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Cholesterol & Heart Health
Dr. Rich Gosselin discusses what cholesterol is and how it affects heart health, the difference between HDL and LDL, and diet and lifestyle changes to keep your levels in a healthy range.
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Learn more about Rich Gosselin, MD
Rich Gosselin, MD
Dr. Rich Gosselin is a cardiologist with the Montefiore St. Luke's Cornwall Cardiovascular Institute, specializing in cardiovascular disease and nuclear cardiology. He received his medical degree at the Georgetown University School of Medicine and completed his residency in internal medicine at the TUFTS Medical Center - Floating Hospital for Children. He is fellowship trained in Cardiology (University of Massachusetts Medical Center) and Interventional Cardiology (St. Vincent Hospital).Learn more about Rich Gosselin, MD
Transcription:
Melanie Cole (Host): Did you know that our bodies need cholesterol? Not everybody knows that, really. However, not every form of cholesterol is good for you and really, how do you manage it? This is Doc Talk presented by Montefiore St. Luke’s Cornwall. I’m Melanie Cole. And our guest today is Dr. Rich Gosselin. He’s a cardiologist with the Montefiore St. Luke’s Cornwall Cardiovascular Institute. Dr. Gosselin, I’m so glad to have you with us because what a great topic. Not everybody really knows what cholesterol is, whether it’s good or bad for you. Tell us what it is.
Rich Gosselin, MD (Guest): I’m very pleased to be on the show today Melanie. Thank you for having me on. Cholesterol is a way that our bodies store and deal with fats and it is as you said, a necessary component for the formation of cell membranes, the cells that make up the body, all the parts of our bodies. But too much cholesterol can cause a build up of plaque in our arteries which can lead to heart attacks and strokes and so we have to manage the levels of cholesterols in our body.
Host: So, let’s start with how we know. First of all, there’s different types of cholesterol. There’s good cholesterol, we hear bad cholesterol. These numbers that show up on our blood tests. Tell us about the different types and why they are good or bad.
Dr. Gosselin: So, we need to know our cholesterol and the way we do that is by having it drawn in a blood test. And the American College of Cardiology recommends that around the age of 20, everyone have their cholesterol levels checked and have it monitored every several years. The cholesterol profile, all the components of the cholesterol make up your total cholesterol. But it breaks down into good cholesterol which we call HDL or high density lipoprotein and LDL or low density lipoprotein as well as triglycerides. The LDL is the bad cholesterol and most of the guidelines that we practice by now focus on managing the levels of LDL and trying to lower our bad cholesterol.
Host: So, these different types of cholesterol exist in our system. How does the bad cholesterol contribute to heart disease? What’s happening?
Dr. Gosselin: So, when your levels of bad cholesterol are too high and certainly other risk factors are very important in managing this process as well. But the cholesterol can actually build up inside of the lining of the blood vessels which can narrow the space that the blood has to flow through the vessels. And also, this process can cause one of these cholesterol build ups or plaques to rupture and then a blood clot can form within the vessel. If a blood clot forms within the vessel of your heart, then that causes a heart attack. If a blood clot forms within the vessels that supply the blood to the brain; that causes a stroke. And so again, that’s why we want to make sure that we minimize the amount of LDL in our system.
Host: So, what causes high cholesterol? Is it our diet, Dr. Gosselin? Is it our sedentary lifestyle? Is it hereditary? Tell us what are some of the causes and what we can do about that.
Dr. Gosselin: Absolutely. For a lot of individuals, the levels can be managed and controlled with lifestyle type modifications. As you say, diet and cholesterol. Obesity. A sedentary lifestyle. All of those factors can contribute to our bad cholesterol being high. But unfortunately, for some people, it is purely a genetic process and they can run marathons and they can be vegan and eat totally plant-based diets and you would expect for most people that given that lifestyle, your cholesterol would be under very good control. But for some people, it’s just genetically not in the cards and they are going to have very high cholesterol regardless. And unfortunately, those individuals tend to be at highest risk for heart attacks and strokes. Particularly at a young age.
Host: So, then what do we do about it? If someone comes to you, they get their blood test with their primary care provider and their cholesterol level is high, they come to see a cardiologist; what’s the first thing that you do? Do we look right to medications, Dr. Gosselin or are there some things you really want people to try first?
Dr. Gosselin: Not necessarily. But the way the American College of Cardiology and the American Heart Association currently recommend looking at cholesterol and treating cholesterol; is looking at your overall picture of risk. And for patients that have already had a cardiac event, either a heart attack or stroke or stents put in; these individuals absolutely positively need to be on cholesterol medication regardless of whether or not they’ve made the attempt at lifestyle modification.
