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The Good, the Bad and the Healthy
By Mark Bilella, MD, Contributing Writer |
When I used to work in the cardiac units, I would always see patients
in their mid-fifties come in with chest pain and heart attacks. After
some lab work, we would find markedly elevated cholesterol. The patient
would always say the same thing: “I have been healthy all my life. In
fact, I haven’t seen a doctor in over twenty years.” So is ignorance
bliss? It doesn’t seem so.
What is your cholesterol? Most young adults don’t even know what their
levels are. How can you tell if it is elevated? It is not something you
can tell by looking in the mirror. The American Medial Association
recommends that everyone get a baseline cholesterol level in their
thirties, earlier if there is a strong family history of heart disease
or other risk factors. How do you know you have a problem if you never
get checked?
It is also important to know the breakdown of your types of cholesterol.
When it comes to heart disease, there is “good cholesterol,” called HDL
and “bad cholesterol,” called LDL. Having more HDL helps reduce the risk
of heart disease, while having more LDL increases the risk. Your
physician can perform this analysis with fasting blood work. Doctors
primarily focus on getting the LDL cholesterol lower. The exact goal is
based on other risk factors for heart disease such as age, family
history, hypertension, diabetes and tobacco use.
High cholesterol levels are due to both genetic and environmental
factors. If you have a strong family history of high cholesterol, yours
may be elevated as well. Unfortunately there isn’t much you can do to
change your family history.
Environmental factors, however, can be changed. The typical American
diet is really unhealthy. The average portion size is twice as large as
it was twenty years ago, and the amount of fat and cholesterol in our
meals is much greater. Do you know how many fat calories are in a fast
food burger? Maybe that is the problem. Americans often don’t pay
attention to the nutritional values of the food they eat. Eating a diet
high in lean meats, fish and vegetables will help keep our cholesterol
levels under control. Other lifestyle changes include increasing one’s
activity level. Regular cardiovascular exercise has been shown to both
increase the good cholesterol and lower the bad cholesterol.
Sometimes lifestyle changes aren’t enough, and your doctor will
recommend starting a medication. No one wants to start on a daily
medication, but the data is strong that these medications not only
reduce cholesterol levels, but also reduce the risk of heart attacks,
strokes and death. Many of my patients are scared of the side effects of
these cholesterol-lowering medications. The truth is they should be
scared of the heart disease that is more likely to occur by not taking
the medications.
I recommend everyone get a baseline cholesterol level at some point and
go over risk factors for heart disease with your physician. Discuss
lifestyle changes, including proper nutrition and exercise, and discuss
the need for cholesterol lowering medications and the risks and benefits
of these drugs.
Good luck and good health.
Mark Bilella, M.D., is
physician and co-owner of Internal Medicine and Pediatrics of Tampa Bay
at
www.medpedstampabay.com.
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