LIPID DISORDERS AND HEART DISEASE

What is a lipid disorder?
It is more than just elevated cholesterol and more than elevated LDL cholesterol. Any abnormality in lipids (fats in the blood) that would increase risk of getting coronary artery disease and atherosclerosis.

We’ve all heard a lot about cholesterol, what else is there?
If you look at people that have coronary artery disease they don’t often have just one lipid abnormality. They don’t just have elevated total cholesterol. In fact, you can have normal cholesterol and have heart attacks. And you can have normal LDL (bad) cholesterol and still have a heart attack. You can have low HDL (good) cholesterol for example, and have heart attacks in presence of normal LDL cholesterol.

HDL is a protective cholesterol?
In lipoprotein-a, for example, 10 percent of people with lipoprotein-a can have heart attacks with a normal LDL. It’s a special LDL lipid particle.

Are there other lipid disorders?
There are others. For example, if you have high triglycerides and low HDL, commonly seen in diabetes, that’s a risk factor, or if you have small dense LDL particles instead of large fluffy ones, that’s a risk factor.

IMPROVED EARLY DETECTION

Now the average person isn’t going to know if they have any of this, right?
That’s right. And most doctors don’t have the laboratory facilities to really measure all these either.

Why is this important?
It’s important because with the way it’s approached now I think you reduce the disease about thirty, thirty five percent, we’re going to have to attack all these other lipid particles to get it on up toward a hundred percent.

PREVENTING LIPID DISORDERS

What two or three things can people do today to help prevent development of these lipid disorders?

Probably the most important thing that people can do is to avoid saturated fat in their diet.

We’ve heard that about cholesterol, but it holds true for all lipid disorders?
Most of them. Saturated fat is the most important thing. And people that have any problem in handling saturated fat should keep it out of their diet. And that’s probably three-fourths of the people in the country. There are some people that have no genetic abnormalities to speak of that can handle all this fat in their diet O.K. without getting disease, but that’s a minority of the population.

Is that an American or a worldwide phenomenon?
That’s a worldwide phenomenon. It’s seen very clearly, for example, in the Japanese population migration from Japan to Hawaii and from Hawaii to San Francisco. And if you expose this, or any, population to a high-fat diet they’ll get heart disease.

Anything else that can help prevent development of these lipid disorders?
There are other more minor things, like you should avoid too much cholesterol itself, although saturated fat is more important than cholesterol itself. Cholesterol – you could probably eat the equivalent of two eggs a day of cholesterol, but eggs are in baked goods and a lot of other places, so you have to know what you’re getting. And you have to add it all up, of course. And you get cholesterol from other sources like meats and dairy products and so on. So you have to know your foods, to add it up, but don’t just get up and have two eggs every morning.

Are high blood pressure and lipid disorders reversible?
You can treat them.

So not only can these behaviors help you prevent these conditions, they can reverse these conditions once they’ve developed?
The behaviors can have an effect, but you may have to use a medication to get the blood pressure or lipids to goal levels.

But we can’t at this point eradicate these conditions?
That’s right, these are problems that stay with you the rest of your life unless you’ve got a problem that is causing it. There are secondary causes of both hypertension and lipid disorders that when alleviated the blood pressure and lipid disorder can be corrected.

What might an example of that be?
Renal artery stenosis (constriction of the artery to the kidney) causing hypertension.

That’s just something that some people have and some people do not?
That’s right. Less than five percent of the population have secondary causes of hypertension. And an example of a secondary cause of high cholesterol that can be treated is hypothyroidism. Cholesterol goes up pretty high in hypothyroidism, but you give thyroid replacement medication and it comes down. So you have to be aware of things that can elevate but can be corrected.

What age should they begin to be monitored?
I think in their early twenties is a good time to begin. That’s about as early as people are going to be compliant enough to do anything with them. Teenage years and college years are rough. It’s tough, it just won’t go. I always say after twenty three then people have enough sense to do something.