High Cholesterol despite correct weight, diet, exercise...What to do?

[pdxgal]

This looks like a CYA, generic form letter response from the doctor, so I won't worry about it. As other have stated your Total/HDL ratio looks fine. I would be more worried if your doctor gave you this response to your face, when you already do so much of the recommendations. If so, it might be time to look for a new doctor that actually know their patients.

+1

 

[badatmath]

Check out the NNT (number needed to treat): https://thennt.com/nnt/statins-for-heart-disease-prevention-without-prior-heart-disease-2/

This was for no heart disease:

None were helped (life saved)
1 in 104 were helped (preventing heart attack)
1 in 154 were helped (preventing stroke)
Harms:
1 in 50 were harmed (develop diabetes)
1 in 10 were harmed (muscle damage)

Numbers are better if known heart disease.

1 in 83 were helped (life saved)
1 in 39 were helped (preventing non-fatal heart attack)
1 in 125 were helped (preventing stroke)

 

[Chuckanut]

Check out the NNT (number needed to treat): https://thennt.com/nnt/statins-for-heart-disease-prevention-without-prior-heart-disease-2/

This was for no heart disease:

None were helped (life saved)
1 in 104 were helped (preventing heart attack)
1 in 154 were helped (preventing stroke)
Harms:
1 in 50 were harmed (develop diabetes)
1 in 10 were harmed (muscle damage)

Numbers are better if known heart disease.

1 in 83 were helped (life saved)
1 in 39 were helped (preventing non-fatal heart attack)
1 in 125 were helped (preventing stroke)

The only problem with the above is that, IIRC, it is measured over only five years. CVD takes decades to develop so five years may not be enough to see a difference. Alas, such long term studies are difficult to do. My research has convinced me that CVD is strongly correlated with high LDL levels over the years. So I choose a low dose treatment. YMMV.

 

[badatmath]

The only problem with the above is that, IIRC, it is measured over only five years. CVD takes decades to develop so five years may not be enough to see a difference. Alas, such long term studies are difficult to do. My research has convinced me that CVD is strongly correlated with high LDL levels over the years. So I choose a low dose treatment. YMMV.

Oh I don't disagree at all. I simply thought it was interesting because I believe (in general) we prescribe too many medications to people to the point that we need medication to manage the side effects of the medication.

No one has as yet told me to take a statin so I remain blissfully able to not decide for now.

 

[Exchme]

Thanks. I can probably get those tests on my own, but I'll send a note to my Dr. to see if he will authorize such tests (so insurance will pay).

My cardiologist ordered a calcium scan, but the insurance did not pay. I did the calcium scan anyway ($130 a couple years ago) and the scan saw an artery that had more calcium than 80% of folks, so I got put on a statin. I found it weird that a test that the test the doctor used to diagnose a problem wasn't covered, but was told that was often the case with this test.

 

[UtahSkier]

For better understanding, read up on LDL; small dense vs large buoyant. Get an NMR lipid profile to see the nature of your LDL. High triglycerides is associated with small dense LDL, which is the bad LDL.

Your triglycerides being 100 suggests you are perhaps 60-40 good-bad LDL, which is fine.

 

[Dtail]

Some folks just seem to have elevated cholesterol, usually hereditary, and lifestyle may not matter.
Your blood sugar nd blood pressure are in good range to decrease risk of diabetes or hypertension.
Sometimes Statins are the answer, but not everyone will take them.

That is where I am/was. Had all good numbers except LDL, so started taking a statin 20 mg daily and now below 100.

 

[Sue J]

When my doctor tells me that I have a number higher than it should be I always ask , "Is this scary high? Or is it just not optimal?" So far it's always just not optimal. I can judge if it's just above the preferred number or way out of line.

This would be for cholesterol or triglycerides, not blood pressure.

 

[COcheesehead]

I have high cholesterol as well, it’s in the family, but my good cholesterol is off the charts so my ratios are good. I had an ultrasound done on my arteries and I show zero plaque. My doctor told me diet has only a minor effect on cholesterol. He used the example that you’d have to be eating a dozen donuts a day for it to matter. Instead, he said exercise is the best way outside of medication to control it.

