Q: I had my annual medical examination recently and for the first time my blood cholesterol level is higher than normal. Why is there so much ado about blood cholesterol? I know there are many medicines that can lower blood cholesterol, but my doctor did not prescribe me any. Don't you think I should start taking one of these drugs? I'm 45 years old. --email@example.com
MANILA, Philippines - A: There is much ado about blood cholesterol because when a person's blood cholesterol level is persistently high, cholesterol get deposited in the form of plaques in the walls of the person's blood vessels, which harden, weaken and clog the vessels. This condition, known as atherosclerosis is the main cause of heart attacks and strokes.
To bring down your blood cholesterol level to normal (i.e., less than 200 mg/dl) you can either modify some of your lifestyle practices or take cholesterol-lowering drugs, or do both.
On their own, cholesterol-lowering drugs can reduce blood cholesterol. They thus offer a very tempting shortcut in solving your problem. The most widely-used among these drugs are the statins, which include atorvastatin, fluvastatin, lovastatin, pravastatin and simvastatin. These drugs block the synthesis or production of cholesterol and facilitate the removal of LDL (bad cholesterol) from the bloodstream.
Statins are routinely prescribed for people who have known heart and blood vessel disease secondary to atherosclerosis because scientific research has already established that regular intake of statins reduces the mortality and cardiovascular morbidity rates in these patients.
Statins are now also increasingly being given to people with high blood cholesterol and other risk factors for heart disease even if these people do not have heart disease. This is because more recent studies have shown that statins improve survival and reduce the risk of major cardiovascular and cerebrovascular events in these people.
However, statins are not routinely given to otherwise healthy people like you for a couple of reasons. Firstly, statins are not harmless. They have adverse effects, the more severe of which are myopathy (i.e., muscle disease), hepatotoxicity (liver damage), peripheral neuropathy, impaired heart contraction and autoimmune diseases. Secondly, these drugs can bring down blood cholesterol to below normal level and people with persistently low blood cholesterol level have a higher risk of dying from cancer (lung and blood), respiratory and liver disease, hemorrhagic stroke, suicide and trauma.
Instead of immediately resorting to cholesterol-lowering drugs, you should adopt certain lifestyle practices that have been tried and tested in lowering blood cholesterol. I'm sure your doctor has advised you on these practices, but let me re-iterate them: if you smoke, stop; if you drink, drink moderately; watch your diet; and, exercise.
Diet is the single most important lifestyle influence on blood cholesterol. A high blood cholesterol level is, very often, simply the result of eating food that is rich in cholesterol and saturated fat. You can significantly reduce your blood cholesterol by adhering to a low-fat, high-fiber diet. Eat lean meat. Trim all extra fat from meat and avoid pork and pork products. Remove the skin and fat from chicken and other fowls. Limit your intake of processed meat and innards (liver, kidneys, etc.). Eat a lot of fish, but avoid shellfish (lobsters, shrimps, crabs) and canned fish. Consume a lot of leafy vegetables and fruits. Take skimmed instead of whole milk. Minimize intake of foods that contain or have been prepared using butter, saturated fats, lard, gravies, bacon drippings and cream sauces.
Dietary modifications have to be combined with exercise. Thus, you need to exercise, but not necessarily heavily. Brisk walking for 30 minutes five times a week is good enough.
Only if the above lifestyle modifications fail to bring down your blood cholesterol should you resort to cholesterol-lowering drugs.
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