Dr. Alfred O. Berg, M.D., M.P.H. is Chairman
of the U.S. Preventive Services Task Force. He is Professor and Chair
of the Department of Family Medicine, University of Washington. Dr. Berg
is board certified in Family Practice and in General Preventive Medicine
and Public Health and is a member of the Institute of Medicine of the
National Academy of Sciences. He has been at the University of Washington
since 1977 and has held administrative positions in the residency section,
research section, and the WWAMI network of affiliated residency programs.
Lipid Disorders and Your Heart
Most people recognize the term "cholesterol" as being related to heart disease.
Having high levels of cholesterol in the blood is one of several "lipid disorders"
that can place you at increased risk for developing heart disease. Cholesterol
is a normal substance in the body needed to maintain health; however, too much
cholesterol can predispose you to coronary heart disease (CHD). Many people
think of CHD as a men's disease, but each year just as many women die of CHD,
making it the leading cause of death in the U.S. in both sexes, totaling more
than 500,000 deaths per year.
How do lipid disorders cause heart disease?
Cholesterol is carried through the blood bound to two types of lipoproteins.
Low-density lipoprotein (LDL) carries most of the cholesterol in the blood.
High levels of LDL can cause cholesterol to deposit in blood vessels, clogging
the arteries. Clogged arteries can reduce the flow of blood to the heart, causing
a heart attack. High-density lipoprotein (HDL) helps remove cholesterol from
the blood and helps prevent cholesterol from building up. The risk for heart
disease increases as levels of LDL increase, but decreases as levels of HDL
How do you know if you are at high risk of CHD?
Your risk of coronary heart disease is higher than average if you use tobacco,
don't exercise regularly, have a family history of heart disease, have a high
cholesterol level, or have diabetes or high blood pressure. If you do not have
any of the other risk factors, you should still pay attention to your cholesterol.
The U.S. Preventive Services Task Force (USPSTF), a group of experts charged
with reviewing the existing evidence on a number of medical conditions, recently
concluded that men should be screened routinely for cholesterol beginning at
age 35, women at age 45. Men and women with other risks for heart disease can
be screened for cholesterol as early as age 20. Even though cholesterol levels
generally begin to stabilize after middle age, the USPSTF indicated that screening
is still a good idea well after age 65, especially if you are otherwise in good
health and have not been screened before, or have experienced any change in
your health status such as gaining weight.
If you think you might be at risk, what steps should you take?
The most important interventions are those that everyone should be doing
to stay healthy: eat a balanced diet, exercise regularly, and don't smoke. Getting
a blood test for high cholesterol is also a good idea, because it can lead to
treatment before heart disease develops or worsens. Your clinician should measure
your HDL in addition to measuring total cholesterol. Reducing dietary saturated
fat and losing weight can lower total cholesterol and LDL cholesterol by as
much as 20 percent, but most patients are not able to reduce total cholesterol
by more than 10 percent after modifying their lifestyles (other lifestyle changes
were discussed in an earlier column on Coronary Heart Disease
Prevention for Women by Nanette K. Wenger, M.D. Therefore, cholesterol-lowering
drugs may be indicated if you are one of those who does not respond readily
to lifestyle changes. The USPSTF examined the one drug study that included women
and concluded that treatment appeared to be as effective in postmenopausal women
as in men.
The point here, as with all areas of your health, is to take charge of your
health early in the game and to know that help is available. Heart disease is
as much a problem for women as for men, but the good news is that most of it
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Created: 5/17/2001  - Alfred O. Berg, M.D., M.P.H.