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 | Cholesterol
By Micheal Spilane, MD
If you've eaten bacon and eggs at breakfast every morning for seventy years and have consumed twice your lifetime share of ice cream and prime rib, isn't it a little late to start worrying about cholesterol? The answer is no. It's probably never to late. Medical scientists have convincingly demonstrated that a fatty diet and elevated blood cholesterol are major risk factors for the development of heart disease, heart attack, stroke and sudden death. The good news is that changes in diet and cholesterol-lowering drugs can substantially decrease the risk of these morbid complications. Even in the elderly.
Cholesterol is a fatty molecule that is transported and stored in the body along with an attached protein. Depending on the type of attached protein, the cholesterol has differing functional and pathologic characteristics in the body's physiology. Low-density cholesterol complexes (LDL) cause blood vessel disease and are called bad cholesterol. High-density cholesterol complexes (HDL) actually help prevent disease and are called good cholesterol. The blood total cholesterol count is clinically less important than the types of cholesterol present.
Doctors used to believe that cholesterol and other fatty gunks slowly accumulated in the body's blood vessels over many decades, causing progressive narrowing and eventual blockage. If this theory were correct, treatment of a cholesterol problem in later life would not be expected to produce much benefit--like the horse is out of the barn. But research demonstrates that treatment of cholesterol problems in the elderly is nearly as beneficial as treatment in younger patients. Cholesterol and other fats do accumulate in the blood vessels over many years, but new evidence shows that blockage is usually caused by a blood clot that develops over a fatty deposit. For reasons that are becoming increasingly understood, these deposits can become inflamed and ulcerated, resulting in release of chemicals that promote the formation of blood clots. Effective treatment of cholesterol seems to inhibit inflammation of existing deposits, thus preventing blood clots and blockage of a vessel.
The bottom line is that cholesterol is bad and treatment is effective, and the treatment is effective even if begun in later life. What's the treatment and who should get it? Almost everyone can benefit from a low cholesterol diet, but those with high blood cholesterol levels benefit most and need to catch a bit of diet religion. The required diet is hardly an impossible one, but it does demand avoidance of things that are pretty tasty. Once habits are changed, the new diet becomes quite acceptable. Many geriatricians (including myself) were initially skeptical about the benefit of using cholesterol-lowering drugs to treat older patients. But things have changed! Numerous scientific studies show that these drugs are effective in older adults and have a low incidence of associated side effects. The most effective and most frequently prescribed cholesterol-lowering drugs are called statins. Many different pharmaceutical companies sell them, but the proprietary name of each has statin appended at its end (for example, simvastatin, pravastatin and atorvastatin). If a person is following a low cholesterol diet, use of these drugs can decrease the bad type of cholesterol by over 50 percent. And the drugs lower the bad cholesterol while boosting the good cholesterolthe ideal treatment result. Other types of cholesterol-lowering drugs are available and used, but they tend to be less effective and produce more side effects.
Before recommending treatment for cholesterol, a physician will analyze a patients risk for stroke and heart attack. The risk factors include the presence or absence of smoking, high blood pressure, diabetes, heart disease and family history of stroke or heart attack. Treatment with a cholesterol-lowering drug will be recommended at differing levels of LDL and HDL cholesterol, depending on the number of existing risk factors. Some experts are now advising cholesterol medication for all patients with diabetes or disease of the hearts blood vessels, even if blood levels of cholesterol are not elevated.
Do not be surprised if your doctor asks you to give up the bacon and eggs and switch to Grape Nuts. The doctor is trying to help you, and not help the mortician. If a cholesterol-lowering drug is advised, clutch your wallet but take the advice.
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