By Dan Murphy
All of us have heard about cholesterol, but very few know what it does, and how to control it. Dr. Alon Gitig, Director of Cardiology at Mount Sinai Doctors-Westchester spoke with us to try and inform our readers about cholesterol and how it can impact your heart health.
“Cholesterol is an oily substance made in the body for biological uses. It does have a function, and your body does need cholesterol to build healthy cells. We need cholesterol, but we need it to be controlled, and in the places where it was meant to be There are biological functions of cholesterol which are important for health, for example in cell membranes or in certain hormones such as sex hormones.”
When Can Cholesterol Become a Heart Health Risk? “Most of my patients are aware that high levels of cholesterol can increase your risk of heart disease. Cholesterol becomes a problem when we see it in large amounts in the blood steam. This leads to plaque formation along the walls of a patient’s arteries. Plaque is what can cause narrowed arteries or, if plaque becomes biologically active and ruptures, it can cause sudden clotting, and lead to heart attack or stroke.”
How Can We Change Our Habits to Control Cholesterol? “I advise my patients to eat a diet that has low amounts of saturated fat by cutting back on meat and dairy, and to eat more plant-based foods. Feeding studies performed in humans have shown that eating greater amount of cholesterol (common sources are egg yolks and shrimp) usually does not lead to elevations in blood cholesterol levels. For most people, eating diets high in saturated fat, especially processed fast foods, is what elevates cholesterol levels, especially dairy and red meat. “
“In societies where people’s lifestyles more resemble pre-Industrial Revolution times, they are almost immune from high cholesterol and related artery diseases. This is because their diets are comprised primarily of unprocessed foods, mostly from plant-based sources, and they have much higher levels of physical activity on a daily basis. We know that these factors are important in maintaining low blood cholesterol levels and healthy arteries,” said Dr. Gitig.
What is an Average Cholesterol Value? What Should it be?
“In industrialized societies, the average LDL cholesterol values are in the range of 125-130 (mg/dL). While these values are typical, they are not likely optimal. Industrialized societies with these average cholesterol numbers have staggeringly high rates of arterial diseases caused by cholesterol plaque (coronary artery disease/heart attack, stroke, peripheral arterial disease of the legs).”
“And there are still certain areas of the world that live much more traditional lifestyles (some populations on the Greek Isles, areas of rural China and Japan, certain indigenous populations of Central and South America) whose people almost never develop arterial disease. The people living in those regions tend to have LDL cholesterol values in the 50-80 range.”
What medications are available for Cholesterol? What are the benefits and risks of taking medications?
“The most used medications to lower cholesterol are called statins, which are also among the most widely prescribed class of medications in the world. Dozens of studies have been done investigating use, and we have many years of clinical observation in hundreds of millions of real-life patients.”
“There is a ton of misinformation out there. Statins are possibly the most studied drugs in the history of the world, with probably more focus on their safety profile than any other medication. We know that in 5-20% of patients that can be side effects of muscle or joint pain, which can almost always be easily be reversed if the medication is stopped, or dose reduced,” said Dr. Gitig, who warned about the misinformation regarding statins online.
“There are risks associated with ingesting any external substances such as Rx drugs or naturopathic herbal supplements, just as there are risks associated with ingesting alcohol. Several studies have found NO RISK in patients for increased dementia or changes in neurocognitive function who used statins.”
“Here are the facts. Cholesterol is the principal component of plaque. You cannot get plaque in your arteries unless you get cholesterol in your bloodstream. The only way that cholesterol gets to the walls of the arteries is to be delivered through the blood stream.”
“If you have high cholesterol, or are at risk, there are two ways to lower it. Make a lifestyle change or medication. Lifestyle is always the preferred approach in my opinion, as I believe that evidence suggests it has more powerful benefits. However I also believe in lower cholesterol targets than what most people assume are fine, and many people need medication to achieve those levels. You should have a thorough evaluation of your lifetime risk of arterial diseases by a doctor with experience in prevention. If your risk is elevated, I strongly suggest that you take action and remember that the risk of doing nothing is often much higher than the risk of serious medication side effects
“Exercise, diet and lifestyle changes, should all be a part of my patients’ path to better heart health, and I work hard on this with the folks I treat. However I also believe that we have enough evidence to feel very confident that these medications, used correctly, are far more likely to help you achieve optimal health than to hurt you,” said Dr. Gitig.
A standard blood test given to most patients during their physical is the usual way that cholesterol is tested. The most popular statins are Lipitor (atorvastatin), Crestor (rosuvastatin), and Zocor (simvastatin).
Alon Gitig, MD, is Director of Cardiology at Mount Sinai Doctors-Scarsdale and Mount Sinai Doctors-Yonkers. He is also an Assistant Professor of Cardiology, Icahn School of Medicine at Mount Sinai, and Medical Director of the Heart Failure Management Program for the Mount Sinai Health Network.
To make an appointment, visit
https://www.mountsinai.org/locations/westchester.
