Transcription:

Melanie Cole (Host): Whether you're looking to prevent heart disease or trying to prevent any further damage following a heart attack, your cholesterol levels play an important role in your health and the ability of your body to help fight disease. My guest today is Dr. Vivek Sailam. He's a cardiologist with Lourdes Health System. Welcome to the show, Dr. Sailam. So, I'd like to start by asking you to give a little physiology lesson to the listeners--what is cholesterol?

Dr. Vivek Sailam (Guest): Well, good morning, thank you for having me again on the show. It's a great pleasure. I wanted to give you a brief outline on what cholesterol is. It's a big topic, especially in the cardiovascular world. Cholesterol is a substance that is made by your body and is made up of different components. Specifically, the components or what we talk about in the office. There is an LDL particle; there's an HDL particle; and there's particles of triglycerides. Those are the main components of cholesterol and they are molecules that float in your bloodstream. The way I like people to remember it is that your LDL is your bad cholesterol, the “L” is for “lousy”; the HDL is your good cholesterol, and “H” is for “healthy”; triglycerides is the third component in these molecule structures that float around in your bloodstream. What's the big difference or the big issue with cholesterol, is that if there's too much of it in your body, it can get stuck in the arteries of your body, and with those, that can cause a blockage. Specifically, if there's a blockage in your heart artery, that can cause a heart attack and cholesterol can build up anywhere in your body, so it's very important to keep your levels at a minimum.

Melanie: Is cholesterol something, Dr. Sailam, that your body makes, that your body really needs, or do we get it from outside sources?

Dr. Sailam: Yes. Cholesterol is something that we make, and also cholesterol is something that we can get from our diet and outside sources. So, when we're born, our cholesterol levels are at a certain number, and in most cases, our LDL levels when we're born are about 30 or 40. Now, depending on your genetics, depending on your environmental factors, i.e., how you eat, what your lifestyle is like, those numbers can go up tremendously or they can stay level. So, cholesterol, yes. It's made in your body. It's a natural substance that is created by your body, you need it to survive, and then depending on your lifestyle and your genetics, the levels can rise dramatically.

Melanie: So, then, we all get our blood taken if we're somebody that's a real good health advocate and go to the doctor, get your blood, and they see all of these numbers for triglycerides and total cholesterol. Please explain those numbers, what they mean for the listener.

Dr. Sailam: Absolutely. That's a really big topic when patients come to see me in the office. They bring their lab work in and they're upset because they look at their lab work and they see a total cholesterol of let's say 250, and then they give you numbers specific to that saying your LDL is 130, your HDL is 75, and your triglycerides are 120. That's just as an example. What I tell patients, what I want everyone to be aware of is that the total number is not significant. It is the breakdown of the cholesterol that is significant, that may put you at risk for having heart disease or cardiovascular disease. So, in our literature that we have as far as data is concerned, the majority of the studies that have been done with cholesterol have been revolving around LDL cholesterol and LDL particle sizes. So, again, as I mentioned, that is the bad cholesterol or the lousy cholesterol that we have to focus in on. LDL has been implicated in causing a majority of the blockages in the body, so we work on trying to reduce LDL cholesterol size particles now, in most cases, for most patients, to reduce the risk of having cardiovascular disease.

Melanie: So, when people are looking at all of those numbers and you're talking to them about ways to change that, give us some of the risk factors and lifestyle modifications, things that affect your cholesterol.

Dr. Sailam: Yes, so, the big thing that affects our cholesterol, especially in the Western hemisphere, is our diet. Many of the foods that we eat are fatty foods and they contain large amounts of cholesterol. And, even some of the foods that are quote unquote supposed to be “lean”, have cholesterol, i.e. some of those foods that are common, that people don't know have a lot of cholesterol, are things like shrimp, lobster, and scallops. These types of foods have been touted as being healthy; however, they do have a lot of cholesterol in them. So, people have to be very conscientious about their diet. Now, in addition to that, if people have tobacco use, they're diabetic, have high blood pressure--all of these things will predispose patients for having higher cholesterol levels because of the inflammation in the body and the cholesterol levels can go up. So, it's very important to limit risk factors. Genetics also play a big part of your cholesterol levels. Certain individuals have genetic predispositions to having high cholesterol and that puts them at higher risk for having heart disease. It's very important to identify those individuals because they're going to need more aggressive treatment for their numbers.

Melanie: So, Dr. Sailam, now so many people hear about cholesterol medications when we're talking about treating high cholesterol with more than just lifestyle or if it's a genetic component. So, speak about some of the statins and things that they hear because people get concerned about the side effects of these medications versus their ability to lower our cholesterol numbers.

