In last week’s column, a description of the 4 major types of lipids measured on a cholesterol panel was provided.  To briefly review, the lipid panel is made up of the total cholesterol in the blood.  The higher the total cholesterol, the more likely the person is to have a stroke or a heart attack in some point in their life.  The second component was the HDL or good cholesterol.  Ironically, the higher this type of cholesterol, the less likely the person is to have a stroke or heart attack.  Values of 65 mg% or more are associated with longevity.  The LDL or bad cholesterol is the best single marker for heart attack or stroke problems in the future. Lastly, the triglyceride level is basically a measure of carbohydrates that were eaten in the previous week but not burned.  These carbohydrates are then changed into fat so they can be stored in the body for future use.

     A very common cholesterol problem occurs when the total cholesterol and the LDL cholesterol (bad cholesterol) are both elevated.  This most commonly results from a problem in getting rid of cholesterol in the body.  The liver has a system of chemical reactions that make cholesterol at about 1200 mg per day.  The family of “statin” drugs (Lipitor, Mevacor, Pravachol, Lescol, Zocor) inhibits the rate in which the body makes cholesterol and allows the disposal process to catch up; thereby, the total cholesterol in the blood is lowered.  This family of medications has been clearly shown to decrease the rate of stroke and heart attack in people with high blood cholesterols.  These drugs have the fringe benefits of decreasing osteoporotic changes and apparently acting as an antioxidant to prevent damage to blood vessels.  They have the side effect of causing muscle aching in some individuals.  A person with a cholesterol of  250 mg% or more and an LDL (bad cholesterol) of 160 mg% or more, the “statin” family of drugs are certainly the preferred medications.

     As I have stated before, nothing is ever simple in medicine.  It turns out that about half of the people who develop a heart attack secondary to cholesterol problems don’t even have a high total blood cholesterol or a very high LDL (bad) cholesterol.  Instead, they have a cholesterol pattern identified by a low HDL (good) cholesterol and a high triglyceride level.  This is a group of people who have the so-called “pattern B” or “small dense LDL pattern”.  This group of people will not benefit from the “statin” family of drugs.

     Medical science is yet to identify the basic cause of this abnormal cholesterol pattern.  We do know however that it is effectively treated by increasing exercise and decreasing caloric intake.  Note, this is in contrast to the patient’s who have high blood cholesterol and high LDL; that group of people can exercise all day long and many of them are thin to begin with.  Diet and exercise is not an answer to the person who has high total blood cholesterol and high (bad) LDL.

     Most recent surveys of the United States population indicate that more than 60% of the population is well above their ideal body weight.  Totally a fourth of the population qualifies as being obese and more than 10% of the population qualifies as being morbidly obese.  These numbers are testimony to the failure of “diets” as an answer for our overweight problem.  By the same token, individuals who have small dense LDL (bad) pattern of abnormal cholesterol are no better at dieting or exercise than the rest of the population.  While diet and exercise are an excellent answer on how to fix the small dense LDL (bad) pattern, it doesn’t seem to be an answer for the general population.

     Rather, medications are available that will change the small dense LDL pattern into a normal pattern but the “statin” group of drugs don’t work.  Specifically, drugs that seem to work for this pattern include Niacin, Gemfibrozil (Lopid), and Tricor.

     The group of people who have high LDL (bad) cholesterol and those with the small dense LDL pattern make up the 2 large groups of abnormal lipid patterns causing heart attacks and strokes.  There are many other blood lipid abnormalities that need to be treated in a different manner yet.  These individuals can be identified through lipid panels done at your local clinic.

     During the month of March 2003, the clinics of Rural Health, Inc. will be providing a special rate for lipid screening tests.  This is the time to get your blood cholesterol checked at a very cheap price.  New Medicare regulations will provide for a lipid-screening test once a year but will only cover a single component of the entire panel more than once a year.  Thus to monitor a patient’s medications in the future, Medicare will no longer cover the entire panel but only that single component that is being targeted by medications.

     The regulations and the considerations regarding an individual’s cholesterol panel can be reviewed with the healthcare provider at your local clinics.  Prevention of stroke and heart attack by effectively treating abnormal blood lipids is well worth the efforts.