Similarly, people that have diabetes, current guidelines recommend that they should be on medication as well. People that have true familial hypercholesterolemia, what we talked about with this genetic predisposition to having high cholesterol where it runs in the family; these individuals, the current guidelines would also recommend that they should be started on medication immediately. Because the medications that we use are so incredibly powerful, in terms of reducing the risk of heart attack and stroke.
But all of those segments are really the minority of the population. For most individuals, depending on your overall level of risk; the first thing that we try to do is get them to improve their lifestyle by losing weight, increasing their amount of activity and managing their diet.
Host: So, when you say managing our diet, what does that mean Dr. Gosselin? Should we be trying to adhere to a plant-based diet, is it not necessarily that we have to go that far? What would you like us to do in terms of foods that can maybe help lower our cholesterol? Does fish help to lower it? What should we be doing?
Dr. Gosselin: Sure. So, certainly a plant-based diet is a very, very difficult diet for many people to adhere to and the average American has a difficult time staying on such a strict diet. Just minimizing the amount of fried foods in our diet, minimizing the amount of saturated fats, trying to increase fruits and vegetables, oatmeal in the morning can reduce your cholesterol a couple of points. And generally, avoiding fast food and also the other side of the equation with exercise. Increasing your exercise and losing a few pounds can certainly go a long ways towards doing that too.
If some individuals want to choose a plant-based diet and be strictly vegetarian or vegan; they will almost certainly see significant reductions in terms of their cholesterol, again, unless it’s a genetic predisposition with them. But for many people, that’s a very difficult goal to achieve.
Host: And you mentioned medications earlier and how powerful they are. Many people are afraid. They hear on the commercials Dr. Gosselin all those side effects of the statins and cholesterol medications. What are we to make of that? And tell us what the medications really are intended to do.
Dr. Gosselin: Certainly. So, we have several medications that we can choose from to manage people’s LDL or bad cholesterol, but the largest class of those medications is the statin medications. Medications like Lipitor, Zocor, Crestor; these are the medications that most of us have heard of and many, many, many of us have either been on or know someone that’s been on. They are very powerful in terms of reducing cardiovascular risk. And there are a lot of myths out there in terms of the frequency of symptoms. Certainly there are side effects associated with any or all medications and 10-20% of patients on statin medications experience side effects. But there’s a lot of kind of half truth data out there on the internet simply because of how frequently these medications are prescribed.
Upwards of 50 million Americans are on these medications and if 10% of people that are on the medication have side effects, that’s 5 million people. So, that’s a vocal majority. And many of us know that muscle aches are the biggest side effect with that, and we all have muscle aches occasionally. It’s very easy for people to have some mild aches and attribute that to the medication when sometimes it can be just from the amount of exercise you’ve been doing, and you can be sore from that.
Certainly if the symptoms are truly limiting someone and affecting their lifestyle; then the medication can be changed or adjusted in an attempt to help with these symptoms.
Host: So, then as we wrap up Dr. Gosselin, what great information. I mean this is something that so many people have questions about. What should our numbers be? What is a good level of cholesterol between HDL and LDL, what would you like us to see on that blood test and how can we achieve those really good numbers? Give us your best advice.
Dr. Gosselin: So, in 2013, the American College of Cardiology and the American Heart Association changed their guidelines and they really moved away from looking at certain target numbers. Again, this only applies to patients that have not had any kind of cardiovascular event or for patients that do not have the genetic predisposition or have diabetes. But for all other patients, the current guidelines would recommend that we assess our overall risk using a calculated equation to determine what the ten year risk of cardiovascular events is.
And if you are over a certain percentage or certain likelihood of an event; generally about 7.5%, the American College of Cardiology would recommend starting moderate intensity statin therapy which your doctor can obviously recommend certain types of medications that can do that. For other individuals, certainly people that have a very high risk more than 20% risk of heart attack or stroke in the next ten years, or individuals that have already had a cardiac event; they would recommend high intensity statin therapy in an attempt to reduce the cholesterol, the LDL cholesterol of more than 50%.
Host: So, now your best advice on what we can do to live that healthy lifestyle and keep track of our cholesterol.
Dr. Gosselin: Sure, well everyone starting from a very young age should be encouraged to be more active, be encouraged to modify their diet in a way that minimizes their cholesterol and their long-term risk and it’s not all about cholesterol either. Obviously, being overweight can lead to other health conditions such as diabetes, which is a very, very important risk factor in terms of long-term cardiovascular risk and smoking, we didn’t touch on but obviously that is a very powerful risk factor as well. So, diet, exercise, weightloss, these are the things that we should all be doing and trying to maintain a healthy active lifestyle from a young age and if we are able to do so; it’s something that we can carry with us throughout our lives and hopefully live to an old age and be active and have a good quality of life.
Host: Absolutely 100%. Great advice Dr. Gosselin. So important for us all to hear about the ways that we can manage our cholesterol, try and get it down with some of the lifestyle changes that you’ve mentioned. It’s so important. Thank you again for joining us and sharing your incredible expertise.