Dr. Sailam: For sure. Absolutely. That is one of the main concerns that patients have when they come to see us in the office is the side effects of medical treatment or medication treatment. In recent times, over the past 20 years or so, statins--I should say more than that, more than 20 years--statins have become the mainstay of treatment for cholesterol. Now, statin medications, as many of you may have known, have become very mainstream and they're part of the guidelines from the American College of Cardiology. They reduce cholesterol levels by blocking certain enzymes in your liver. So, they reduce the production and levels of LDL. Statin medications are the most studied medications that we use on the market at this time, and as far as side effects are concerned, there is certainly a concern with side effects. Some people cannot tolerate these medications because of muscle aches, because of joint pains, because of GI issues, and then these medications in certain cases, can affect your liver, too. So, the thing I always tell my patients is that if we use these medications at the proper dose, and we use them carefully, meaning that we monitor liver function, we monitor cholesterol level, and we use the right dose for the patient based upon their risk, the side effect profile is very low and its very safe. There are millions of people who are being treated with these medications and have very good safety profiles, as long as they're closely monitored, and that's an important part of using medication. As I mentioned, they are in our guidelines right now. They are part of an expanding criteria for treating patients because a majority of the data associated with cholesterol reduction revolves around statin treatment. We do have other medications now on the horizon; however, statins are the mainstay.

Melanie: If somebody goes on cholesterol medication, is this a lifetime medication or can they get off of it? And also speak about the exercise relationship to cholesterol levels.

Dr. Sailam: So, that's a very good question because it's a tough question, and, again, that's a question that's commonly asked in the office, too. "Can I get off these medications?" There are certain cases where patients can get off these medications if they have a dramatic lifestyle modification. Now, what does that mean? That means the patients will have to have a dramatic weight, a dramatic cessation of smoking. If they're diabetic, then they'd have to reverse their diabetes, their blood pressure would have to go do. So, basically, their risk profile would have to change dramatically. There are studies out right now and data that show that with lifestyle modification, you can have about a 15% reduction in your cholesterol level without medication. The hard part of this is to get people to do lifestyle modifications and if you want to talk about exercise, that's a huge part of lifestyle modification, because we have a sedentary lifestyle in the majority of cases. I'm a big proponent of exercise. I exercise three to four times a week and I see the results in terms of cholesterol reduction. The great thing with exercise is that not only do you reverse lifestyle patterns, you can reverse diabetes, you can reverse blood pressure, and you can also change your cholesterol profile, meaning you can increase your HDL levels with exercise and HDL, as I mentioned earlier, is your healthy cholesterol and it's protective. So, with exercise and dietary modifications, you can raise your HDL level, which will be protective, and lower your LDL levels, which again is great for benefits for down the road in terms of preventing cardiovascular disease.

Melanie: Dr. Sailam, I'd like you to take a minute and speak about some of the complementary things that people wonder about, because fish oil has been touted as helping to lower cholesterol, oatmeal--do any of these things hold merit?

Dr. Sailam: Fish oil is good if it is in a prescription strength. Most of the fish oil that we purchase over-the-counter has different amounts of active ingredients in them, so the efficacy of those particular medications that we purchase over-the-counter is not known. We have two prescription strength fish oil formulations on the market which would have to be given by your physicians. Those two medications that are on the market, in terms of fish oil, will lower your triglyceride levels as a majority of their usefulness. So, they will not lower your LDL levels to any great degree, they will not raise your HDL levels to any great degree, but if you have very high triglycerides, meaning that you have a genetic disposition to having high triglyceride levels, they will lower them about 40-50%. So, they are very useful for lowering triglycerides, but I do not want patients to think that taking fish oil over-the-counter is going to be terribly useful in terms of lowering their cholesterol levels as a whole. As far as oatmeal and dietary things, oatmeal will lower your cholesterol because it's healthy for you in terms of if you eat it plain without any excess sugar, but oatmeal lowers your cholesterol because you're not eating fatty foods with it, or you shouldn't be eating fatty foods with it.

Melanie: So, in just the last few minutes, give your best advice and wrap it up for us about cholesterol, what you think that patients really need to know and understand about those numbers that we see when we're looking at our cholesterol levels and why they should come to Lourdes Health System for their care.

Dr. Sailam: Well, I think that the most important thing with cholesterol that I see, especially in clinical practice on a day-to-day basis, is that we can't focus in on the numbers alone. The patients have to take these numbers and use those numbers in conjunction with their overall risk, and that will determine if they would have to take medications. Can we do lifestyle modifications with these patients? Or, do we need both? So, cholesterol numbers themselves, have to be used as a piece of data in the overall risk for a patient. And, why should they come to Lourdes for analyzing this data? Because I believe, I really believe this, is that our cardiologists here are the best in the area. They will take a patient's data, they'll put it together in a cohesive manner, and give the person a concise and clear treatment plan that is per the guidelines and we'll have good outcomes for these patients. That's really what I think gives us the advantage in terms of our competitors in the area, is that we give great, concise, cohesive care plans for patients and we have great outcomes.

Melanie: Thank you so much, Dr. Sailam, for being with us today. You're listening to Lourdes Health Talk. For more information, you can go to www.lourdesnet.org. That's www.lourdesnet.org. This is Melanie Cole. Thanks so much for listening.