WVFC is happy to welcome Dr. Holly Andersen, a member of our Medical Advisory Board. Dr. Andersen, Assistant Professor of Medicine at the Weill Cornell Medical Center,
has additionally served as the Chief Medical Resident for
the Department of Medicine and Director of Education and Outreach for
the Ronald O. Perelman Heart Institute at The New York Presbyterian
Hospital. She has also
been an expert panelist on internet webcasts and an on air medical
consultant to ABC World News Tonight, MTV, the CBS Evening News, NBC
Evening News, The Early Show, The Fox Television Network, The Fox News
Channel, and The British Broadcasting Company. Dr. Andersen speaks
extensively on preventive cardiology, cardiovascular disease in
athletes and in women.

Dear Dr. Andersen,

I am 50 years old and am in really good health and if I may say so, in really good shape. I am 5’5″ and weigh 115 pounds. I eat very carefully, avoiding most fats, and eat multiple small meals a day, all with lots of vegetables, fish and organic poultry that is skinless.  I eat low fat cottage cheese with fruit twice a day. I take a fish oil supplement for Omega 3 and calcium and Vit D.  I exercise every day, aerobic exercise 30 minutes and then 30 minutes of weight training and stretching alternating with Yoga and meditation. I never smoke and I have two glasses of red wine a week to improve my heart health.  My blood pressure is perfect, my pulse is low normal, and I have no illnesses. I take no medicines. I have a great life and very little stress.

But, I have a problem that seems to be genetic.  My mother and her family all had very high cholesterol, but lived to be in their late 80’s without strokes or heart attacks.  I don’t think that they used any of the lipid lowering cholesterol drugs that are being pushed these days.  My general internist feels that it is very important that I take one of these drugs. I tried lipitor but felt lousy on it.  I had muscle pain, nausea and just not well in general.  I gave it a month then I gave it up.  My total cholesterol is 270 and my LDL is 170.  My trigylcerides are normal.

Since my family did well with this same genetic cholesterol problem and I am otherwise healthy, how do I find out if it is essential for me to use these drugs?  Honestly, there is nothing else that I can change to lower my bad lipids.

I know you can only give general advice but lots of my friends are being pushed to take these drugs as well.  How do we know if we have to do this?

Thank you,

Margaret

Dear Margaret,

Congratulations: you certainly seem to be taking your health and particularly your heart health seriously.  It matters.  We have many good treatments and technologies today, but nothing replaces or is more important than a healthy lifestyle.  A healthy diet, regular exercise, and abstaining from smoking are crucial to good health.

Before counseling you, I would ask a few more questions.

• How “perfect” is your blood pressure?  Blood pressures of less than 120/80 are most desirable, but basically the lower, the better.
• What’s your waist-to-hip ratio?   Your body mass index (BMI) — a measurement of your weight indexed by your height — is 19.1. This is normal, but another important measurement to consider is your waistline. The fat stored in your abdomen stimulates the process of atherosclerosis (plaque formation in the arteries). The safest waistline for heart health in a woman is < 29 inches, although some reports say that waistlines under 33 inches are okay.  What’s yours?
• I am a big fan of yoga and meditation — although the benefits of these are more difficult to measure, I believe they significantly positively impact your health.

I would say the same for laughter, sleep, good companionship and optimism.

It is a good sign that your mother and her family lived into their eighties without heart disease or stroke, despite their high LDL’s and total cholesterols.  Perhaps you have a genetically potent HDL – the good or “scavenger” cholesterol — which helps rid your arteries from cholesterol and fatty plaque.  We have investigational assays to measure the effectiveness of HDL’s, but these are not clinically available.  How high is your HDL?  The higher, the better.  What are your triglycerides (another contributor to atherosclerosis)?  Fasting levels should be less than 150.

Margaret, depending on your answers, you may be feeling more or less at risk right now. You should be happy that you have so many good things going for you, but you are still more likely to die from cardiovascular disease than all cancers combined.  So what do you do? Should you add a medication that may help you further prevent this disease?

It is certainly not wrong to do so. I like my low to moderate risk patients to have LDL’s below 130, and like it better when their LDL is below 100. I discuss the risks and benefits of adding cholesterol-lowering medications with my patients quite frequently. I don’t tell my patients to take a heart medication that makes them feel bad, but today there are many medications to choose from, if one is not easily tolerated. Furthermore, I know that if a patient is reluctant to take a medication, they probably won’t – even if I prescribe it for them. You need to feel you are making the right choice for you.

You may wish to consider having a further test to better evaluate your risk. Although no test is perfect, you might talk to your doctor about one of the following:

• 
  Measuring your C-reactive protein, or CRP.  This protein, easily measured in your blood, has recently been established as an independent prognosticator of your cardiovascular risk. A recent study found that people with elevated CRP’s, even with acceptable cholesterol levels, can benefit from taking a statin medication.
• 
  A carotid doppler, which is an ultrasound image of your neck arteries. It can help determine if the process of atherosclerosis has begun.
• Lastly, (although I rarely order this test) a scan of your heart called an EBCT, which does expose you to some radiation, will give you a “calcium score” that roughly estimates the plaque build up in your heart.

Good luck, Margaret.  Continue your healthy ways.