It doesn't hurt, but it kills
What you need to know about "bad" and "good" cholesterol
Irina Nevinnaya, Rossiyskaya Gazeta
The fact that the cholesterol level is "off the scale", we often find out by chance: during a medical examination, for example. Or, much worse, when problems with blood vessels and the heart already begin, the pressure begins to jump. After all, cholesterol "does not hurt", but gradually kills, being one of the main factors in the development of atherosclerosis. What do you need to know about "high" and "low" cholesterol? What is cholesterol "bad" and "good"? From what age to control its level? Is it enough to follow a diet and is it necessary to take medications prescribed by a doctor? This was told to "RG" by Marat Yezhov, Doctor of Medical Sciences, leading researcher of the Federal State Budgetary Institution "Russian Cardiological Research Center" of the Ministry of Health of Russia, President of the National Society for the Study of Atherosclerosis.
– As you know, high cholesterol for the time being does not manifest itself in any way: a person feels normal. He doesn't have any pain. But what will happen if nothing is done, cholesterol is not controlled, not treated?
Marat Yezhov: Hypercholesterolemia is one of the main factors leading to atherosclerosis. Excess cholesterol accumulates, is deposited on the walls of blood vessels, affecting the coronary arteries, the vessels that feed the brain – the carotid and vertebral arteries, as well as the arteries of the lower extremities. Accordingly, a person develops coronary heart disease (CHD), cerebrovascular insufficiency, intermittent lameness and, as extreme manifestations, heart attack, stroke, gangrene and amputation of the lower extremities. Atherosclerosis is a mute enemy, it develops slowly and gradually. Accordingly, cholesterol can be called a silent killer without exaggeration. In Russia, according to WHO, 60% of the population has elevated cholesterol levels. Its extremely high values, this is already the data of our National Society for the Study of Atherosclerosis, in every tenth. And one in 200-300 people has genetic disorders of lipid metabolism.
– It is clear that the earlier deviations in the state of health are detected, the easier it is to recover. When should I start regularly monitoring cholesterol?
Marat Yezhov: On average, a 25-year-old person may have initial manifestations of atherosclerosis of the heart vessels. In general, if we take the entire population in our country, we are dealing with an average cholesterol level of about 6 mmol/l with a norm of up to 5. If a person is already ill with coronary heart disease, his total cholesterol level should not exceed 4, and low–density lipoproteins (LDL) - 1.8 mmol / l. Therefore, at a young age, it is worth regularly, at least once a year, to take an analysis to determine total cholesterol. If there are deviations from the norm, conduct more detailed studies (the so–called lipid profile – levels of low and high density lipoproteins – LDL and HDL, as well as triglycerides). And, of course, take measures together with a cardiologist.
– Why does the cholesterol level increase with age? Is the wrong diet to blame? Something else?
Marat Yezhov: The nature of this process is multifactorial. Classical risk factors are well known. They are divided into those that do not depend on us, and those that we can influence. The first include gender, age, family history, or, in other words, heredity. There are genetic "breakdowns" when extremely high cholesterol values – both 15 and 20 mmol / l – are detected already in infancy. No one understands why such a child tries to run and can't, starts crying. And he has a typical "chest toad", angina pectoris.…
Therefore, if there were early cases of strokes and heart attacks in the family, you need to be doubly attentive to your health and the health of children.
– And what can we say about the factors that we can influence? What is this way of life?
Marat Yezhov: Yes, of course. In addition to high cholesterol, hypertension is literally the leading risk factor. This is followed by hyperglycemia and diabetes mellitus, smoking, lack of sufficient physical activity, improper nutrition, when fats and carbohydrates predominate in the diet to the detriment of vegetables, fruits, seafood... Metabolic syndrome, which occurs as a result of an incorrect lifestyle, and leads to type II diabetes and hypertension.
– You mentioned "bad" and "good" cholesterol – these are low-density lipoproteins (LDL) and, accordingly, high-density lipoproteins (HDL), two fractions of cholesterol, whose levels are determined together with the level of total cholesterol. What is their role? Should the person himself figure it out, or is it a doctor's business?
Marat Yezhov: I don't see anything wrong if the patient tries to understand in detail what is happening in his body. After all, in this case, he will take a more responsible approach to treatment.
According to the most recent recommendations published in 2016 by the European Society of Cardiology, "bad" LDL cholesterol is recognized as the leading indicator for both diagnosis and decision–making on treatment. That is, we have to work specifically on bad cholesterol, trying to bring its content in the blood to normal. The indicator of triglycerides is also important – their high concentration is also in principle atherogenic, that is, it leads to atherosclerosis. In addition, the higher the concentration of triglycerides, the higher the risk of pancreatitis.
As for "good" cholesterol (HDL) – the higher its level, the better. It is believed that it is "bad" cholesterol that "settles" on the walls of blood vessels, forms plaques, leading to stenosis. "Good", on the contrary, is involved in the reverse transport of cholesterol and helps to remove it from the body. But all attempts to find drugs that would artificially increase the level of HDL failed. The researchers thought that if you achieve a high HDL, you can "start" the processes occurring in the body in reverse: the plaques will disappear, the risk of stroke and heart attack will be less. But it was not possible to implement this idea.
– That is, recommendations for patients: eat right, lead an active lifestyle, regularly monitor the level of "bad" cholesterol and glycerides and, if the doctor recommends, take medications that normalize their indicators. Statins are usually prescribed. But many are afraid of them – sometimes even doctors warn that they have a bad effect on the liver...
Marat Yezhov: As for the diet, even a serious restriction in the diet of animal fats and "fast" carbohydrates will not help bring cholesterol levels back to normal if it is seriously elevated. It is believed that by adjusting the diet, the maximum that can be achieved is a reduction of 10-15%. Therefore, drug therapy is mandatory. The "gold" standard for the correction of hypercholesterolemia, prevention of cardiovascular complications is really statins. And there is no need to be afraid of them, the probability of side effects when taking them is negligible compared, for example, with aspirin or paracetamol, which can be bought without a prescription at all.
In addition, other classes of drugs with a different mechanism of action have recently been developed and registered, which are used either together with statins, enhancing their effect, or independently. So the doctor has a lot to choose from, choosing the most effective therapy for the patient.
– But, probably, it is no less important that the patient performs these appointments. After all, we are talking, in fact, about lifelong medication.
Marat Yezhov: Yes, unfortunately, poor adherence to therapy is quite common. The patient says: I feel good, why take pills, "get poisoned"? Or he drank for six months, does not feel any changes, and the medicine is not very cheap. He thinks: well, what is the money to spend? But I repeat again: cholesterol does not hurt. But this is a "normal" state – for the time being.
And the second important point: we need early diagnosis and constant monitoring of these patients. Lipid centers are needed so that specialists can target such patients. Ideally, it would be right for every large institution to have a lipid cabinet. Now our society is developing the concept of such a program.
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22.09.2016