Receiving a call from your doctor’s office that your cholesterol is high can be rather scary. Let’s learn what the numbers in this panel really mean, and how doctors decide when it’s time for a medication. After receiving feedback from some of you in regards to the last post, in which I discussed how to interpret a CBC, or Complete Blood Count, I thought it would be useful to continue the series to talking about interpreting another test: your cholesterol panel. Controlling your cholesterol level is vital to heart health.
That’s because cholesterol plays a role in plaque build-up. And if enough of this build-up in the blood vessels exists, it can contribute to clogging of the arteries. This clogging causes diminished blood flow and oxygen to vital organs like the heart and brain, causing a heart attack or stroke, respectively. Therefore, it’s important to understand cholesterol so that we can help prevent heart disease, the number one killer of both men and women in the U.S
When and How Often Should You Get Screened?
According to the United States Preventive Services Task Force (USPSTF), an organization that sets evidence-based guidelines for clinicians to follow, the following groups should be screened for cholesterol: ·
- All men over the age of 35 ·
- Women over age 45 with increased risk for heart disease What are these heart disease risk factors? Having covered them in great detail, you may recall that it includes the following risks:
- Being male Age (the older the person, the higher the risk)
- Early family history of heart attack or stroke (first-degree relative females less than age 65 and males less than age 55)
- Diabetes Hypertension Cigarette smoking Obesity Abnormal cholesterol
- For younger people, they recommend screening men age 20 to 35 and women age 20 to 45 only if they have increased risk for heart disease. What about for others?
- For men age 20 to 35 without any risk factors and for women of any age without any risk factors, they do not make any recommendations due to lack of evidence.
It should be said, however, that these recommendations from reviewing evidence in 2008 are in the process of being revised. They also suggest a frequency of testing of five years for most patients, but earlier with those closer to requiring treatment and later for those with repeated normal cholesterol panels without risk factors for heart disease. The American Heart Association, on the other hand, recommends cholesterol screening every 4-6 years for all adults age 20 and older.
How to Interpret Your Cholesterol Panel
Attempting to decipher the multiple numbers in this panel can be daunting. Some values are preferred higher and some values are preferred lower. Which is which? And how do you sum it all up in order to determine if you need treatment? Well, let’s learn about the various components first:
Total Cholesterol This includes all various cholesterol panel components all summed up into one number. I wouldn’t get too excited if this number is elevated, as long as the other components are within normal limits. Because after all, your good cholesterol value (which is preferably elevated) is also included in the total. Therefore, if your good cholesterol is elevated, then your total will be too Here’s a formula for how the total is calculated: Total Cholesterol = LDL + HDL + 20% of your total triglyceride level
HDL This is termed the “good” cholesterol. Ideally, we prefer this number to be above 40. In fact, the higher the better, as it is heart protective. So if your other “bad” cholesterol numbers are elevated, having an elevated HDL will help to counteract some of that risk. How to increase this number? Through exercise and physical activity.
Triglycerides This is one type of “bad” cholesterol that reflects either a high fat or high carbohydrate diet. Diabetics consuming a high sugar diet and heavy alcohol drinkers often show a high triglyceride value. Also, note that if you show up non-fasting for your cholesterol panel, the other values can be calculated. However, the triglyceride may be elevated no matter what. Therefore, if an accurate triglyceride value is desired, a 12-hour fast (which means nothing to eat or drink) is ideal. A normal value is considered less than 150. But triglycerides are not typically treated until reaching 300 to 400. Very elevated values are important to treat because one of its main risks is causing a severe illness called pancreatitis (or inflammation of the pancreas) when left untreated.
LDL Lastly, but surely not the least, the LDL cholesterol represents arguably the most important value in the cholesterol panel, signifying the greatest correlation between cholesterol and heart disease. Elevated LDL levels indicate the greatest risks for plaque buildup in the blood vessels. The main group of cholesterol drugs used to lower heart disease risk most targets LDL cholesterol. A normal value is considered less than 130 for most people. Those with heart disease, diabetes, kidney disease, or being treated with medication may have lower LDL goals.
Interpreting the Need for Medication
The truth is, not everyone with elevated cholesterol panel components may require medication. Just because one or more of your values is elevated doesn’t mean that you are now required to take a statin. Doctors take your numbers into account, along with your risk factors for heart disease and stroke, and then determine your risk level. Here is a popular formula used by doctors to determine your risk and need for medication therapy, called a “Framingham Score,” which gives a score based on your cholesterol numbers, sex, age, and other risk factors, by finding your personal risk of heart disease development in the next 10 years. Now, you can be armed with the best information before your doctor asks you to return to discuss your elevated cholesterol levels. Find your Framingham Score and discuss what the best option for treatment for you will be.