Collaring cholesterol: Cardiologist details therapies to lower LDL


There seems to be a troublemaker in every group and in the health-robbing triad of cholesterol, coronary artery disease and peripheral vascular disease, the culprit is cholesterol.

Happily, important new therapies have become available during the past decade, according to an article in the National Library of Medicine entitled, “PCSK 9 Inhibitors: A Short History and a New Era of Lipid-lowering Therapy.”

“It all starts with cholesterol, a fatty substance created by your liver,” said Dr. Ellis Christian, board certified cardiologist and vascular specialist.

“Our bodies need cholesterol. It’s part of the metabolism and essential for bodily functions.

But in our diets, we get cholesterol in higher portions than needed. This creates a high circulating amount of cholesterol, which can start to deposit in the sediment along our blood vessel walls, creating these mounds of obstruction.

“That’s where it causes issues. It can cause obstructed flow to either the heart or your brain or your leg that usually manifests as stroke-like symptoms. It can also cause chest pain or pain in your legs when you walk.”

Of course, as we have been told for years, not all cholesterol is bad. The American Heart Association breaks down the good and the bad cholesterol based on the two types of lipoproteins that carry cholesterol to and from cells. One is low-density lipoprotein (LDL).

The other is high density-lipoprotein (HDL).

LDL cholesterol is considered the “bad” cholesterol because it contributes to fatty buildups in arteries. This narrows the arteries and increases the risk for heart attack, stroke and peripheral artery disease.

HDL cholesterol can be thought of as “good” cholesterol because a healthy level may help protect against heart attack and stroke. The HDL carries LDL (bad) cholesterol away from the arteries and back to the liver, where the LDL is broken down and passed from the body.

But HDL cholesterol doesn’t eliminate LDL cholesterol, because only a fraction of the blood cholesterol is carried by HDL.

Triglycerides are another type of fat that builds up in the body. High levels of triglycerides and low levels of HDL raise the risk of heart disease.

A simple blood test will show your cholesterol levels per deciliter of blood, or mg/dL. The lipid panel will give you results for your HDL cholesterol, LDL cholesterol, triglycerides and total blood cholesterol. Basic guidelines suggest levels of less than 200 for total cholesterol, less than 100 for LDL cholesterol, more than 40+ for males and 50+ for females for HDL cholesterol, and less than 149 for triglycerides.

“You want to minimize the LDLs as much as possible,” Dr. Christian continued. “People with an LDL level below 100 have lower risks of heart disease and stroke. Lower is better. Ideally that number would be below 70.

“We take medications such as statins to lower those cholesterol levels. In the past 25 years or so we’ve noticed that heart attacks and strokes have decreased because more people are on statins. In my opinion, statin medications have been one of the best advancements in cardiovascular care.

“There are two processes that happen with what we call atherosclerotic cardiovascular disease (ASCV),” Dr. Christian explained. “You can have chronic processes, which is ASCV, and then you have acute processes which are strokes and heart attacks. In the chronic process, the plaque progressively narrows and over time occludes the blood vessel. In the acute process, the plaque that you have in any area, whether it be your neck, which is your carotid arteries, or your heart, which is your coronary arteries, can rupture.

“Your body recognizes the plaque rupture just as it would a cut on your arm, and it sends blood cells called platelets to plug it up. That can stop blood flow to any respective organ, be it your heart or your brain, causing a stroke or a heart attack. Strokes and heart attacks are caused by the same process and that’s why they are both treated relatively the same. That’s how the two processes overlap.”

You can manage your cholesterol levels and help prevent heart attacks and strokes by eating a well-balanced diet rich in fruits, vegetables, nuts and fish, as in the Mediterranean diet, and staying away from greasy foods and dairy products. If you are a smoker – quit. And exercise at least 30 minutes a day.

If you’ve already had a stroke or heart attack or blockage in your legs, you definitely want to be on a statin drug to lower your LDL.

“Once on a statin, you should not quit even if your levels become normal,” Dr. Christian warned. “Statins do more than just lower cholesterol levels. They also lower the inflammation level along the blood vessel lining, thereby decreasing the plaque rupture process. It also stabilizes the plaque, almost like a sealant, which decreases the risk of it breaking off and causing a stroke.

“What we don’t want our patients to do is have a false sense of security by lowering their cholesterol levels and then the genetic factors or whatever factors that are in play cause them to have another heart attack or stroke. That’s why we advise our patients to stay on the statins for the rest of their lives.”

For those individuals who can’t tolerate statins, there is a newer class of drugs called PCSK9 inhibitors, first introduced in 2015. These injectable drugs are given once every two weeks and are just as effective as statins in minimizing atherosclerotic risk by decreasing levels of LDL cholesterol.

“Studies show that PCSK9 inhibitors have a powerful effect, and in some cases can actually prevent heart attacks or strokes. They can be taken on their own or in addition to a statin,” according to the National Library of Medicine article.

In general, cholesterol levels start to climb around age 55 for men and 65 for women. It’s recommended that you get a blood test done at least once a year during your annual checkup. If you have preexisting conditions like hypertension, heart disease or diabetes, you may need to increase the frequency of your blood work depending on the recommendation of your provider.

Dr. Ellis Christian is the owner of Anley Cardiovascular in Fort Pierce. He received his medical degree from Meharry Medical College in Nashville, Tennessee, and served his internship in internal medicine at the University of Chicago. He completed his cardiology and interventional cardiology training at the University of Tennessee in Memphis. He is now accepting new patients at Anley Cardiovascular, 1300 N. Lawnwood Circle, Fort Pierce. The phone number is 772-302-3977.

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