 

[FIREd_2015]

I've had borderline cholesterol most of my life. My results from this past December was slightly higher than yours (Total - 227, HDL - 63, LDL - 141, Triglycerides - 110). Based on what I've read, a better test of cardiovascular risk is the Apolipoprotein B/A1 ratio. I've been using Jasonhealth.com (thanks to another forum member who suggested the site) to order my own tests. In addition to Apo B and Apo A I also test Homocysteine levels. Since I'm on ACA insurance it's cheaper to order it myself than go through insurance.

 

[audreyh1]

My Total cholesterol and LDL levels are higher than yours. Last LDL was 167. But my doctors think my blood levels are great because my HDL is high (69) and my triglycerides are quite low (63), and this gives a ratio below 1. That low ratio indicates large fluffy LDL particles dominate. We target triglycerides below 80.

A low-fat high carb diet does help keep LDL levels lower, but I’m not convinced that should be the goal. I think triglycerides and blood sugar staying low is very important. My high fat low carb (and no processed food/junk) diet keeps triglycerides and blood sugars way down. Developing pre-diabetes and diabetes is what significantly raises heart disease risks and avoiding that is more my focus. I do have A1C measured, and it is in a healthy range.

 

[badatmath]

. Developing pre-diabetes and diabetes is what significantly raises heart disease risks and avoiding that is more my focus. I do have A1C measured, and it is in a healthy range.

I am apparently the only living human that has never had A1C test. All my doctors only orders fasting glucose. I have asked why and they just kind of snap you don't need A1C you are fine. Like okay whatever I have no reason to suspect any issues in that department anyway.

 

[audreyh1]

I am apparently the only living human that has never had A1C test. All my doctors only orders fasting glucose. I have asked why and they just kind of snap you don't need A1C you are fine. Like okay whatever I have no reason to suspect any issues in that department anyway.

One of my more wellness oriented doctors tracks it because in his mind when blood glucose goes out of control "it is way too late - your body has already given up" - also meaning there has already been a tremendous amount of damage done to your body and your arteries and it's going to be way harder to reverse. He likes to track fasting insulin and A1C because together they help forecast trouble way ahead of time - years ahead. So does high blood pressure which is an advance symptom of metabolic disease which leads to diabetes.

In cases like this just use the internet ways to order the tests you want.

Some of these situations also are due to insurance covering things.

 

[athena53]

I've been using Jasonhealth.com (thanks to another forum member who suggested the site) to order my own tests. In addition to Apo B and Apo A I also test Homocysteine levels. Since I'm on ACA insurance it's cheaper to order it myself than go through insurance.

I use reqestatest.com, also suggested by someone on this site. No BS, no surprise bills. They tell you what the tests will cost, you pay it, you show up at the lab and typically results are on-line the next day.

 

[Amethyst]

You're not the only one. I first learned about A1C on this forum. Remember, it is filled with exceptionally cautious, conscientious folks who research everything to do with their health.

I am apparently the only living human that has never had A1C test. All my doctors only orders fasting glucose. I have asked why and they just kind of snap you don't need A1C you are fine. Like okay whatever I have no reason to suspect any issues in that department anyway.

 

[Chuckanut]

My Total cholesterol and LDL levels are higher than yours. Last LDL was 167. But my doctors think my blood levels are great because my HDL is high (69) and my triglycerides are quite low (63), and this gives a ratio below 1. That low ratio indicates large fluffy LDL particles dominate. We target triglycerides below 80.

A low-fat high carb diet does help keep LDL levels lower, but I’m not convinced that should be the goal. I think triglycerides and blood sugar staying low is very important. My high fat low carb (and no processed food/junk) diet keeps triglycerides and blood sugars way down. Developing pre-diabetes and diabetes is what significantly raises heart disease risks and avoiding that is more my focus. I do have A1C measured, and it is in a healthy range.

Regarding HDL and triglycerides, I remember reading about 5 years ago that the Trig/HDL ratio was a much better predictor of CVD than total cholesterol. My experience is that a lower processed carb diet lowers triglyceride.