That wraps up this awesome episode of Doc Talk presented by Montefiore St. Luke’s Cornwall. Head on over to our website at www.montefioreslc.org for more information and to get connected with one of our providers. If you found this podcast as informative as I did, and I know that you did; please share with your friends, share on social media and be sure to check out all the other fascinating podcasts in our library. I’m Melanie Cole.
Melanie Cole (Host): Did you know that our bodies need cholesterol? Not everybody knows that, really. However, not every form of cholesterol is good for you and really, how do you manage it? This is Doc Talk presented by Montefiore St. Luke’s Cornwall. I’m Melanie Cole. And our guest today is Dr. Rich Gosselin. He’s a cardiologist with the Montefiore St. Luke’s Cornwall Cardiovascular Institute. Dr. Gosselin, I’m so glad to have you with us because what a great topic. Not everybody really knows what cholesterol is, whether it’s good or bad for you. Tell us what it is.
Rich Gosselin, MD (Guest): I’m very pleased to be on the show today Melanie. Thank you for having me on. Cholesterol is a way that our bodies store and deal with fats and it is as you said, a necessary component for the formation of cell membranes, the cells that make up the body, all the parts of our bodies. But too much cholesterol can cause a build up of plaque in our arteries which can lead to heart attacks and strokes and so we have to manage the levels of cholesterols in our body.
Host: So, let’s start with how we know. First of all, there’s different types of cholesterol. There’s good cholesterol, we hear bad cholesterol. These numbers that show up on our blood tests. Tell us about the different types and why they are good or bad.
Dr. Gosselin: So, we need to know our cholesterol and the way we do that is by having it drawn in a blood test. And the American College of Cardiology recommends that around the age of 20, everyone have their cholesterol levels checked and have it monitored every several years. The cholesterol profile, all the components of the cholesterol make up your total cholesterol. But it breaks down into good cholesterol which we call HDL or high density lipoprotein and LDL or low density lipoprotein as well as triglycerides. The LDL is the bad cholesterol and most of the guidelines that we practice by now focus on managing the levels of LDL and trying to lower our bad cholesterol.
Host: So, these different types of cholesterol exist in our system. How does the bad cholesterol contribute to heart disease? What’s happening?
Dr. Gosselin: So, when your levels of bad cholesterol are too high and certainly other risk factors are very important in managing this process as well. But the cholesterol can actually build up inside of the lining of the blood vessels which can narrow the space that the blood has to flow through the vessels. And also, this process can cause one of these cholesterol build ups or plaques to rupture and then a blood clot can form within the vessel. If a blood clot forms within the vessel of your heart, then that causes a heart attack. If a blood clot forms within the vessels that supply the blood to the brain; that causes a stroke. And so again, that’s why we want to make sure that we minimize the amount of LDL in our system.
Host: So, what causes high cholesterol? Is it our diet, Dr. Gosselin? Is it our sedentary lifestyle? Is it hereditary? Tell us what are some of the causes and what we can do about that.
Dr. Gosselin: Absolutely. For a lot of individuals, the levels can be managed and controlled with lifestyle type modifications. As you say, diet and cholesterol. Obesity. A sedentary lifestyle. All of those factors can contribute to our bad cholesterol being high. But unfortunately, for some people, it is purely a genetic process and they can run marathons and they can be vegan and eat totally plant-based diets and you would expect for most people that given that lifestyle, your cholesterol would be under very good control. But for some people, it’s just genetically not in the cards and they are going to have very high cholesterol regardless. And unfortunately, those individuals tend to be at highest risk for heart attacks and strokes. Particularly at a young age.
Host: So, then what do we do about it? If someone comes to you, they get their blood test with their primary care provider and their cholesterol level is high, they come to see a cardiologist; what’s the first thing that you do? Do we look right to medications, Dr. Gosselin or are there some things you really want people to try first?
Dr. Gosselin: Not necessarily. But the way the American College of Cardiology and the American Heart Association currently recommend looking at cholesterol and treating cholesterol; is looking at your overall picture of risk. And for patients that have already had a cardiac event, either a heart attack or stroke or stents put in; these individuals absolutely positively need to be on cholesterol medication regardless of whether or not they’ve made the attempt at lifestyle modification.
Similarly, people that have diabetes, current guidelines recommend that they should be on medication as well. People that have true familial hypercholesterolemia, what we talked about with this genetic predisposition to having high cholesterol where it runs in the family; these individuals, the current guidelines would also recommend that they should be started on medication immediately. Because the medications that we use are so incredibly powerful, in terms of reducing the risk of heart attack and stroke.
But all of those segments are really the minority of the population. For most individuals, depending on your overall level of risk; the first thing that we try to do is get them to improve their lifestyle by losing weight, increasing their amount of activity and managing their diet.
