Cholesterol screening is a common part of routine blood tests during wellness checks with your primary care provider. But what exactly is cholesterol? What’s the difference between “good” and “bad” cholesterol? And what should you do if the screening shows that your cholesterol is high? Amitoj Marwaha, MD, a cardiologist at Valley, discusses these questions and more in this DocTalk video.
An abbreviated summary of the talk is below the video.
Learn more about cardiac care at Valley.
Cholesterol is important for living; it isn’t a fat, as many people believe. Rather, it’s a type of steroid that plays a vital role in how our body functions. Cholesterol is essential for maintaining cell membranes, forming certain hormones, and even creating vitamins. However, like many good things, too much cholesterol can lead to problems.
What are the different types of cholesterol and other blood lipids?
There are many types, but the two main ones are HDL, or high-density lipoprotein, and LDL, or low-density lipoprotein. HDL is often called the “good” cholesterol because it helps transport cholesterol to the liver, where it’s processed and removed from the body. On the flip side, LDL is the “bad” cholesterol, as it does the opposite—delivering cholesterol from the liver to the rest of the body. That’s where problems can start if LDL levels get too high.
How does cholesterol contribute to the risk of heart disease and other health conditions?
Excess LDL cholesterol can start to build up in blood vessels over time, forming what are called “plaques.” These plaques are like rust inside a pipe—gradually narrowing the vessel and reducing blood flow. If the plaque becomes unstable and breaks loose, it can block an artery, which can lead to a heart attack or stroke.
How can people reduce their cholesterol levels naturally through diet and lifestyle changes?
When it comes to lowering cholesterol, simply cutting out cholesterol-rich foods isn’t enough. It’s actually the fats you consume—particularly trans fats and saturated fats—that have the biggest impact. These fats, often found in animal products and processed foods, can raise cholesterol levels. We advise substituting them with healthier options, like vegetable oils or fish oils. Anything that’s liquid at room temperature is a better bet.
Also, exercise is important in controlling cholesterol; it not only helps lower LDL but can also raise HDL levels. There aren’t many things that can raise your good cholesterol, but regular activity can.
When would medication be needed to manage cholesterol levels, and what types are commonly prescribed?
While diet and exercise are important, some people may still need medication to keep their cholesterol in check, particularly if they have evidence of plaque buildup. Regular cholesterol screenings and online risk calculators can be used to assess your chances of developing coronary disease, heart attack, or stroke. If you’re in a high-risk category, medications are usually advised, with statins often as the first line of defense. While earlier generations of statins had more side effects, modern statins are much safer and are highly effective.
How often should adults have their cholesterol levels checked, and why is regular monitoring important?
For adults without significant risk factors, checking cholesterol is recommended every three to five years. However, if you’ve had a heart attack, stroke, or any plaque buildup, annual checks are important. If we’re adjusting your medications, your provider may check your levels again in three or four months to stay on top of cholesterol management once treatment starts.
What are some common myths or misconceptions about cholesterol?
First, that cholesterol is only a problem for older adults. We’re seeing more and more young people with high cholesterol, and plaque buildup can start as early as the late teens or early 20s. We are now seeing patients in their 20s with heart attacks, something that used to be extremely rare. The second myth: Just because you don’t feel any symptoms doesn’t mean everything’s fine. Cholesterol-related conditions are often silent, with no noticeable symptoms until something serious, like a heart attack or stroke, happens. Don’t wait for a warning sign; get checked.
What advancements in cholesterol management or treatment have been made in recent years?
PCSK9 inhibitors are a relatively new class of medication that offers a powerful alternative for those who can’t tolerate statins. These injectable drugs lower LDL levels by up to two-thirds, and while they’re still expensive, they offer hope for patients struggling with statin side effects. For example, they don’t have the muscle pain that some people experience with statins. PCSK9 inhibitors are also very effective when taken in conjunction with statins.
If a patient has high cholesterol, when should they be referred to a cardiologist?
Most patients with high cholesterol can be managed by their primary care provider, especially if their levels respond well to statins. However, if cholesterol remains high despite medication, or if side effects from statins are an issue, a referral to a cardiologist may be necessary. Other patients with plaque buildup or a history of heart disease, heart attacks, or strokes may also need to have specialized care.
Understanding Our DocTalk Videos
The information shared in the video above represents the opinions of the individual healthcare provider(s) featured. Our DocTalk presenters will sometimes give a general overview including risks, symptoms, and treatments for the medical conditions they are addressing. Therefore, they may not cover specific details that would be available in other resources or in an appointment with a provider about your own healthcare conditions. Please also note that the written summary may not capture every detail contained in the video, and additional information might only be in the video format. Our goal is to inform, educate, and inspire healthier living. If you have any questions about the video content, please contact us HERE.
