Managing High Cholesterol: Should You Choose Medication or Lifestyle Changes?

Q: Managing High Cholesterol: Should You Choose Medication or Lifestyle Changes?

Dear Ms. <br>Fei：<br>1. <br>According to the regulations of our national health insurance, patients with cardiovascular diseases or diabetes whose total cholesterol level exceeds 160 mg/dL or low-density lipoprotein cholesterol (LDL-C) exceeds 100 mg/dL may be eligible for pharma

High cholesterol

I have had high cholesterol issues since childhood.
After taking lipid-lowering medication for about a year, my cholesterol levels returned to normal.
My doctor believes I can try stopping the medication.
Since stopping, I have been exercising regularly and following dietary guidelines, but my cholesterol levels remain high.
Last month's report showed low-density lipoprotein (LDL) at 189, high-density lipoprotein (HDL) at 81, and triglycerides within normal range.
My doctor has allowed me to choose whether to continue medication.
I would like to ask the doctor if I can really choose not to take medication, or if it is advisable to continue using it.

fei, 20~29 year old female. Ask Date: 2018/02/09

Dr. Xiao Yongxun reply Internal Medicine

Dear Ms.
Fei:
1.
According to the regulations of our national health insurance, patients with cardiovascular diseases or diabetes whose total cholesterol level exceeds 160 mg/dL or low-density lipoprotein cholesterol (LDL-C) exceeds 100 mg/dL may be eligible for pharmacological management.
If there are two or more risk factors, non-pharmacological treatment should be attempted for 3 to 6 months; if total cholesterol remains above 200 mg/dL or LDL-C exceeds 130 mg/dL, medication can be considered.
If there is only one risk factor, non-pharmacological treatment should also be attempted for 3 to 6 months; if total cholesterol remains above 240 mg/dL or LDL-C exceeds 160 mg/dL, medication can be considered.
If there are no risk factors, non-pharmacological treatment should be attempted for 3 to 6 months; if LDL-C remains above 190 mg/dL, medication can be considered.
Cardiovascular diseases include patients with coronary atherosclerosis and ischemic cerebrovascular disease.
Risk factors include hypertension, males aged 45 years or older, females aged 55 years or older or postmenopausal, a family history of early coronary heart disease (males aged 55 years or younger, females aged 65 years or younger), HDL-C less than 40 mg/dL, and smoking.
2.
Based on the above criteria, you may indeed consider pharmacological treatment and management.
Your physician may have considered your young age, lack of specific risk factors, and borderline LDL-C levels, which is why there is no strong clinical recommendation for medication at this time.
I believe he is correct.
If you still have questions, it is advisable to discuss them further with him.
3.
Lifestyle modifications are very important, including dietary control, regular physical activity, good weight management, and smoking cessation.
Dietary control is particularly crucial.
You may already be aware of many aspects; in simple terms, chew your food thoroughly during meals, eat until you are about 80% full, avoid excessive animal fats or trans fats (including three-in-one coffee, two-in-one coffee, milk tea, butter, pastries, fried foods, etc.), avoid sugary beverages or high-fructose corn syrup, increase vegetable intake (steamed or blanched vegetables are sufficient), consume appropriate amounts of fruit, aim to eat natural foods, avoid processed foods, and do not overeat at dinner.
Additionally, ensure adequate sleep and engage in moderate daily exercise.
For more detailed information, please discuss with your physician.

Reply Date: 2018/02/09

More Info

Managing high cholesterol is a critical aspect of maintaining cardiovascular health, and the decision between continuing medication or relying on lifestyle changes can be complex. Based on your history of high cholesterol and the recent lab results indicating elevated low-density lipoprotein (LDL) cholesterol, it’s essential to weigh the benefits and risks of both approaches.

Understanding Cholesterol Levels
Your recent cholesterol report shows an LDL level of 189 mg/dL, which is considered high. The American Heart Association recommends that LDL levels should ideally be below 100 mg/dL for optimal heart health. On the other hand, your high-density lipoprotein (HDL) cholesterol is at 81 mg/dL, which is good, as higher levels of HDL are associated with a lower risk of heart disease. Your triglycerides being normal is also a positive sign.

The Role of Medication
Given your history of high cholesterol and the fact that you were previously on medication that successfully brought your cholesterol levels to normal, it’s understandable that your physician would suggest a trial off medication. Statins and other lipid-lowering medications can significantly reduce the risk of cardiovascular events, especially in individuals with a history of high cholesterol. However, these medications can have side effects, and some patients may prefer to manage their cholesterol through lifestyle changes alone.

Lifestyle Changes
1. Diet: It sounds like you have made significant dietary changes, which is excellent. Focus on a heart-healthy diet that includes:
- Fruits and Vegetables: Aim for a variety of colors and types.

- Whole Grains: Foods like oats, brown rice, and whole-grain bread can help lower cholesterol.

- Healthy Fats: Incorporate sources of omega-3 fatty acids, such as fatty fish (salmon, mackerel), nuts, and seeds, while avoiding trans fats and limiting saturated fats found in red meat and full-fat dairy products.

- Fiber: Soluble fiber found in oats, beans, lentils, and fruits can help lower LDL cholesterol.

2. Exercise: Regular physical activity can help raise HDL cholesterol and lower LDL cholesterol. Aim for at least 150 minutes of moderate-intensity aerobic exercise per week, such as brisk walking, swimming, or cycling.

3. Weight Management: If you are overweight, losing even a small amount of weight can help lower cholesterol levels.

4. Avoid Smoking and Limit Alcohol: If you smoke, quitting can improve your HDL cholesterol level. If you drink alcohol, do so in moderation.

Monitoring and Follow-Up
Since your physician has given you the option to choose whether to continue medication, it’s crucial to monitor your cholesterol levels closely. It’s advisable to have your cholesterol rechecked in about three months after making lifestyle changes to see if there’s a significant improvement. If your levels remain high, it may be necessary to reconsider medication.

Conclusion
Ultimately, the decision to use medication or rely solely on lifestyle changes should be made in consultation with your healthcare provider. If you feel confident in your ability to maintain a healthy lifestyle and your cholesterol levels improve with these changes, you may opt to forgo medication. However, if your levels do not improve or worsen, it may be in your best interest to resume medication to reduce your risk of cardiovascular disease. Regular follow-ups and open communication with your healthcare provider will be key in managing your cholesterol effectively.

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