Is lowering your cholesterol one goal on your list of New Year’s resolutions?   With the insights gained from his medical practice, Thomas Matheson, M.D., volunteered to write about coronary artery disease for the January 2007 column, Health Matters, published by The Central Oregonian.  Understanding the facts will help you take better care of your heart.   Here is what Dr. Matheson has to say:

Some of the main progress and improvements in health care in this country have been the management  of coronary artery disease, both from the surgical approach, which would be a discussion at some other time, and the medical management of the elevation of cholesterol and triglycerides.

 The early research and theories on cholesterol and triglycerides in the 1960s and about the time of the Framingham study were that cholesterol might or might not have some significance.   The elevated triglycerides were first picked up in the sense that blood would be set in the Lab, and there would actually be a coat of fat on the top of the blood, and they began to research what this meant.

 Finally, we have the pattern today which is a total cholesterol, a triglyceride level and high density lipoprotein or HDL, which is a good or protective cholesterol product; and an LDL or low density lipoprotein, which is the bad cholesterol. LDL tends to invade the wall of the arteries, both large and small, and lead to arteriosclerotic problems, obstructive problems to vessels, stroke and heart attack.

The drugs that now are used to treat this entity are the group of drugs called statins: Pravachol, Zocor, Lipitor or Crestor.

The second group of drugs are drugs specifically designed to treat the elevated triglyceride component: Lopid or a new drug called Tricor. Niacin, which is actually a vitamin, in high doses has also been effective in changing HDL and lowering fat or triglyceride levels and is often used in concert with statins and/or Lopid.

There are four different patterns of cholesterol and triglyceride abnormalities, all of which have significant long-term risk in the sense of coronary artery disease.   

One is an elevated total cholesterol and an elevated LDL.

Two, a normal or minimally elevated cholesterol with a very low HDL.

Three, an isolated or independently elevated triglyceride or,

Four, a pattern with an elevated cholesterol, elevated triglyceride, elevated LDL and often a low HDL.  Treatment of these varies.

The statins have several effects.   One, they lower the total cholesterol, generally, they lower the LDL and can have some effect to raise the HDL, although it is less dramatic.  In the body, they also actually make the wall of the artery more slick, and therefore prevent the deposit of the LDL on the wall of the artery, as it just simply doesn’t stick.  This seems to be a very quick effect, and is felt to represent a reduction in risk of stroke and heart attack.

There have been a lot of studies on a frequency of a second heart attack or coronary event after a first heart attack, and it has been shown that statins dramatically reduce the risk of a second event.   It is harder to get research on the prevention of a first event, though the long-term Framingham studies indicate that the treatment of the cholesterol abnormalities reduces the overall cardiac risk.

The effects of Lopid and Tricor are to reduce triglycerides primarily. They may have some benefit in raising HDl, though it is not dramatic. The Lopid or Tricor can be used alone or they can be used in concert with statins.   However, there are some significant risks of side effects with this combination and this is generally monitored very closely.  The addition of niacin to these drugs often is beneficial, especially in lowering triglycerides and elevating HDLs, although this can increase the risk of liver problems. These, however, usually return to normal when the medicines are stopped.

 Research has shown that there has been a significant reduction in heart attacks or coronary events with the more aggressive management of cholesterol and triglyceride abnormalities, as well as many other lifestyle changes.

The management of cholesterol with diet, exercise and medication is certainly important in long-term health maintenance and needs to be incorporated into medications and lifestyle changes, but it does appear that we are reducing the frequency of the first heart attack, and we are certainly reducing the frequency of the second and subsequent heart attacks.

The treatment of coronary artery disease is a multiple directed program .   It includes correction of hypertension, if is it present; correction of obesity, if present; and increased regular exercise program for both general physical and cardiac conditioning; and correction of cholesterol abnormalities, again if present.  Total cholesterol should be lowered under 200, LDL, depending upon significant findings, should be lowered under 130 and in some studies after an actual coronary event it is felt to be lowered to a level of about 70; HDL should be elevated.  All of these factors combined can certainly improve lifestyle and reduce the risk of both coronary artery disease and fatal coronary artery events.

 Thomas Matheson, M.D., has offices in Pioneer Health Care Center , 1103 NE Elm Street .  He may be reached by calling 447-6263, or 447-3999 for an appointment .  Dr. Matheson is a Family Practice physician who has taken care of patients in Crook County since 1976.  Dr. Matheson was one recipient of the 2005 Mentor Role Model Award conferred by Minority Access at their Sixth National Role Models Conference. He was recognized for his participation in a mentoring / shadowing program for students.