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What causes total cholesterol, LDL and HDL to be high?

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Posted on Mon, 18 May 2015
Question: My total cholesterol is high and so is my HDL and LDL. My HDL is so high that my ratio of LDL to HDL is abnormally low. My doctor says I don't have to worry about my cholesterol because high HDL is what you want. I feel nervous about this because my family has familial hypercholesteremia and most of the males in this generation and the previous generation have had heart attacks or bypass surgery before age 60. I am a female though. Maybe I am off the hook?
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Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
A comprehensive medical follow up is advisable.

Detailed Answer:

Hello XXXX!

Thank you for asking on HCM!

I understand your concern, as you have a strong familial history for coronary heart disease.

Your doctor is quite right, when he confirms the positive protective effects of HDL cholesterol. This fraction is considered "good cholesterol", and the general approach when dealing with dyslipidemia, is to raise HDL cholesterol and lower LDL cholesterol.

Facing your strong heredity for ischemic heart disease, I would recommend you to follow a very meticulous scheduled program for lowering high LDL cholesterol. For the first three months a trial of diet and life style modification would be encouraged.

A healthy profile diet (I strongly would recommend Mediterranean diet) with low fat, and high fibers content would be the best choice to follow.

A daily scheduled physical activity (at least 1 hour walking, or aerobics, cycling, swimming, etc), avoiding smoking contacts, fighting eventual overweight, controlling possible high blood pressure, would help to reduce the risk burden for future cardio-vascular ischemic events.

If after around three months on these healthy multidimensional profile modifications, we are facing with a disappointing lipid profile results, then we have to call medications for help. A statin (Atorvastatin, Rosuvastatin, etc) would be helpful to achieve our objectives.

Remember that high HDL cholesterol is considered beneficial and protective against coronary ischemic events. Nevertheless, abnormally very high HDL cholesterol levels, are paradoxically found to be atherogenic.

So, at the end, I would like to explain that no one could do anything to change our inherited cardio-vascular genomics, BUT a variety of life style and medical interventions are possible to minimize overall risk for future ischemic cardio-vascular events.

I recommend you to be in close relationships with your attending doctor, to check periodically your medical status, and prevent potential future risks.

Hope to have been helpful to you. Greetings! Dr. Iliri


Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Ilir Sharka (30 minutes later)
Thank you doctor for your thoughtful response. I am low normal weight, have low normal blood pressure and have never smoked so would seem safe. However, the males in my family also have low normal blood pressure, low normal weight and have never smoked, and they exercised (which I do only erratically) and they still had heart attacks plus stents or bypasses. None of us follow a Mediterranean diet though, and that may hurt us in combination with our genes. My father now has Alzheimers and a neurologist said his high cholesterol may have contributed (he doesn't seem to have any other risk factors). I will try the Mediterranean diet and exercise (if I can make myself), and otherwise try a statin. I appreciate your help.
doctor
Answered by Dr. Ilir Sharka (15 hours later)
Brief Answer:
You are welcome!

Detailed Answer:

Hello again XXXX!

Though your close relatives have experienced ischemic heart problems and relevant medical interventions, you should not be distressed about possible future heart issues.

You fortunately have identified your weak inherited cardiovascular determinations, as well as your actual modifiable coronary risk factors (lipid profile, high LDL cholesterol).

All this clear medical background will be of utmost importance in keeping your blood vessels, especially coronary arteries, healthy and under close medical supervision.

You have now the right point of view on dealing with your medical concerns.

Feel free to ask me whenever your need.

Best Regards! Dr. Iliri
Above answer was peer-reviewed by : Dr. Pradeep Vitta
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Dr. Ilir Sharka

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Practicing since :2001

Answered : 8356 Questions

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What causes total cholesterol, LDL and HDL to be high?

Brief Answer: A comprehensive medical follow up is advisable. Detailed Answer: Hello XXXX! Thank you for asking on HCM! I understand your concern, as you have a strong familial history for coronary heart disease. Your doctor is quite right, when he confirms the positive protective effects of HDL cholesterol. This fraction is considered "good cholesterol", and the general approach when dealing with dyslipidemia, is to raise HDL cholesterol and lower LDL cholesterol. Facing your strong heredity for ischemic heart disease, I would recommend you to follow a very meticulous scheduled program for lowering high LDL cholesterol. For the first three months a trial of diet and life style modification would be encouraged. A healthy profile diet (I strongly would recommend Mediterranean diet) with low fat, and high fibers content would be the best choice to follow. A daily scheduled physical activity (at least 1 hour walking, or aerobics, cycling, swimming, etc), avoiding smoking contacts, fighting eventual overweight, controlling possible high blood pressure, would help to reduce the risk burden for future cardio-vascular ischemic events. If after around three months on these healthy multidimensional profile modifications, we are facing with a disappointing lipid profile results, then we have to call medications for help. A statin (Atorvastatin, Rosuvastatin, etc) would be helpful to achieve our objectives. Remember that high HDL cholesterol is considered beneficial and protective against coronary ischemic events. Nevertheless, abnormally very high HDL cholesterol levels, are paradoxically found to be atherogenic. So, at the end, I would like to explain that no one could do anything to change our inherited cardio-vascular genomics, BUT a variety of life style and medical interventions are possible to minimize overall risk for future ischemic cardio-vascular events. I recommend you to be in close relationships with your attending doctor, to check periodically your medical status, and prevent potential future risks. Hope to have been helpful to you. Greetings! Dr. Iliri