High Cholesterol: Risks, Ratios, and Treatment Options

High cholesterol (Hypercholesterolemia)

Hello, I recently went to the hospital for a health check-up at the age of 40 and had a blood test.
The results showed cholesterol at 221 mg/dl and triglycerides at 117 mg/dl.
The doctor explained that cholesterol is divided into high-density lipoprotein (HDL) and low-density lipoprotein (LDL), so I went to a laboratory for further testing.
The results were HDL: 42 mg/dl and LDL: 116 mg/dl.
Is my cholesterol ratio too high? Am I at high risk for heart disease? Should I consider medication, or can I manage this with dietary changes? Why is only my cholesterol elevated while the others are within normal ranges? What do these numbers signify? Thank you for your explanation.

Chen, 40~49 year old female. Ask Date: 2002/07/03

Dr. Liu Jinyong reply Family Medicine

1.
Further related examinations are needed.

2.
The medical history and chief complaints are incomplete regarding diabetes mellitus (D.M.), smoking history, and heavy alcohol consumption.

3.
The patient wishes to undergo relevant examinations and treatment at a hospital near their residence, specifically the Department of Health's hospital.
Coronary risk classification: CHO/HDLC Quantiles
- Male:
- 5%: 2.94
- 10%: 3.30
- 25%: 3.95
- 50%: 4.88
- 75%: 6.09
- 90%: 7.30
- 95%: 8.02
- Female:
- 5%: 2.57
- 10%: 2.90
- 25%: 3.48
- 50%: 4.23
- 75%: 5.17
- 90%: 6.39
- 95%: 7.25
LDL: The National Cholesterol Education Program has indicated the following guidelines for LDL.
Risk Classification:
- Desirable: <130 mg/dl (3.36-4.11 mmol/L)
- Borderline: 130-150 mg/dl (3.36-4.11 mmol/L)
- High: ≥160 mg/dl (≥4.13 mmol/L)
VLDL is calculated using the following equation:
VLDL (very low-density lipoprotein cholesterol): Conventional units (mg/dl): VLDL = TRIG/5
If TRIG = 200, then VLDL = 40 (200/5 = 40).
Total cholesterol - HDLC - VLDL = LDL.
Friedewald indicated that this equation is not appropriate when triglycerides are greater than 400 mg/dl (4.52 mmol/L).
Ratio risk: Chol/HDLC
The Chol/HDLC ratio is determined by dividing the total cholesterol result by the HDLC result: 5.26.
Cholesterol ratio values may indicate high-fat, high-cholesterol foods, obesity, alcoholism, diabetes, familial hyperlipidemia, nephrotic syndrome, nephritis, chronic liver disease, cholestasis, hypothyroidism, etc.

An HDL-C ratio greater than 5.0 indicates a lower risk of atherosclerosis and coronary artery disease.
Possible causes of low HDL-C include familial hyperlipidemia, diabetes, liver disease, and kidney disease.

High LDL-C levels increase the risk of atherosclerosis and coronary artery disease.
Possible causes of elevated LDL-C include high-fat, high-cholesterol foods, familial hyperlipidemia, diabetes, liver disease, kidney disease, pregnancy, and hypothyroidism.
Recommendations: Individuals with abnormal lipid levels should receive nutritional counseling and regular follow-up examinations.
They should monitor their food intake and caloric consumption, limit sweets, high-cholesterol, high-fat, and high-calorie foods, moderate alcohol and tobacco use, engage in regular moderate exercise, monitor blood pressure and blood sugar changes, and maintain an ideal body weight.

Reply Date: 2002/07/03

More Info

Understanding high cholesterol and its implications for health is crucial, especially as we age. Based on your recent lab results, let's break down the components and their significance.

Your total cholesterol level is 221 mg/dL, which is considered borderline high, as the desirable range is less than 200 mg/dL. The breakdown of your cholesterol levels shows an HDL (high-density lipoprotein) of 42 mg/dL and an LDL (low-density lipoprotein) of 116 mg/dL. HDL is often referred to as "good" cholesterol because it helps remove other forms of cholesterol from your bloodstream. An HDL level below 40 mg/dL is considered a risk factor for heart disease, while an LDL level below 100 mg/dL is optimal. Your LDL level is within the near-optimal range, but your HDL is on the lower side, which can increase your risk for cardiovascular diseases.

The cholesterol ratio, calculated by dividing total cholesterol by HDL, is another important metric. In your case, the ratio is approximately 5.26 (221/42). A ratio above 5 is generally considered a risk factor for heart disease, indicating that you may be at a higher risk for developing cardiovascular issues.

Regarding your question about whether you are in a high-risk group for heart disease, the combination of your total cholesterol, HDL, and LDL levels suggests that you should be cautious. While your LDL is not excessively high, the low HDL level is concerning. Additionally, other risk factors such as family history, lifestyle choices (diet, exercise, smoking), and other health conditions (like diabetes or hypertension) play a significant role in your overall risk profile.

As for treatment options, lifestyle modifications are often the first line of defense. This includes:
1. Dietary Changes: Focus on a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins. Limit saturated fats, trans fats, and cholesterol intake. Foods high in omega-3 fatty acids, such as fish, can also help improve your cholesterol levels.

2. Physical Activity: Regular exercise can help raise HDL cholesterol and lower LDL cholesterol. Aim for at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous activity each week.

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

4. Avoiding Tobacco Smoke: If you smoke, quitting can improve your HDL cholesterol level.

5. Regular Monitoring: Keep track of your cholesterol levels and other cardiovascular risk factors through regular check-ups with your healthcare provider.

In some cases, if lifestyle changes are not sufficient to manage cholesterol levels, medication may be necessary. Statins are commonly prescribed to lower LDL cholesterol, but the decision to start medication should be made in consultation with your healthcare provider, considering your overall health, risk factors, and personal preferences.

In conclusion, while your cholesterol levels indicate some areas of concern, particularly with your HDL, there are effective strategies to manage your risk. It is essential to engage in a healthy lifestyle and have regular discussions with your healthcare provider to monitor your cholesterol and overall cardiovascular health. If you have further questions or concerns, do not hesitate to reach out to a healthcare professional for personalized advice.

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