Ask Dr. Pat

Cholesterol Management: Prescription for Lifestyle Change Or Prescription for Medication

Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

Dear Dr. Pat:

Like so many women, I am overweight. I am 169 pounds and 5 feet, 3 inches tall.  I am a 55-year-old woman in good general health otherwise. I walk on a treadmill three times a week for 40 minutes but don’t really have time for much more after commuting to work and sitting at a desk for most of the workday.  I eat breakfast in the car, usually a breakfast bar and coffee and find that I can’t focus with the boring work I do unless I eat frequently.  I often stop at a fast food place near work on the way home because I can just drive through and eat on the way home.  After many attempts at losing weight, I have just accepted that my repetitive  work and long commute will make this impossible. I am single and don’t have much energy left for socializing on the weekends.  I am a bookkeeper and unemployment is high in my area in Pennsylvania so I can’t get another job that would be closer or more interesting.  I am lucky to have health insurance and a decent work environment in a stable company that offers on-site counseling, health seminars and even a weight loss group that meets daily for lunch with a nutritionist.  I just never take advantage of these support services because I don’t really see the point.

I gained most of my weight since menopause and  most of it is on my belly. I know this  isn’t good for my heart. My blood pressure is still normal, most of the time. My family history does worry me a bit, since my grandmother had a heart attack that caused her death at 80 years old. My mother and her sisters have high blood pressure and some heart enlargement. Everyone on both sides of my family has high cholesterol.  My cholesterol was reasonable until menopause three years ago, then the cholesterol jumped to a total cholesterol of 264, with bad cholesterol of 158 and good cholesterol of 62.

My GP encouraged me to start a statin but I have chosen not to do so, yet.  I read that there are new guidelines for the use of these statin drugs and hope that I might not have to take medication.  I would like to be able to talk to my GP with more information since I really don’t want to take this drug. What should I do to control my cholesterol?

Carla

 

Dr. Pat Responds:

Dear Carla:

Your question about the change in recommendations for cholesterol-lowering medications is timely.  This is a topic that has been discussed across the country between patient and doctor, in reports and editorials in many major medical journals and in the press, including here at Women’s Voices for Change.

I do understand that you have impediments to healthy eating and exercise with a long commute and repetitive  and sedentary work.  But, Carla, there are ways to make small changes in your life that can contribute to weight loss and stress reduction.  I acknowledge that it takes planning and determination, but here are my suggestions.

  1. Join that weight loss group that meets with a nutritionist at work. Support from other people who want to be healthier and are working together to help each other in a structured format is often a successful way to change old habits and find new ways to eat less and to make healthier food choices.  Social isolation can contribute to depression and loss of hope.  Joining the weight loss group at work is a good start to connecting to others.
  2. Make a list of manageable meals and snacks that are portable and easy to prepare when you come home at night.  Do careful grocery shopping and as much preparation as possible  for the week  during the weekend so that you can quickly make a salad and soup for your late evening meals during the week. Each work night, prepare breakfast, snacks and lunch for the next day and place in a modern insulated “lunch box” all  ready to grab for your long drive in the morning.
  3. It could be helpful if you spoke with the counselor at work about strategies that could help you drive past those drive-through cholesterol joints that have seduced you with their promise of “quick and tasty” so that you can make it home for a light and healthy evening meal. Cognitive Behavioral techniques teach us to change how we think, which will help us change how we feel and behave.
  4. I am glad to hear that you have access to a treadmill and that you walk 40 minutes three times a week.  Add 20 minutes to that regimen on the other days of the week.
  5. Ask your supervisor at work if you can have a standing desk.  Varidesk (and other companies like it) makes a relatively inexpensive, easy to assemble desk that sits on top of an existing desk. I use one at home and it gives me a break from the hours I sit at work. It is easy to move the desk up or down so that I can sit or stand but I find that I actually stand all the time now while working on charts or writing. My legs feel like I have a workout even when I haven’t done anything but stand.  Ask your doctor if she would write a note to your company suggesting that a modest investment in this standing desk would improve your health and energy.  I am thinking about buying another Varidesk for my consultation room at work.  I need to sit when I am in conversation with patients but I could quickly move the desk to a standing position when I have phone or computer work to do.  After all, “sitting is the new sugar” in terms of choices that are bad for health.
  6. Look for opportunities to join in physical activity in your community on the weekends. You might consider training for a walk that raises money for a charitable cause that means something to you.  It sounds like you spend much of your waking time indoors so joining others in physical activity outdoors would be good for mood and energy.

Americans have become accustomed to taking a pill that theoretically will  solve their medical problems when many of these problems might be better addressed with lifestyle change.  You may still need a drug to lower your cholesterol but if you can eat healthier, slowly lose weight, stand at a desk for part of every day and have some daily exercise, your heart health will certainly improve.

Dr. Kirsten Healy, a cardiologist and member of Women’s Voices Medical Advisory Board, will discuss  the subject of cholesterol management, as we know it in 2017. We have asked her to give us an answer to your question, based on her interpretation of how the current  guidelines inform—but not dictate—treatment.

Dr. Pat

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