FWIW, I have read that meds to raise HDL levels have been a universal flop. So far there is no evidence that using meds to raise HDL has any significant benefit on CVD. I could be wrong, so do your own research. Things change fast in the field of human health and there is a lot of bad science floating around. So I’ve been told.

 

[Luvtoride]

Just got the results of my yearly-physical blood tests, accompanied by a brief note from the doctor: "Total cholesterol elevated above 200 at 223 and LDL cholesterol elevated above 100 at 133. Recommend eating a healthy low-fat low LDL cholesterol diet and exercising regularly as tolerated to help with these. Other labs did not show any significant/concerning findings. Thank you."

Thing is, I'm an ovo-lacto-vegetarian, who consumes oatmeal, salads, and olive oil daily. I eat only low-fat dairy (I absolutely cannot stand vegan "dairy" products), barely touch cheese, and limit myself to 3 eggs a week. I eat sweets occasionally. I exercise every day, including three, 3-hour gym workouts per week. There's not an extra pound on me. There are no more lifestyle changes I can make.

For reasons no one seems able to explain, my cholesterol has been borderline high for the past 10 years (I'm 66). This time around, my fasting blood sugar was 82, my triglycerides 100, and my HDL was 69, which is not as high as previous years, but still well in the good range. Blood pressure runs 110/70.

My older siblings struggle with obesity, Type 2 diabetes and heart disease, so there's Family History to consider, but honestly, what else can I do?

Your thoughts are welcome. (I'm aware that diet and nutrition topics can get heated rather quickly - please try to avoid triggering Porky, thanks!).

I'd find a new doctor. Your doctor's approach to "guiding you" is insulting. Sending you a note with such generic recommendations is not helpful.

 

[badatmath]

You're not the only one. I first learned about A1C on this forum. Remember, it is filled with exceptionally cautious, conscientious folks who research everything to do with their health.

Yes. At least folks here try to research. I tried to join a hypertension forum and it is full of people going "I'm 19 years old and my doctor won't give me pills and my bp is 125/80 am I going to die". Um, not today probably. Just total panic and no attempt to look at the facts.

When I was 19 I thought I was invincible!

 

[JoeWras]

Yes. At least folks here try to research. I tried to join a hypertension forum and it is full of people going "I'm 19 years old and my doctor won't give me pills and my bp is 125/80 am I going to die". Um, not today probably. Just total panic and no attempt to look at the facts.

When I was 19 I thought I was invincible!

I actually feel bad for young people today. Their phone feeds them constant poison. No wonder they feel so down.

 

[Golden Mean]

My Total cholesterol and LDL levels are higher than yours. Last LDL was 167. But my doctors think my blood levels are great because my HDL is high (69) and my triglycerides are quite low (63), and this gives a ratio below 1. That low ratio indicates large fluffy LDL particles dominate. We target triglycerides below 80.

My GF (over 65) is the same. She's known as a lean mass hyper responder. I very much suspect this is the norm for most women eating a proper human diet.

It was probably mentioned in this thread that although you can push down your LDL count, it doesn't lead to longer life. All cause mortality increases as cholesterol drops below 210.

 

[Koolau]

W*rk with a doctor that you trust. If meds: They are very effective. If change in diet: Try it. If fugedabodit! Do so.

 

[RetMD21]

Op, you are low risk. The American college of cardiology would not recommend a statin or CA calcium scan.

https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/advice/riskgraph/

Docs probably hesitate to recommend Hgb A1c testing because it isn't approved for screening. Insurance may not cover it if they submit the correct codes

 

[Pluperfect]

I have a fraught relationship with medical tests. I'm the same age as the OP (66), but female. And unlike the OP, I currently have a diet high in processed foods and sugar. I've never been overweight, and have always had total cholesterol in the low 200s.

When I was in my early 30s a doctor told me to work on my diet and come back and get my cholesterol retested. I ate as I always did and came back and my numbers were better and the doctor congratulated me. My first experience with thinking, "Hmm..." when it came to cholesterol, and actually, medical advice in general.

