From an interview with
Dr. Ravi Parikh, Cardiologist
McLeod Cardiology Associates – Florence

Cholesterol is a waxy substance. It’s not inherently “bad.” Your body needs it to build cells and make vitamins and other hormones. But too much cholesterol can pose a problem, according to McLeod cardiologist Dr. Ravi Parikh. 

How does cholesterol work?

Cholesterol is a normal part of the body; in fact, it’s found in every single cell in the body. There are two types of cholesterol; in layman’s terms, one is bad cholesterol and one is good. The bad cholesterol builds up plaque in the coronary arteries, which are the arteries that supply blood to the heart muscle. In addition to its other positive functions, the good cholesterol is responsible for clearing out some of the bad cholesterol and keeping it in check.

What do “my numbers” mean?

HDL is the good cholesterol, also called high density lipoprotein, and the LDL is the bad cholesterol, or low density lipoprotein. We check these cholesterol levels and track them over time to assess the risk of future disease. In patients who come in for the first time for a check up through their primary care provider, it really helps us gauge what kind of risk they have for what we call ‘major adverse cardiovascular events’ – strokes, heart attacks, vascular disease, blood clots or narrowing in the arteries in the legs. We have these fancy calculators where we plug all these numbers in and it provides us with a 10-year risk. We use these numbers to determine how to move forward. 

Who is at risk for high cholesterol?

People with the highest risk are those who have a family history of heart disease. If you have family members, particularly parents or siblings (men who are less than 55 years old, women who are less than 65) with cholesterol issues, you are at higher risk. Diabetes, smoking, having a sedentary lifestyle – these go hand-in-hand with having high cholesterol. So, while age and family history are important, other factors do contribute to that risk.

Are there symptoms if you have high cholesterol?

No. High cholesterol is very silent. That’s why the current recommendation is that any adult over age 20 should have their cholesterol checked once, and repeat it about every five years. This is the standard for healthy patients. For people who have had strokes, heart attacks, or have narrowing in their arteries, it’s more frequent, so anywhere from six months to a year until those levels are under control. Initially, we might recommend changes in diet and exercise as treatment, or we might start the patient on a statin, which is a cholesterol lowering medicine. If that’s the case, we may decide to check it after an eight-week period, and then usually about six months to a year later. 

What are preventive measures to help keep cholesterol numbers in a healthy range?

As for preventive measures, you can typically expect about a 30% reduction in your cholesterol with exercise, diet, and lifestyle modifications. If you’re a smoker, it’s good to quit smoking or to strongly think about it. If you have a sedentary lifestyle, it’s good to get on your feet and be active and exercising at least 20 to 30 minutes a day. That’s usually the first line treatment. 

There are medications that can reduce cholesterol levels. There’s statin therapy, so drugs like atorvastatin (brand name Lipitor) or rosuvastatin (brand name Crestor); those are very common medicines. There are also injectable medicines that are new, and there are other new medicines for cholesterol lowering for people who are statin-intolerant. 

To learn more, talk with a cardiologist near you.