Host: So, when you say managing our diet, what does that mean Dr. Gosselin? Should we be trying to adhere to a plant-based diet, is it not necessarily that we have to go that far? What would you like us to do in terms of foods that can maybe help lower our cholesterol? Does fish help to lower it? What should we be doing?
Dr. Gosselin: Sure. So, certainly a plant-based diet is a very, very difficult diet for many people to adhere to and the average American has a difficult time staying on such a strict diet. Just minimizing the amount of fried foods in our diet, minimizing the amount of saturated fats, trying to increase fruits and vegetables, oatmeal in the morning can reduce your cholesterol a couple of points. And generally, avoiding fast food and also the other side of the equation with exercise. Increasing your exercise and losing a few pounds can certainly go a long ways towards doing that too.
If some individuals want to choose a plant-based diet and be strictly vegetarian or vegan; they will almost certainly see significant reductions in terms of their cholesterol, again, unless it’s a genetic predisposition with them. But for many people, that’s a very difficult goal to achieve.
Host: And you mentioned medications earlier and how powerful they are. Many people are afraid. They hear on the commercials Dr. Gosselin all those side effects of the statins and cholesterol medications. What are we to make of that? And tell us what the medications really are intended to do.
Dr. Gosselin: Certainly. So, we have several medications that we can choose from to manage people’s LDL or bad cholesterol, but the largest class of those medications is the statin medications. Medications like Lipitor, Zocor, Crestor; these are the medications that most of us have heard of and many, many, many of us have either been on or know someone that’s been on. They are very powerful in terms of reducing cardiovascular risk. And there are a lot of myths out there in terms of the frequency of symptoms. Certainly there are side effects associated with any or all medications and 10-20% of patients on statin medications experience side effects. But there’s a lot of kind of half truth data out there on the internet simply because of how frequently these medications are prescribed.
Upwards of 50 million Americans are on these medications and if 10% of people that are on the medication have side effects, that’s 5 million people. So, that’s a vocal majority. And many of us know that muscle aches are the biggest side effect with that, and we all have muscle aches occasionally. It’s very easy for people to have some mild aches and attribute that to the medication when sometimes it can be just from the amount of exercise you’ve been doing, and you can be sore from that.
Certainly if the symptoms are truly limiting someone and affecting their lifestyle; then the medication can be changed or adjusted in an attempt to help with these symptoms.
Host: So, then as we wrap up Dr. Gosselin, what great information. I mean this is something that so many people have questions about. What should our numbers be? What is a good level of cholesterol between HDL and LDL, what would you like us to see on that blood test and how can we achieve those really good numbers? Give us your best advice.
Dr. Gosselin: So, in 2013, the American College of Cardiology and the American Heart Association changed their guidelines and they really moved away from looking at certain target numbers. Again, this only applies to patients that have not had any kind of cardiovascular event or for patients that do not have the genetic predisposition or have diabetes. But for all other patients, the current guidelines would recommend that we assess our overall risk using a calculated equation to determine what the ten year risk of cardiovascular events is.
And if you are over a certain percentage or certain likelihood of an event; generally about 7.5%, the American College of Cardiology would recommend starting moderate intensity statin therapy which your doctor can obviously recommend certain types of medications that can do that. For other individuals, certainly people that have a very high risk more than 20% risk of heart attack or stroke in the next ten years, or individuals that have already had a cardiac event; they would recommend high intensity statin therapy in an attempt to reduce the cholesterol, the LDL cholesterol of more than 50%.
Host: So, now your best advice on what we can do to live that healthy lifestyle and keep track of our cholesterol.
Dr. Gosselin: Sure, well everyone starting from a very young age should be encouraged to be more active, be encouraged to modify their diet in a way that minimizes their cholesterol and their long-term risk and it’s not all about cholesterol either. Obviously, being overweight can lead to other health conditions such as diabetes, which is a very, very important risk factor in terms of long-term cardiovascular risk and smoking, we didn’t touch on but obviously that is a very powerful risk factor as well. So, diet, exercise, weightloss, these are the things that we should all be doing and trying to maintain a healthy active lifestyle from a young age and if we are able to do so; it’s something that we can carry with us throughout our lives and hopefully live to an old age and be active and have a good quality of life.
Host: Absolutely 100%. Great advice Dr. Gosselin. So important for us all to hear about the ways that we can manage our cholesterol, try and get it down with some of the lifestyle changes that you’ve mentioned. It’s so important. Thank you again for joining us and sharing your incredible expertise.
That wraps up this awesome episode of Doc Talk presented by Montefiore St. Luke’s Cornwall. Head on over to our website at www.montefioreslc.org for more information and to get connected with one of our providers. If you found this podcast as informative as I did, and I know that you did; please share with your friends, share on social media and be sure to check out all the other fascinating podcasts in our library. I’m Melanie Cole.