10-15% reduction in LDL cholesterol; therefore a patient with a significantly elevated LDL cholesterol will not likely achieve an adequate response without medication. Patients who are not overweight and who eat sensibly, whose LDL cholesterol is significantly elevated have an inherited metabolic defect affecting cholesterol metabolism and need to take cholesterol lowering medication.

If you don't know your cholesterol number, ask your doctor for a fasting lipid profile. If you have an elevation of LDL cholesterol and have been told that you need to take a cholesterol-lowering drug, consider that the newer "statin" drugs are well tolerated by most people and will result in a significant reduction in LDL cholesterol. I have been taking a low dose of such a drug for six years, have had no problems, my LDL cholesterol dropped by 40%, and, I believe, I am decreasing the likelihood that I will have coronary artery disease like my mother and father had.

Dr. Hammond was born in Jackson, Tennessee and after graduating from Jackson High School, he attended Rhodes College and the University of Tennessee at Memphis medical school. After a residency in Obstetrics and Gynecology at the Medical College of Georgia, he returned to Jackson to join The Jackson Clinic in 1979. He has life—time board certification by the American Board of Obstetrics and Gynecology and has maintained voluntary recertification. He and his wife Paulette have three children.