Last month, we learned what lipids are, how they function in our body and what can happen if one’s lipid levels are too high. This month, Dr. Barry Tedder, board certified cardiologist and lipidologist, explains how he uses the data from a lipid panel to determine a patient’s long-term risk for developing heart disease and whether treatment would be beneficial.

“When I look at a lipid panel,” said Tedder, “I can tell a lot about your risk for diabetes and heart disease. For example, when triglycerides are mildly elevated in conjunction with a low HDL, I know you are pre-diabetic or diabetic. You are metabolically not healthy. High triglyceride levels usually indicate that you regularly eat more calories than you burn, especially sugar and starchy carbs. Or if your LDL level is over 190, it may indicate that you have a common inherited cholesterol problem associated with developing earlier heart disease. I sit down with my patients to discuss the findings and what the best course of treatment is.

“I use a 30-year risk assessment because almost half of heart attacks or strokes occur before age 60. Therefore, waiting until age 50 to 60 to start a prevention plan is basically waiting for advanced disease to already be present and too late to be effective. Heart disease is a long-term process that starts in your teens and builds slowly with time. If we want to avoid a heart attack at age 50, 60 or 70, we have to start in the 30s by addressing lifestyle changes and any lipid abnormalities or blood pressure problems with medications as needed. Besides the lipid panel, I look at all risk factors, age, smoker or nonsmoker, high blood pressure and, in particular, a family history of heart disease, when deciding whether or not to treat with medications.”

Tedder says that anyone with an LDL over 190 needs treatment regardless of age in order to prevent heart disease.

“The hard part is when you have an LDL between 120 and 160; that is when I really consider other risk factors,” he said. “A family history of heart disease is a big reason to treat high lipids. If you are in the intermediate range, I may use other blood tests like hscrp, Lp(a), blood sugar or A1C to help decide whether or not to address high lipids. A CT calcium score for patients over 40 can also provide useful information in determining a need for treatment. Lifestyle changes (exercise, smoking cessation, a quality diet, quality sleep, stress reduction, etc.) are always emphasized with anyone who has moderately elevated lipids.”

Tedder also noted that one in five individuals has an inherited elevated lipoprotein (a) level, which is an even stronger risk for having heart attacks, strokes and heart aortic valve problems.

“Unfortunately, there is no effective medical treatment for high Lp(a) as yet, making it even more important to address other risk factors,” said Tedder. “New drugs to treat high Lp(a) are in the development phase and should be on the market in the near future. Everyone should have their Lp(a) checked once in a lifetime.

“We are born with an LDL of 30. If we could maintain that LDL level our whole life, coronary artery disease would be rare. Your body makes plenty of the cholesterol that is necessary for bodily functions (as discussed in the previous article), so it is virtually impossible to lower your LDL cholesterol too much with medication, a common fear among patients.”

The doctor recommends that children should have their first lipid panel at 9, or earlier if there is a strong family history. Adults over 20 should have a lipid panel every four to six years as long as it remains within a healthy range; more frequently if they have a family history of heart disease or other risk factors like diabetes.

“What normal cholesterol is varies from person to person depending on your risk level,” said Tedder. “A 30-year-old healthy person versus a 60-year-old who has already had a heart attack will have different acceptable cholesterol levels. The target goals vary depending on one’s risk level. A healthy lifestyle from birth that includes eating nutritious foods, exercising regularly, avoiding cigarettes and having good sleep habits is the best way to prevent heart disease later in life.”

When asked if it was possible to prevent all heart attacks by keeping LDL low, Tedder said probably not because of other risk factors like smoking or diabetes.

“It is possible to reverse or shrink some plaque buildup in the arteries with medications that keep LDL to extremely low levels and by making lifestyle changes as mentioned above,” he said. “In order to live a healthy vigorous life as we age, we need to start thinking about coronary disease like we do cancer and screen or treat early with lipid lowering therapy as needed and by having healthy habits. It is a well-established fact that a poor diet, smoking, excessive alcohol use and a lack of exercise exacerbates your risk for heart disease and many other chronic illnesses.”

If you haven’t had your cholesterol checked in some time or ever, make an appointment with your family practice doctor.

(Editor’s note: Lisa Tedder is the wife of Dr. Barry Tedder, who practices at St. Bernards Heart and Vascular and specializes in preventative cardiology and lipidology. They reside in Jonesboro and have two adult children.)