What is the link between high cholesterol and heart disease?
High cholesterol is not the only factor in heart disease, but it’s a very significant factor. High blood pressure, smoking, diabetes, obesity and genetics also play a role.

How common is high cholesterol in men?
It’s becoming more and more common every day. High cholesterol goes hand in hand with our weight, which overall has gone up considerably, so in turn, cholesterol numbers are going through the roof. Another reason is that guidelines have changed. Total cholesterol in the 200s used to be considered normal; now anything over 200 is high. These changes were based on studies showing that people in the normal range were still having a considerable amount of heart disease such as angina and heart attacks. It is hoped that the new, lower guidelines will decrease some of our risk.

What is a lipid screen?
It’s a fasting blood test that measures total cholesterol, HDL (high-density lipoprotein), LDL (low-density lipoprotein) and triglyceride levels.

Your total cholesterol number should be below 200. HDL, known as the “good cholesterol,” should be 40 to 60, and the higher that number, the better, because it gives you some cardiac or heart protection. LDL, known as “bad cholesterol,” should be 130, or less for people with no heart disease or other risk factors. If people have other significant risk factors, this level should be below 70. We know if that number is left high, it contributes significantly to heart disease. Triglyceride levels should be 150 or less.

When should I start getting screened?
Because of obesity levels, we’re actually seeing teenagers and young adults with high cholesterol. So in your 20s, it’s a good idea to have a baseline test to see where you are. If you have a high cholesterol level when you’re 22 but don’t check it until you’re 50, it’s already done considerable damage. If your cholesterol is normal, you don’t need to be tested for five to 10 years. Testing frequency should increase as we age, or if our cholesterol is elevated.

What’s the course of action for high cholesterol?
Unless levels are sky high, I recommend that people first try to make modifications in their diet and exercise. I’m a big proponent of exercise, because it can play a considerable role in reducing cholesterol and triglycerides, and it also raises the HDL or good cholesterol. We recommend a heart-healthy diet, which emphasizes fruits, vegetables and whole grains, includes more fish and chicken, and less beef and pork. Omega-3 oils such as fish oil, canola oil, flaxseed or flaxseed oil may increase HDL. It’s also important to control high blood pressure and diabetes, watch alcohol intake and quit smoking.

How effective are cholesterol-lowering medications?
If lifestyle changes do not work, we often prescribe medication. For some people, these medications can be very effective. The main drug we use is in the statin class, which includes drugs like Zocor, Lipitor and Crestor. We also use niacin, which can also be purchased over the counter. One thing I see commonly is that people who are taking cholesterol-lowering drugs think they can forget about their lifestyle changes, such as diet and exercise. That’s not true, because the medication itself may not lower cholesterol enough, and sometimes that level will bounce right back up if lifestyle changes aren’t followed.

What are possible side effects of medications?
Statins can cause liver and kidney dysfunction, so we watch that closely. Patients often worry the most about muscle aches and pain, but that’s usually a mild side effect. If muscle pain is severe, we try to find a different medication that will work without side effects.

What warning signs should alert me to get tested for heart disease?
Chest pain or a squeezing pressure in the chest – especially during exertion such as exercise or climbing stairs – is a very definite warning sign. Some people will also notice that their endurance has dropped, or they’ll experience shortness of breath.