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Suggest Treatment For Elevated Cholesterol Levels?
Question: I just picked up my cholesterol results, and I am so disappointed. It is 230 and I know that is high, but I am not overweight, walk a lot, try to eat pretty healthy, and it is higher this year than last year. Last year it was 189, and had come down from the year before and I was so happy, and contributed it to me walking. This year I have walked more, and it is higher than ever. Total is 230 TRIG is 52, HDL is 92.4, VLDL CHOL CALC is 10, and LDL is 128. Can you tell me if this is bad for my results and if I need to be on medicine for it, or have my arteries checked to see if there would be blockage?
Brief Answer:
No need for medicines at this time
Detailed Answer:
Hi, thank you for using Healthcare Magic. Total cholesterol is recommended to be under 200. You were at this a year ago. What was your HDL then? It is quite high now, so it is possible that level increased and caused the total cholesterol number to be higher. HDL can be increased by regular exercise.
HDL is protective for the heart, thus is known as the "good" cholesterol. Above 40 is considered protective against blockage of heart arteries. You are well above that. Additionally, a cardiac risk ratio is calculated by dividing total cholesterol by HDL. Yours would be 230/92.4 = 2.5. This is an excellent ratio. You have less than half the risk for heart disease than the average!
All your other numbers are good, except for the LDL ("bad") cholesterol. We like to see this under 100. Treatment for this might be considered in high risk patients, but I suspect you are not high risk. People with diabetes, chronic hypertension, personal history of heart problems such as angina, strong family history of heart attacks, and smokers are high risk. If you have any of these, or especially if you have a combination of risk factors, then I recommend you discuss whether any kind of treatment is necessary with your doctor. With the good cholesterol being so high, I would probably just be following your levels for now.
There is no reason to get your arteries checked at this time unless you are having actual cardiac symptoms like chest pain with exertion. Unless you are considered high risk or are symptomatic, a cardiac stress test is not even recommended at this time, let alone any direct studies of the arteries (cardiac cath). Personally, I have cholesterol numbers very similar to yours (total 230, HDL 100, LDL 115) and am not pursuing any kind of treatment or tests. I'm just keeping an eye on it.
I suggest you keep up the healthy lifestyle you have chosen and recheck your levels again in another year. Be sure you have fasted 12 hours for the blood test, as not fasting can affect LDL and total cholesterol results. Otherwise, don't worry about these results.
Hope this answers your query. If you have further questions, I would be happy to answer them.
No need for medicines at this time
Detailed Answer:
Hi, thank you for using Healthcare Magic. Total cholesterol is recommended to be under 200. You were at this a year ago. What was your HDL then? It is quite high now, so it is possible that level increased and caused the total cholesterol number to be higher. HDL can be increased by regular exercise.
HDL is protective for the heart, thus is known as the "good" cholesterol. Above 40 is considered protective against blockage of heart arteries. You are well above that. Additionally, a cardiac risk ratio is calculated by dividing total cholesterol by HDL. Yours would be 230/92.4 = 2.5. This is an excellent ratio. You have less than half the risk for heart disease than the average!
All your other numbers are good, except for the LDL ("bad") cholesterol. We like to see this under 100. Treatment for this might be considered in high risk patients, but I suspect you are not high risk. People with diabetes, chronic hypertension, personal history of heart problems such as angina, strong family history of heart attacks, and smokers are high risk. If you have any of these, or especially if you have a combination of risk factors, then I recommend you discuss whether any kind of treatment is necessary with your doctor. With the good cholesterol being so high, I would probably just be following your levels for now.
There is no reason to get your arteries checked at this time unless you are having actual cardiac symptoms like chest pain with exertion. Unless you are considered high risk or are symptomatic, a cardiac stress test is not even recommended at this time, let alone any direct studies of the arteries (cardiac cath). Personally, I have cholesterol numbers very similar to yours (total 230, HDL 100, LDL 115) and am not pursuing any kind of treatment or tests. I'm just keeping an eye on it.
I suggest you keep up the healthy lifestyle you have chosen and recheck your levels again in another year. Be sure you have fasted 12 hours for the blood test, as not fasting can affect LDL and total cholesterol results. Otherwise, don't worry about these results.
Hope this answers your query. If you have further questions, I would be happy to answer them.
