First the Bad News.
50% of patients who suffer their first heart attack have a “normal cholesterol” value.
The latest national cholesterol guidelines are predicted to qualify 12.9 million MORE Americans for statin medications.
We learned about the relationship between high cholesterol levels and coronary artery disease around 35 years ago. As a medical community, we responded by recommending a push nationwide to adopt a low cholesterol, low fat diet. We suggested substituting more “healthy grains” in our daily routine which became the foundation of the food pyramid for so many years. Unfortunately, we did not predict that the subsequent expected rise in dietary carbohydrates would lead to elevated blood sugar levels which ultimately have worsened cholesterol (more accurately “lipoprotein”) abnormalities, and is directly related to the rise in diabetes and obesity. To replace the taste sensation of natural fat, the food industry responded to our demands with the addition of sugars in many forms to keep us satisfied. This has contributed significantly to the increasing weight of the nation and the accompanying insulin resistance and diabetes that we are seeing. The insulin resistance is directly linked to the surge in fatty liver disease which is a major organ responsible for cholesterol regulation.
The GOOD NEWS is we are learning more and better understand the relationship between the “good” and “bad” cholesterol. We are starting to have more clarity on the relationship of sugars to weight gain and metabolic diseases, and a better understanding that not all fat in our diet is bad but that “Bad Fat” is bad for you (such as transfats).
A number of us have incorporated advanced lipoprotein (“cholesterol”) analysis into our decision making process in treating patients optimally. We also offer simple affordable silent coronary artery disease screening to help clarify to patients whether they are truly at higher or lower risk. Many of us feel the recent guidelines have significant room for improvement to avoid unnecessary lifelong drug treatment, and to identify those people at risk who would be missed. Advanced lipid tests, family history of coronary heart disease and documented silent coronary disease are currently not included in the guideline’s decision equation and should be. Talk to your doctor!