Cholesterol

This week a study called the Jupitor trial was released.  It found that the drug Crestor reduced the risk of death from heart problems by 44% compared to people who took nothing.  The people they studied were men over 50 and women over 60. People at this age are at highest risk for heart attacks.  The unique quality of these people is that their cholesterol levels were not high enough to need cholesterol medicines.  For the medical community this is a “WOW!” study.  The reason this is important is because we know that half of all heart attacks occur in people with normal cholesterol levels.  How do we find these people?  The Jupitor study looked at CRP(C-Reactive Protein) levels.  There have been several studies that point to CRP as being useful to find these folks.  While one study is interesting, it is never enough to “prove” an idea.  Nonetheless the opportunity to reduce the risk of heart attacks by half in people is quite an opportunity. As a physician, starting today I will take a more aggressive approach with this group of people.

Some of you may wonder what cholesterol really is. Cholesterol is actually an essential part of the body, but too much of certain kinds will cause a pile of trouble.  When you have your cholesterol checked the full panel will test for four kinds of cholesterol:  the total cholesterol, LDL, Triglycerides and HDL.  

The LDL and Triglycerides are “bad” cholesterols.  They have been shown to increase the risk of heart attacks and strokes.  Lower numbers are best. All kinds of things will keep these numbers down.  To  name a few: high fiber, small meals, exercise, not smoking, low fat meals, limited sugar and other carbohydrates, eating mostly fruits and vegetables and many medications.  Some people are born with high bad cholesterols.  But they can still decrease their numbers with changes in how they live.  That means they can have fewer heart attacks and strokes.

The HDL cholesterol is the “good” cholesterol.  Higher HDL is better. It goes up with diet,exercise, a small amount of alcohol and stopping smoking.  This cholesterol protects against heart attacks and strokes.  The HDL cholesterol can make your total high.  It is the one reason why a high total cholesterol might actually be good.

The CRP test is a test which looks for inflammation.  That means we know all sorts of things will make it go up.  Even something as minor as a cold can raise this number.  Fascinating to think about it being used to look for people at  higher risk for heart attacks. The details for using this test are not fully worked out at this point.

Cholesterol medicines come in many major types.  Statins like Crestor and many others have huge advantages.  They clearly can reduce the risk of heart attack and stroke.  Most people can take these medications without any problems whatsoever.  The FDA has even considered letting them be sold over the counter.  They will remain available by prescription, probably best because heart disease is serious stuff.  Better to visit with your doctor before you get into trouble.  Niacin is a vitamin that also lowers cholesterol, a good choice for some people.  Then there is the fibrate class.  These lower triglycerides  but also have other advantages.  There are a many other kinds of cholesterol medicines, but these are the major groups with many studies to support their use.