It depends on which part of your lipid profile is elevated and how you’re going about lowering your cholesterol. Ultimately, the results will be different for every person. Elevated triglycerides (fats present in the blood plasma) tend to come down the fastest, usually in a few months or even less. This will often result in a corresponding drop in your total cholesterol. Total cholesterol is a combination of HDL (good cholesterol) and LDL (bad cholesterol); therefore, a sudden drop or increase can be potentially misleading. You’ll need to pay close attention to your levels of HDL and LDL to determine if you’ve really decreased bad cholesterol and increased good cholesterol. If triglycerides are not elevated, it may take longer to see a decrease in your total cholesterol. The speed with which your cholesterol levels improve also has to do with the method you’ve employed. Changing your lifestyle through diet and exercise is great for overall health, but it may take some time for cholesterol levels to improve. If, in addition to a healthy lifestyle, you’re taking cholesterol-lowering drugs per doctor’s orders, you could see improvement in as little as one month. Consult with your doctor to see if you’re on the right track. Q2. If I have low cholesterol and no other risk factors for heart disease that I know of, should I be taking a statin? I saw the results of a recent study that suggested a statin drug could benefit people like me. — Jim, California I assume that you are referring to JUPITER (Justification for the Use of statins in Primary prevention: an Intervention Trial Evaluating Rosuvastatin), whose findings were recently published in The New England Journal of Medicine and were featured on television and in a number of newspapers. This study is very reassuring in that it shows that where risk is present, statins are effective at reducing that risk. In your case, I don’t think you necessarily sound like a candidate for a statin, but you need to discuss your particular situation with your doctor to determine whether more advanced testing is something that would be right for you. About the JUPITER Study JUPITER involved 17,802 participants (men over 50 and women over 60) in the United States and 25 other countries who had both elevated levels of C-reactive protein (CRP), a marker for inflammation in the body, and normal levels of bad LDL cholesterol. Although the study referred to its subjects as “apparently healthy individuals,” many of them exhibited other known risk factors for heart disease, including smoking, excess weight, increased blood pressure and/or above-normal blood sugars, and a family history of heart disease. Each participant was assigned to take either a placebo (dummy pill) or the statin drug Crestor, with none of the doctors or participants aware of who was taking which. The study, which was supposed to last five years, was halted after about two years when it was found that those taking Crestor were doing much better than the people who were on the placebo. According to study leader Paul M. Ridker, MD — a CRP blood test patent holder who has received financial support from AstraZeneca, the maker of Crestor — those on the statin reduced their risk of a heart attack by 54 percent, risk of a stroke by 48 percent, and the chance of needing bypass surgery or angioplasty by 46 percent. Assessing Your Risk Factors This study is certainly important research that further substantiates the effectiveness of statins in lowering the risk of cardiac events. It also shows that we have moved well beyond cholesterol as the primary risk factor for heart disease. In fact, roughly half of heart attacks and strokes occur in people without high cholesterol. We have known for some time that inflammation in the body, as indicated by a high level of CRP, is a risk factor for many chronic conditions, including heart disease. But this new study does not mean that everyone who has a high CRP level should be taking a statin. C-reactive protein is just one factor that needs to be considered, along with many others, in assessing overall cardiac risk. Beyond Basic Blood Tests I believe that too much emphasis has been placed on using traditional lipid testing alone in evaluating cardiac risk. To get an accurate picture of overall cardiovascular risk, particularly in those with preclinical disease, you have to go beyond basic blood tests. Accordingly, I will recommend advanced blood tests for some of my patients. For example, there’s the hs-CRP test, which measures levels of C-reactive protein. Before an elevated CRP is diagnosed, this test should be repeated three times with at least several weeks in between, and only when there are no apparent infections or injuries. Other useful diagnostic tools include the lipoprotein (a) test, which measures a type of dangerous LDL particle called Lp(a); and the lipoprotein subfraction test, which measures the size and density (and thus quality) of your LDL and HDL particles. I find that a person’s family history and the presence or absence of belly fat (another indicator of inflammation) are good predictors of future problems. In addition, looking directly at the heart’s blood vessels using CT heart scanning is invaluable in determining risk. So, too, is examining the carotid arteries by means of ultrasound. Q3. I am a cardiac patient with high cholesterol. I watch my diet, exercise five times a week, and take Vytorin. I also drink alcohol most days of the week. Does “hard liquor” have any more negatives than beer or wine? – Louis, Georgia If you drink alcohol it is important to do so in moderation. Drinking too much alcohol of any kind can lead to increased triglyceride levels, blood pressure, and caloric intake, which can result in excess weight or obesity, a higher risk of developing diabetes, and possible heart failure. The American Heart Association recommends that patients discuss alcohol intake with their health care provider and that intake be limited to one drink per day for women and two drinks per day for men. A drink is equal to 12 ounces of beer, four ounces of wine, 1.5 ounces of 80-proof spirits, or one ounce of 100-proof spirits. There is no definitive data that drinking a certain type of alcohol (beer versus wine or hard liquor) is better or worse for the heart, though the effects of red wine are being studied. Q4. I’m 36 years old and my good cholesterol is too low. What can I do? – Nilsa, Florida High density lipoprotein (HDL) — or “good” cholesterol — is believed to protect against plaque buildup in your arteries by carrying cholesterol away from the arteries and back to the liver for removal from the body. Though higher levels of HDL are associated with a lower risk for heart disease, experts still debate if raising your HDL cholesterol is the answer. A woman’s HDL goal should be greater than 50 mg/dL (greater than 40 mg/dL in men). You can raise your HDL levels by eating a diet low in saturated fat and trans fat but high in monounsaturated fats. Lose weight if you need to and get at least 30 minutes of moderate-intensity exercise on a minimum of four days per week. If you smoke, quit. Despite positive lifestyle changes, though, some individuals may still be candidates for HDL-raising drug therapy because they are at increased risk for cardiovascular disease. Discuss your options with your health care provider. Q5. I have just started taking a statin and am a little nervous. It’s the first time I’ve been on a prescription medication. What are the side effects I should watch for? Like all medications, cholesterol-lowering medications (statins) may cause some people to experience side effects. When taking these drugs, you should have regular blood tests performed by your doctor. A small percentage of people taking statins, which are now among the most common cholesterol-lowering medications prescribed, develop abnormalities in liver tests (one to two percent on average). Fortunately, these are usually reversible when the medication is reduced or stopped. Side effects can also include muscle aches, constipation, weakness, abdominal pain, and nausea. They are usually mild and tend to go away. Unexplained muscle pain and weakness could be a sign of a rare but potentially serious side effect called myopathy. Types of myopathy include myalgia (muscle ache or weakness without abnormalities in the muscle enzyme creatine kinase, or CK), myositis (muscle symptoms with increased CK levels), or the most serious consequence of myopathy called rhabdomyolysis (muscle symptoms with marked CK elevation), which is rare but can lead to kidney failure and death. For patients that are taking cholesterol-lowering medications and experience muscle aches but normal enzyme levels, the best way to tell if the muscle aches are due to the medication is to stop taking it and see if the symptoms resolve. Your doctor can then advise you whether to permanently discontinue and try another medication. Prevention of cholesterol-lowering medication-associated myopathy can be accomplished by knowing the factors that increase the risk for the condition. These factors include advanced age (over 80), a small body frame, having complex medical problems, taking multiple medications, and whether the medications were started during the perioperative period. If you experience side effects, report them to your doctor right away, so you can determine if a change should be made to your medication. Learn more in the Everyday Health High Cholesterol Center.
