With Cholesterol, Numbers Can Help Indicate Risk

Q:  My LDL cholesterol was 100 and my co-worker's was 60 when we both "clogged up." I required triple bypass surgery and he only needed stents. Now I'm on a statin to lower my LDL and raise my HDL cholesterol.

How can there be such a big difference in the effects our cholesterol numbers had on each of us?

A:  Although national guidelines suggest an LDL cholesterol of 100 or lower for people with heart disease, recent clinical trials suggest a target of 70 may be better. Goals for HDL ("good") cholesterol also depend on the individual's risk factors and medical problems.

The goal levels, created by the National Cholesterol Education Program, vary by individual risk category. "Very high risk" patients, those who have recently had a heart attack or those who already have cardiovascular disease plus other multiple risk factors including smoking, high blood pressure or diabetes, should reduce their "bad" cholesterol (LDL) level to 70, down from 100 under the old guidelines.

Drug therapy is recommended under the new guidelines for nearly all "high risk" patients with LDL levels higher than 100. Those at "moderately high risk" (estimated to have a 10-20% chance of heart attack or cardiac death within 10 years) need treatment if LDL levels are 130 or higher and drug therapy should be considered as an option for them if the levels fall between 100 and 129.

The guidelines did not change for those in the "moderate" to "low" risk categories, who should keep their LDL levels at 130 or lower and 160 or lower, respectively.

Once a person has significant narrowing of an artery to the heart, i.e. the coronary artery, the choice of the appropriate intervention depends on symptoms, overall medical condition (ability to tolerate open-heart surgery), the presence of diabetes, the number of arteries involved and the exact nature of the narrowing or hardening.

Doctors usually try to stent a narrowed artery - in which they put a hollow metal mesh tube in the artery to widen its opening - instead of performing surgery, if they can.

Although cholesterol is clearly a key player in the development of coronary artery disease, it's hard to say whether an LDL cholesterol of 60 would have saved you from surgery. I agree a statin is necessary for you now.

The US Preventive Services Task Force recommends all men over 35 and all women over 45 know their cholesterol levels and discuss any needed treatment with their doctors.

This article includes information from the HealthLink article New Cholesterol Guidelines for High-Risk Patients.

Julie L. Mitchell, MD, MS, is an Assistant Professor of Medicine at the Medical College of Wisconsin. She practices at the Froedtert & The Medical College of Wisconsin General Internal Medicine Clinic - East. Her column appears in the Milwaukee Journal-Sentinel.