September is National Cholesterol Education Month, but awareness of cholesterol may take a different turn next year after the new 2015 Dietary Guidelines are announced later this year.
In their preliminary report, the government’s Dietary Guidelines Advisory Committee stated that dietary cholesterol may no longer be “considered a nutrient of concern for overconsumption,” downplaying the importance of lowering dietary cholesterol intake. The current guidelines, established in 2010, recommend eating less than 300 milligrams per day of dietary cholesterol, about what you would find in one egg.
“Blood levels of cholesterol are still very important, but it turns out that dietary sources of cholesterol are not nearly as important as we used to think,” said Dr. Quinn Pack, a preventive cardiologist in the Heart & Vascular Program at Baystate Medical Center. “Rather, dietary trans-fats and saturated fats are the primary drivers of elevated blood cholesterol.”
Cholesterol is a waxy substance used in making the walls that surround cells and in making a number of hormones used in human metabolism. Cholesterol is manufactured in the liver and is found in every cell in the human body. It travels through our bloodstream with the aid of lipoproteins, which can deposit cholesterol in the blood vessels, forming plaque and increasing one’s risk of heart attack and stroke.
The National Cholesterol Education Program currently recommends that adults age 20 and older have their cholesterol checked every five years.
“Cholesterol levels increase as people age and can change significantly depending on dietary habits, so even if your cholesterol levels were normal in the past, it’s still a good idea to get your cholesterol checked every five years,” said Dr. Pack.
There are two types of cholesterol: high-density lipoprotein (HDL) and low-density lipoprotein (LDL). HDL is also called "good" cholesterol. LDL is called "bad" cholesterol and the one referred to when talking about high cholesterol. These levels will be used to determine your 10-year risk of having a heart attack.
“If your overall risk for a heart attack is elevated, the new guidelines now recommend that the first line treatment is cholesterol-lowering statin drugs. Rather than just targeting specific cholesterol goal numbers, we now work to assure that patients take the highest intensity statin possible. The reason for the change is, over the years, we have learned that statins are good for reducing heart disease risk, regardless of your starting cholesterol numbers,” said Dr. Pack
“Also, a patient who has had a heart attack, even if he or she has had perfect cholesterol levels, should still take a statin drug because they reduce a person’s risk of having a second heart attack. For patients without prior heart disease, but with moderate to extreme levels of cholesterol, they should always be on statins, regardless of their risk factors and even if they lead a pristine lifestyle with plenty of exercise and a healthy diet,” he added.
Many risk factors contribute to having high or low cholesterol, including diet, lack of exercise, excess weight, age, sex, race (African Americans and Hispanics are at greater risk for developing high cholesterol), alcohol, and stress levels. For some, high cholesterol is inherited, but many times it is the result of eating too many trans fats, saturated fats, and dietary cholesterol from animal products. Some risk factors can be reduced by following a heart-healthy lifestyle, while others are beyond your control.
When lifestyle changes such as maintaining a healthy diet and weight, exercising regularly, and not smoking are simply not enough, there are other options such as the statin drugs.
Pack said those who cannot take statins like Lipitor or Crestor may have a new option in cholesterol lowering drugs called PCSK9 inhibitors – now in trial at Baystate Medical Center and across the country. These new biotech drugs, called monoclonal antibodies, block a substance called PCSK9 which ultimately improves the liver’s ability to remove cholesterol from the blood. They differ from statins in that they are injected every two to four weeks by patients, similar to the way a diabetic patient takes insulin.
For more information on the Heart & Vascular Program, visit baystatehealth.org/heart