- An LDL cholesterol over 190 is considered a reason to take medications regardless of any other medical factors
- Dietary intake has a small effect on cholesterol but
- Weight control using any available method can really lower the number
- Smokers, diabetics, men with hypertension are much more likely to need medication when they have a "borderline" number
- Stopping smoking is more important than any cholesterol treatment in terms of heart attack risk reduction.
- African American men have a higher risk of heart disease and may be more likely need to need medication at a given amount of cholesterol.
Between Obamacare and insurance discounts for having a "check up," more and more men are having some kind of preventative physical examination and blood tests done. Although severe problems are occasionally found, most adverse findings are more of the "you need to watch that buddy" variety. Borderline blood pressures, liver enzymes and cholesterol readings are common findings during a check up. Appropriate follow up on all of these issues is important, the evidence of how to proceed weak, and the official guidelines a bit fuzzy. Trying to figure out how to appropriately manage the "not quite bad enough bit of bad medical news" is an major part of my practice and an significant part of men's health. I want to start talking about cholesterol first because the new guidelines have generated an inordinate amount of confusion among patients and doctors.
When should I be concerned? As men age, the chances of getting a heart attack increase and the importance of "borderline" cholesterol numbers becomes more important. Anyone who is a smoker, has hypertension, or is a diabetic needs to take a good look at medication before going on the "I'll lose a few pounds" route. Controlling these factors often means not needed cholesterol medication. Try not to have the man in your life be the "next year" guy: if the cholesterol isn't improving and he's failed at the exercise/weight loss: increases the risk: draw a "medication" treatment line in the sand.
What are the possible treatments? At some point in the future, I will have a giant discussion on all of the various cholesterol reducing meds out there and why they may (or may not) work. Medical therapy primarily consists of statin medications such as Lipitor or Crestor. Although traditionally diet therapy consists of low fat-low cholesterol foods, I encourage weight loss using any diet to lower cholesterol. The less you are, the less your cholesterol is!
Many men with what is thought of as "borderline cholesterol" do not need treatment with medication, but they should be carefully monitored and need to watch their weights.