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Common questions about heart disease.

Q Is it possible to lower high blood cholesterol levels with lifestyle changes alone?

A Yes. Your goal for standard lipids (total cholesterol, LDL, HDL and triglycerides) varies according to your own risk of developing cardiovascular disease. For example, people with coronary disease and those with diabetes are at the highest risk for heart disease, and should be treated most aggressively to reduce their cholesterol and triglyceride levels. If you have an overall lower risk, your levels don't have to be as tightly controlled.

If your cholesterol levels are outside the acceptable range, your health care professional will always advise you to make certain changes to your lifestyle, such as losing weight, stopping smoking and changing your diet. Sometimes, these changes alone may be enough to improve your cholesterol levels. Or, the changes may be the first in a series of steps to improve your cholesterol and triglyceride levels, to be followed by medication. Even if you are prescribed medication, however, you should still modify your lifestyle.

Quitting smoking provides one of the most dramatic benefits. It quickly and substantially raises HDL (the "good" cholesterol), often within 30 to 60 days once you stop smoking. Overall, HDL levels may increase 10 to 15 percent. Additionally, a diet low in saturated fat coupled with regular exercise can also reduce LDL (the "bad" cholesterol) and raise HDL, while restricted carbohydrate diets along with exercise can help lower triglycerides.

Q Are "expanded" cholesterol testing such as the Vertical Auto Profile (VAP) and Berkeley tests worth considering?

A The role of expanded cholesterol testing is an area of active research. Although these tests are commonly used, they haven't yet been shown to lead to changes in the way we treat cholesterol levels that reduce the overall number of cardiovascular events, like heart attacks. Thus, they have not yet been included in national diagnostic or treatment guidelines for high cholesterol and triglycerides. They do, however, provide additional details about traditional lipids while assessing non-traditional markers of cardiovascular risk.

For instance, while a standard lipid profile provides an LDL level, an expanded profile further characterizes the type of LDL, including LDL particle number and size. In addition, markers indirectly related to lipids but associated with cardiovascular risk, like homocysteine and high sensitivity CRP are measured.

Expanded testing might enable your health care professional to better target your therapy to reduce your individual risk.

References

1 Marcuccio E, Loving N, Bennett SK, et al. A survey of attitudes and experiences of women with heart disease. Women's Health Issues. 2003 Jan-Feb;13(1):23-31.

2 Mosca L, Appel LJ, Benjamin EJ, et al. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women. Circulation. 2004 Feb 4.

3 American Heart Association (AHA). Heart Disease and Stroke Statistics--2003 Update. Dallas, TX; American Heart Association. 2002.

4 Cancer Facts and Figures 2004. American Cancer Society. http://www.cancer.org. Accessed January 2004.

5 McSweeney JC, Cody M, O'Sullivan P, et al. Women's early warning symptoms of acute myocardial infarction. Circulation. 2003 Nov 25;108(21):2619-23. Epub 2003 Nov 03.

6 Canto JG, Iskandrian AE. Major risk factors for cardiovascular disease: debunking the "only 50%" myth. JAMA. 2003 Aug 20;290(7):947-9.

7 Hackam DG, Anand SS. Emerging risk factors for atheroscleratic vascular disease: a critical review of the evidence. JAMA. 2003 Aug 20;290(7):932-40. Review.

8 Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA. 2002 Jul 17;288(3):321-33.

9 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Related Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III), JAMA. 2001 May 16;285(19):2486-97.

10 Chobanian AV, Bakris GL, Black HR, et al. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003 Dec;42(6):1206-52. Epub 2003, Dec 01.

11 National Diabetes Statistics. National Institute of Diabetes and Digestive and Kidney Diseases. Nov. 2003. http://diabetes.niddk.nih.gov. Accessed January 2004.

12 Women, Heart Disease, and Stroke. AHA. http://www.americanheart.org. Accessed January 2004.

13 Diabetes, Heart Disease and Stroke. American Diabetes Association. http://www.diabetes.org. Accessed January 2004.

14 Diabetes Creates Serious Cardiovascular Risk. American Diabetes Association. June 17, 2002. http://www.diabetes.org. Accessed January 2004.

15 Doctor, patient dialogue may help prevent serious complications of diabetes. American Diabetes Association. Nov. 17, 2003. http://www.diabetes.org. Accessed January 2004.

16 MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomized placebo-controlled trial. The Lancet. Volume 361, Number 9374, 14 June 2003.

17 The Link Between Diabetes and Cardiovascular Disease. National Diabetes Education Program. April 2002. http://www.diabetes.org. Accessed January 2004.

18 American Academy of Pediatrics. Committee on Nutrition, American Academy of Pediatrics. Committee on Natrition. Cholesterol in childhood. Pediatrics. 1998 Jan;101(1 Pt 1):141-7.

19 High Blood Pressure in Children. AHA Recommendation. http://www.americanheart.org. Accessed January 2004.

20 Choiesterol and Atherosclerosis in Children, AHA Scientific Position. http://www.americanheart.org. Accessed January 2004.

21 de Jongh S, Ose L, Szamost T, et al. Efficacy and safety of statin therapy in children with familial hypercholesterolemia: a randomized, double-blind, placebo-controlled trial with simvastatin. Circulation. 2002 Oct 22;106(17):2231-7.

--Laura Demopoulos, MD

Director of the Women's Cardiovascular Health Center

University of Pennsylvania School of Medicine at Radnor Radnor, PA
COPYRIGHT 2004 National Women's Health Resource Center
No portion of this article can be reproduced without the express written permission from the copyright holder.
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Title Annotation:Ask the Expert
Author:Demopoulos, Laura
Publication:National Women's Health Report
Geographic Code:1USA
Date:Feb 1, 2004
Words:958
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