Above answer was peer-reviewed by :
Dr. Yogesh D
RVID cm.... 07-2.4 Syst Diast N LVID cm... 3.7-5.4 Syst 2.8 Diast 4.9 POST. WALL THICKNESS 0.8-1.1 Diast 1.0 SEPTAL WALL THICKNESS 0.7-1-2 Diast 0.8 LAID 1.9-3.8 Syst 2.8 AORTIC ROOT DIMENSION 2.0-3.7 Diast 2.7 MTRL. VLV. VEL. D.D.R. 80mm/sec-150mm/sec Diast N Comments: The patient underwent 2-D, M-Mode and doppler examination including s pulse-wave, continuous-wave and color-flow analysis; the study is technically adequate; the following is observed: AORTIC VALVE: normal; tricuspid in appearance with normal central closure. MITRAL VALVE: mitral valve prolapse. TRICUSPID VALVE: normal. PULMONIC VALVE: not well visualized. LEFT ATRIUM: normal; no intracavitary masses or clots seen. AORTIC ROOT: normal size with adequate motion. LEFT VENTRICLE: normal chanber size. Normal LV systolic function. Ejection fraction was 60%. RIGHT ATRIUM: normal. RIGHT VENTRICLE: normal size and function. PERICARDIUM: unremarkable; no evidence of effusion. DOPPLER: doppler examination of the aortic, mitral, tricuspid, and pulmonary valves and performed. This shows decreased compliance of the LV. Moderate mitral reguritation and mild tricuspid regurgitation. CONCLUSION: 1. Mitral valve prolapse. 2. Normal LV systolic function. 3. Decreased compliance of the LV. 4. Moderate mitral reguritation. 5. Mild tricuspid reguritation. I wanted to ask a few more questions. This is my echo I had about two weeks ago, and I had to type it out because I don't have a copy machine. I have some swelling in my lower legs in the calves and on top of my foot, not really my ankle, and I will send a pic so you can better see. My heart dr doesn't seem concerned, but I would like to know what causes the swelling being I am not an overweight person, and I wonder if it is because of the leakage in my valves. I would think if the swelling is from my heart that something needs to be done, and it would be concerning. Also I would like to know if it could be from the valves in my legs, or venous thrombosis, or venous insuffeceincy. I know I didn't spell that correctly, sorry. Would you think I have heart failure due to my echo, or what would suggest to look at to see why I am having this swelling in lower legs and feet?
Did you get my follow up question and picture of foot/ankle I sent?
Did you get my follow up question and picture of foot/ankle I sent?
Brief Answer:
Can't say for sure if heart failure present
Detailed Answer:
I did receive the picture. Swelling of extremities requires physical exam and palpation as well as visual exam to be sure. It looks like you may have a little swelling but I can't say more than that. Swelling can be due to many problems, including heart failure.
Heart failure can occur as a result of systolic dysfunction (when the heart is pumping blood out) and/or diastolic dysfunction (when the heart is resting between beats). Your systolic function appears to be within normal limits, although towards the lower end (normal 55 to 70, yours is 60).
Diastolic dysfunction is more difficult to measure. Decreased compliance of the left ventricle suggests you may have some diastolic dysfunction. Your heart is not enlarged or dilated, which would indicate a more serious condition.
Your mitral regurgitation is moderate. Surgery is not usually done unless it's severe.
I am not a cardiologist, and can't make a definite statement about whether you are having some evidence of early heart failure. Leg swelling and shortness of breath associated with your echo findings do concern me that this is a possibility.
My suggestion is to talk to your cardiologist in detail about these findings and your symptoms and try to pin him/her down to whether or not you might have early diastolic heart failure. In your case, a catheter study of your heart could provide more accurate readings of heart pressures etc to get a better idea of just how severe it may be. (They could also check the arteries while they are doing this, although I suspect this is not your problem.)
If you are not comfortable with your cardiologist's assessment, perhaps you should consider a second opinion with another cardiologist in a university/educational setting, where they may be more up to date on new information relating to the heart.
Hope this helps. Let me know if you have further questions.
Can't say for sure if heart failure present
Detailed Answer:
I did receive the picture. Swelling of extremities requires physical exam and palpation as well as visual exam to be sure. It looks like you may have a little swelling but I can't say more than that. Swelling can be due to many problems, including heart failure.
Heart failure can occur as a result of systolic dysfunction (when the heart is pumping blood out) and/or diastolic dysfunction (when the heart is resting between beats). Your systolic function appears to be within normal limits, although towards the lower end (normal 55 to 70, yours is 60).
Diastolic dysfunction is more difficult to measure. Decreased compliance of the left ventricle suggests you may have some diastolic dysfunction. Your heart is not enlarged or dilated, which would indicate a more serious condition.
Your mitral regurgitation is moderate. Surgery is not usually done unless it's severe.
I am not a cardiologist, and can't make a definite statement about whether you are having some evidence of early heart failure. Leg swelling and shortness of breath associated with your echo findings do concern me that this is a possibility.
My suggestion is to talk to your cardiologist in detail about these findings and your symptoms and try to pin him/her down to whether or not you might have early diastolic heart failure. In your case, a catheter study of your heart could provide more accurate readings of heart pressures etc to get a better idea of just how severe it may be. (They could also check the arteries while they are doing this, although I suspect this is not your problem.)
If you are not comfortable with your cardiologist's assessment, perhaps you should consider a second opinion with another cardiologist in a university/educational setting, where they may be more up to date on new information relating to the heart.
Hope this helps. Let me know if you have further questions.
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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