Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.

Best Indicator of Cardio Risk

Monday, 24 October 2011 01:00 PM

Question: You say that cholesterol is necessary for normal cellular function, yet you say the LDL level should be brought down below 130, preferably 100, and is best at or below 80.
Do you disagree, then, with the theory that cholesterol is the wrong indicator for cardiovascular disease, and, instead, one should monitor inflammation as indicated by CRP and homocysteine? As a 72-year-old with high cholesterol but negative CRP, I was just trying to pluck up the courage to stop statins (I've been taking them for 15 years) and check CRP and homocysteine instead. Should I?
Dr. Hibberd's Answer:
Monitoring homocysteine had its advocates in prior years, and like the CRP, it seems to indicate an elevated risk of cardiovascular disease and is best used as a yellow flag. However, they are not specific enough to indicate your medication use. Though folic acid supplementation may help some with elevated homocysteine, the treatment needs to extend further to deal with more specific vascular risk issues.
Cholesterol is a natural building block for our brains and spinal cord, so restriction and lowering strategies need to take into account the age of the patient and co-existing medical diseases. Plaque reversal takes place at LDL levels of 80, and this reversal will improve vascular supply to sensitive organs such as the brain and the heart.
The same does not apply to the growing brain of a child, so targets are definitively different for children. Target levels are also different in those of adults with brain injuries. This is where the hard and fast general guidelines issued for the general population may need expert interpretation and management.
I agree that cholesterol is ONE of many risk factors for premature heart and vascular disease. It needs to be considered in context with other risk factors, and therapy should be specific to each patient.
Other risk factors include:
• Smoking
• Level of physical activity
• Genetics
• Weight
• Gender
• Family history (hypertension, diabetes, or other diseases associated with premature vascular disease)
I would not want to permit elevated cholesterol levels on the basis of CRP or homocysteine levels, but I may be more inclined to manage you with high-fiber, low animal-fat diet advice, with some sensible omega-3 supplementation. Have your thyroid and blood glucose levels checked, as these may adversely affect lipid levels.
I see significant LDL reductions with third-generation, cholesterol-lowering drugs such as Lipitor and Crestor, and I know many cardiologists who use these medications as preventive to reduce their vascular disease risk. Consult your doctor and cardiologist before you self-manage your blood lipids. Ask them if a "drug holiday" is appropriate for you, and to set up a plan to manage your condition.

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Monday, 24 October 2011 01:00 PM
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