Liz's Cholesterol Test
by Roberta Lee, MD (topic expert: health)

Many people know there is good and bad cholesterol, but they aren't quite sure which is which. My colleague, Dr. Dipti Itchhaporia, a cardiologist, helps you to understand the difference.

Liz, a 26-year-old paralegal, had just joined a new firm. She considers herself a very healthy young woman, exercises sporadically and does admit there is probably room for improvement in her diet. Still, Liz has never had any health problems. As part of a physical Liz was required to take for her new job, she had to take a blood test that included a fasting lipid panel to measure her total cholesterol level.

The result of the blood test wasn't good news. It showed a triglyceride level of 3000, total cholesterol of 230, LDL cholesterol of 43. What do these numbers mean?

Cholesterol is broken down into three fractions: Total cholesterol, HDL, the "good" fraction of the cholesterol, LDL, the bad cholesterol and triglyceride, sometimes considered an independent risk factor for heart problems.

Ideally, total cholesterol should be less than 200. The good cholesterol, the HDL, should be greater than 40, the bad cholesterol, the LDL, should be less than 130 (ideally less than 100). In high-risk patients, it should be less than 70. Lastly, the fasting lipid panel also reports triglycerides, which should be less than 150. Her physician recommended changes in diet and a regular exercise program. Because Liz has a strong family history of cardiac disease, she was referred to me, a cardiologist.

Liz is not alone with these types of numbers for her cholesterol. The Centers of Disease Prevention (C.D.C.) report that 50% of Americans have elevated cholesterol levels. Approximately 1.4 million Americans die of heart disease, making it the number one killer of both men and women.

High cholesterol is one risk factor for heart disease. The National Heart, Lung and Blood Institute estimates that with a 10% reduction in the cholesterol levels in the general population, the rate of heart disease would drop by 30%. The National Cholesterol Education Program recommends that everyone over the age of 20 have a fasting lipid panel.

When cholesterol levels are too high, fatty deposits, which we call "plaque," develop in your body's blood vessels -- particularly in the heart. Plaque can cause these blood vessels, called "arteries," to narrow which can lead to decreased blood flow to the heart muscle. This can cause symptoms of chest pain or lead to a heart attack. Decreased blood flow in the arteries of the brain can cause a stroke. Decreased blood flow in the arteries of the legs can cause pain with walking -- what we call "claudication."

Liz and I had a lengthy discussion about her lifestyle, designed an exercise program, and targeted her diet. To help reduce her cholesterol, she was going to incorporate Omega-3 fatty acids in the form of fish oil tablets, flax seed, walnuts, and salmon. At 26, Liz did not relish the thought of lifetime medication. However, she did have a compelling family history of heart disease.

After three months, Liz returned and her total cholesterol dropped to 220 from 230, her LDL was 145 down from 153, and her HDL went to 50 from 43. Her triglycerides dropped from 3000 to 324 with her lifestyle changes. She felt she had given it her 110%. We made a decision to start a low-dose cholesterol medication. It worked. Liz's most recent total cholesterol level was 164 with an LDL of 78, HDL of 52, and triglycerides of 125.

Like Liz, many people are unaware of their cholesterol levels. Getting a simple test to become more informed can prevent serious problems in the long run. In this case, ignorance is not bliss and awareness can foster some real lifestyle changes.