I’m a 38-year-old white male, with a total cholesterol of 247 mg/dl; my LDL cholesterol is 179, triglyceride count is 123, and cholesterol/HDL ratio is 5.7. This is a family problem and my mother and grandmother take medication for it. I live healthily — I bodybuild and have a running routine — I run 3 miles one day and lift weights the next. I’m 5’8″, with a 185 lbs. bodybuilding figure. What can I take in the way of supplements, short of taking medication? I’m very concerned because my father died of a heart attack at age 42 in 1978.
Heart attacks, usually the end result of a process called atherosclerosis involving the large arteries, remains a major killer in all the developed countries; and — given the worrisome trend towards greater obesity in this country — may well become even more of a problem in the future. This is unfortunate because the death rate from cardiovascular disease, which includes heart attacks, has fallen steadily since the 1960s, probably due to fewer people smoking and better control of cholesterol and hypertension (high blood pressure). The question I have chosen today highlights some of the risk factors for this condition.
You have a total cholesterol of 247mg/dl, which is high for any lab. Similarly your LDL cholesterol, the component that contributes most to atherosclerosis, at least in men, is high. Most labs would consider anything over 130mg/dl to be borderline or high. Your cholesterol/HDL ratio is also high — less than 3.5 is desirable, and your HDL cholesterol (the good cholesterol) is 43mg/dl by my calculation, which is not as high as it should be. Cholesterol problems clearly run in your family.
You mention another strong risk factor (one that, unfortunately, no one can modify), and that is your family history — specifically, the death of your father, a first-degree relative, at the age of 42. Premature death from a heart attack, defined as death before age 55, in a first-degree relative increases a person’s risk. In part this family risk may be due to high cholesterol levels, but even if one mathematically takes cholesterol out of the picture, family history remains a significant risk factor.
Other risk factors are: hypertension, diabetes, cigarette smoking, physical inactivity, obesity, high levels of the chemical homocysteine in the blood, high levels of the clotting factor fibrinogen in the blood, and being male. We know that you are male, and that you do aerobic exercise, which is good. I would advise a cholesterol-lowering diet if you are not already on one, and if that does not lower the LDL within a couple of months, I would strongly consider starting medication, probably one of the statins which have been shown in several large recent trials to reduce heart attack risk. They may also raise your HDL slightly, but niacin in doses of several grams per day will do so more reliably. Niacin in sufficient doses is hard to take because of the flushing that it causes, but there are long acting preparations which might avoid this that you can discuss with your doctor. Aerobic exercise, which you are already doing, and modest alcohol intake, like one glass of wine per day, will also raise the HDL level.
Another area to attack will be your weight. Based on your height and weight, your body mass index (BMI) is 28.5, a figure that puts you in the overweight category — defined as a BMI greater than 27. Below 25 is considered a good BMI, above 30 is considered obesity. Given your cholesterol and family history, it would be desirable for you to be positively skinny. More of the aerobic exercise and perhaps less weight work, together with diet will help you shed some of that.
Assuming that you have no problem with hypertension, diabetes or cigarette smoking, the only other risk factor that might be worth working on would be the homocysteine level. This chemical, a normal breakdown product of amino acids, has recently been accepted as a risk factor for atherosclerosis if the level is high, and many labs are now performing this analysis. You might have your doctor check your level, since simple vitamin supplements with folic acid, vitamins B6 and B12 appear to reduce it. There are no large trials yet that have demonstrated that reducing the homocysteine level will reduce the heart attack risk in an individual, but since the treatment is simple, cheap and non-toxic, it would be prudent for you to check it out.
So in summary, you should really work on your cholesterol, with medication if diet alone won’t do it. More aerobic exercise and some weight loss will also help. The vitamins I mentioned may be helpful if your homocysteine level is high; but, other than that, there are no supplements which I can suggest.