What’s Up Doc column: Even young people can have high cholesterol

Dr. Jeff Hersh
Milford Daily News USA TODAY NETWORK
Miami News Record

Columns share an author’s personal perspective.


Q: I am only 23 and found out my cholesterol is high. Should I cut down cholesterol in my diet?

A: Hyperlipidemia (colloquially referred to as high cholesterol) is the medical word for too many “fats” (cholesterol and/or triglycerides) in the blood. There are usually no symptoms directly from hyperlipidemia; the major reason it is a concern is that it increases the risk of cardiovascular disease (CVD), meaning heart disease from blocked coronary arteries, strokes, peripheral vascular disease and/or other problems with arteries. Hyperlipidemia is a risk factor for CVD independent of other risk factors like smoking, obesity, high blood pressure, older age, sedentary lifestyle, diabetes, male sex, family history of CVD and others, and as such it must be evaluated in the context of the patient’s overall risk. There are risk calculators to help quantitate this risk, including the Mayo Clinic’s at https://www.mayoclinichealthsystem.org/locations/cannon-falls/services-and-treatments/cardiology/heart-disease-risk-calculator.

There are different “types” of cholesterol, a substance made by your body (although you also get it from certain foods) that is needed to make certain hormones. For simplicity, it is OK to think about these as LDL (low-density lipoprotein, considered the “bad” cholesterol since elevated levels raise the risk of CVD) and HDL (high-density lipoproteins, thought of as “good” cholesterol as higher levels are somewhat protective against CVD). In addition, high triglycerides (TG), a type of fat found in your blood, is also a risk factor for CVD.

Recommendations are that blood levels of all these should be tested every five years for everyone over age 20, and more frequently for those at increased CVD risk or for other concerns. The target levels for these depend on the specific patient’s overall risk factors, but in general, desired total cholesterol is less than 200 mg/dL, LDL less than 100 mg/dL, HDL greater than 40 mg/dL for men and 50 mg/dL for women, and TG less than 150 mg/dL.

Hyperlipidemia is extremely common. Over 20% of people in their 20s, almost 40% in their 30s, over 50% in their 40s, almost two-thirds of people in their 50s, and up to three-quarters or more of people 60 and older have levels higher than the desired levels noted above.

The first step to address hyperlipidemia should always be lifestyle modifications, both to improve the hyperlipidemia and to minimize other CVD risks. This includes smoking cessation, staying physically active, taking the medications prescribed by your health care provider and eating a healthy diet.

A healthy diet should include at least three servings of vegetables and two servings of fruit per day. Since your body makes cholesterol, minimizing cholesterol in the diet is not very useful. A healthy diet should limit fat intake to less than 30% of the healthy number of calories in your diet (discussed in a recent column), with a focus on which fats are eaten (to maximize HDLs, and minimize LDLs and TGs):

• Polyunsaturated fats (for example, in sunflower, canola, walnut, corn oils, etc.; oily seafood like salmon, herring, etc.; wheat germ and other foods) are essential to provide needed nutrients.

• Monounsaturated fats (for example, in olive oil, nuts, avocados, some dairy fats, lean beef, chicken and other foods) are considered the healthier fats.

• Saturated fats (for example, red meat other than beef, coconut oil, some dairy products and some other foods) are less healthy than monounsaturated fats.

• Trans fats (for example, in many industrial processed foods such as full-fat margarine, commercial baked goods, deep-fried foods, other foods) are considered unhealthy.

• Certain foods can actually help lower LDLs, such as foods with a lot of fiber (nuts, whole grains, beans, lentils, others).

If lifestyle changes (including dietary changes) are not sufficient to get the lipid profile to target levels, medications may be indicated. First-line medications are usually “statins,” a class of medication often successful at bringing lipids to the desired levels and shown to decrease the incidence of CVD events and the risk of death from them. Patients started on statins need to be monitored for possible intolerance and/or complications/reactions. If maximizing benefits from statins (by adjusting the dose as needed) is not sufficient, other medications may be considered.

Although poor lifestyle choices (as discussed above) may contribute to hyperlipidemia, there is usually a genetic component (often inherited, although with such high percentages of people having high cholesterol, the odds are that most people have some family history of elevated cholesterol ) as well. There is even an inherited condition where the patient will have extremely high lipid levels beginning in childhood, very significantly increasing CVD risk and sometimes causing heart attacks, strokes, etc. at very young ages (as early as the 20s in some patients).

Hyperlipidemia is common and is a major risk factor for CVD. The good news is that effective treatments exist, so everyone should be sure they have their cholesterol checked as per recommendations. Minimizing risk by optimizing lifestyle choices, including getting regular exercise, maintaining a healthy diet and weight, and not smoking is a great idea no matter what, as the benefits from these healthy choices include not only lower CVD risk but also lower risk for many cancers and many other diseases.

Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.