Cholestrol - How Low Can You Go?

AS far as cholesterol is concerned, the lower the better.

A HIGH cholesterol level is known to increase one's risk of having a heart attack or stroke. However, in our efforts to lower cholesterol levels, how low should you go?

Consultant cardiologist Datuk Dr Khoo Kah Lin said the lower, the better of the bad cholesterol; especially for people who have other risk factors.

The bad guy here is the low-density lipoprotein cholesterol (LDL-C), the type of cholesterol that clogs up your blood vessels.

People at higher risk of heart attacks include those who have already had one, persistent cigarette smokers, people with constant chest pain (angina), those who have had an angioplasty or bypass surgery, and poorly controlled hypertension or diabetes.

Risk factors for heart disease

Major risk factors are those that research has shown to significantly increase the risk of heart and blood vessel (cardiovascular) disease like:

* Increasing age

* Male sex

* Heredity (including Race)

* Smoking

* High cholesterol

* High blood pressure

* Physical inactivity

* Obesity and overweight

* Diabetes mellitus

Contributing risk factors associated with increased risk of cardiovascular disease include stress and alcohol.

Numbers that count

The latest recommendation from the American National Cholesterol Education Programme (NCEP) for LDL-Cholesterol (LDL-C) is a target level of of 4.1, even for those who have none of the risk factors listed above, says Dr Khoo.

Patient risk category

You are still considered low risk if you have one or two major risk factors.You are in the moderate risk group if you have more than two risk factors including hypertension.

That means you are at risk of getting a heart attack within the next 10 years, unless you maintain an LDL-C level below 3.4.

If you have had a heart attack, that ups your risk score.

If you have more than two other risk factors, including obesity and smoking, you are in the high risk group, which makes you very likely to have a heart attack within the next 10 years, unless you lower your LDL-C to 2.6.

People with diabetes are considered to have a CHD risk equivalent, and should maintain a similar LDL-C level below 2.6.

If you have been treated for cardiovascular disease (angioplasty, bypass surgery) and have multiple risk factors, including diabetes, you are a persistent smoker, obese, have high blood pressure, metabolic syndrome or chest pain, you are at very high risk. If you are in this category, then your LDL-C should be between 1.2 and 1.8.

Is it dangerous to go so low? According to Dr Khoo, the current guidelines on LDL-cholesterol indicate the lower the better, especially for high-risk patients.

He says: "Patients may have hypotension (low blood pressure) or become hypoglycemic (low blood sugar) but there is no such thing in cholesterol. It is not possible for you to bring it down too low."

Reducing high cholesterol

Diet - Eat a healthy and balanced diet, reducing intake of saturated fats and food high in cholesterol. Control salt intake and avoid added sugar in your diet.

Increase fibre, oat bran is a good source, and fish, such as tuna and salmon, and eat more vegetables. By eating right, you can reduce your cholesterol level by seven per cent.

Exercise - Include physical activities that give your heart muscle a good workout. Ideally this should include 30 minutes a day of aerobic exercise such as brisk walking, cycling, dancing or swimming. With regular exercise, you can also reduce your cholesterol level by seven per cent.

Cholesterol-lowering drugs - For those who may not be able to achieve their LDL-C goals quickly, especially those required to bring down their LDL-C from 5 to 2, Dr Khoo would prescribe cholesterol-lowering drugs.

"When we need to aggressively lower the cholesterol level and maintain, we would give cholesterol lowering drugs that can further reduce the level by 15 per cent.

If cholesterol dialysis is required, your high cholesterol level can come from two sources - either the high-fat diet that you eat, or if you have a genetic condition that results in high cholesterol levels despite following the above three methods.

In such individuals, a lifestyle change and drug therapy is not enough and they need to receive cholesterol dialysis to physically remove the excess cholesterol.

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