A few years ago, I ran across a booth the hospital had set up and I got my blood sugar tested because my feet are always cold and one of my toes became red and sort of raw looking and I wondered if I had diabetes. My blood sugar was in the low 60s and I was told it was fine. (As I side note, on the way there we had stopped for dinner and I had a Jersey Mike's roast beef sandwich and several glasses of sweet tea, and refilled it for the road.)

Then right after that the local doc-in-a-box chain had free screenings, so I went several times using different names.

Here are my numbers, reading vertically for the first test, the second test three days later, and the third test 13 days after the second test. All tests were done with fasting.

Total: 232 189 227
HDL: 75 80 81
LDL: blank 75 125
Tri: 441 171 104
gluc: 115 123 111

Ack. I can't get the editing thing to let me put extra spaces in to spread the numbers out a little for readability. Sorry! I'll put them in this format, too:

Test 1: TC 232, HDL 75, LDL ---, Tri 441, gluc 115
Test 2: TC 189, HDL 80, LDL 75, Tri 171, gluc 123
Test 3: TC 227, HDL 81, LDL 125, Tri 104, gluc 111

But I want to show the numbers because of the big differences within a little over two weeks: that first test looks pretty scary, but the other two less scary but in different ways. Which one is "right"? (And I still don't get the glucose numbers, compared to my post-Jersey-Mike's-sweet-tea numbers, but I'm confident I don't have diabetes so I don't care.)

Then we have blood pressure. Whenever I get it tested, it's right after I've walked from the waiting room (where I've been sitting well past my appointment time no doubt) into the examining room (I walk fast, always) and I've been answering questions, and my blood pressure is almost always a little high. Plus I don't enjoy going to the doctor.

So they test it and I say, "Give me a minute--I can get it lower" and I concentrate on breathing deeply in and out and the subsequent reading is always fine. My heart rate is always high, period. So a few months ago I did an experiment, on one of those cuff machines the public can use, at a hospital gym.

I did test after test sitting there, without getting up. Here are the results, with blood pressure followed by heart rate:

132/73 101
107/70 94
123/74 94
122/71 95
107/78 95
114/82 96
113/80 100*
116/77 99*

*The last two were done with the conscious breathing I described above. These numbers tell me it helps only to lower an elevated blood pressure, and has no effect if my blood pressure is already "normal."

IIRC, the legend on the machine told me that the numbers on several of my readings indicated I had elevated blood pressure. But I don't think I do. And as with the cholesterol tests--which one of these is "my" blood pressure?

And finally, after my spate of cholesterol tests I started taking fish oil because I'd heard it would lower my cholesterol. After about four months, I got another cholesterol test and the total cholesterol wasn't significantly different. When the guy told me what the result was, I told him why I got the test and said, "So I'm not gonna take the fish oil any more," and he said, "You should take it anyway."

Huh? I didn't press it, but why?? I took it for something I could measure (unlike "brain health" or whatever) and didn't see a difference, so why continue to take it? Of course it could be that THIS test was wonky, and the fish oil DID dramatically decrease my cholesterol, but I'm just not interested in digging deeper into it. I wanted it to lower my cholesterol, but when it didn't, I'm more than happy to jettison it and close the book.

Maybe I'm just a medical freak, but my experience does show that for at least one person, test results really ARE just a moment in time, and could change from problematic to not that bad in a short period of time, for no discernible reason at all. I don't go to the doctor for checkups or anything, so I don't get bloodwork done, but after this, I know that if I did and got back results that indicated a problem, I'd get another test done as quickly as possible, without changing anything in my life.

And if I REALLY believed in the variability of tests, even if I got results that indicated no problems at all I'd get another test done as quickly as possible without changing anything in my life, because maybe the "okay" test was the anomaly. But of course if the first test tells me what I want to hear, who wants to get another test that might contradict it?

 

[street]

So, the ratio is triglycerides/HDL or total cholesterol/HDL. I have seen both which ones gives you the ratio?

Thanks

 

[audreyh1]

So, the ratio is triglycerides/HDL or total cholesterol/HDL. I have seen both which ones gives you the ratio?

Thanks

They are different ratios. Some use one, some use the other.