High cholesterol. Should I be worried?

[Monkey_in_suit]

Cholesterol 7.1 mmol/L (275 mg/dL)

HDL-Cholesterol 1.2 mmol/L (46 mg/dL)

LDL-Cholesterol 5.6 mmol/L ( 216 mg/dL)

Triglycerides 0.7 mmol/L (62 mg/dL)

Cholesterol and LDL-Cholesterol are high but how really bad are results? Should I be worried and what to do to get better results?

Would like to hear opinion from @Michael569, @undeather and others that know more about this topic

[undeather]

A LDL-Cholestrol of above 200 puts you in the 99th percentile - meaning that you are in the top 1% of people with high "bad"-cholesterol. This directly translates to an high amount of Apo-B particles in your blood, which are the atherogenic (atherosclerosis causing) parts of the LDL-molecule. This is a significant risk factor you should deal with, but it's not a cause for concern in the short run. Cardiovascular risk factors like cholesterol are functions of time and magnitude - meaning that they increase your risk of a stroke/heart attack to the extent of how long and strong (higher/lower numbers) they exert influence on your body. 

Also very important to consider is that there are many risk factors that go into that equation. If your blood pressure is normal, you don't have diabetes, are not obese, don't smoke - then your risk of getting into serious problems in the next 10 or 20 years is very low (I am assuming you are in your 20s/30s). That said, I am sure that it is in your interest to live a long and healthy life - therefore it's important to start working on this right now! 

The first and most important step towards better blood lipids/cholesterol is lifestyle modification! 
How does your diet look like? Are you overweight? Are you sedentary or is there some form of exercise routine in your life? 
I have seen that you are from Croatia, which is known for having one of the worst cardiovascular dietary patterns in central Europe.

Also, are there any early age heart attacks/strokes in yoru family history? Especially before the age of 60?

Edited January 12, 2024 by undeather

[LfcCharlie4]

@undeather why is Crotia worst? 

 

I am going there on holiday this year so guess will see their diet haha

[undeather]

1 hour ago, LfcCharlie4 said:

@undeather why is Crotia worst? 

 

I am going there on holiday this year so guess will see their diet haha

"one of the worst" - Some parts of Croatia show one of the worst cardiovascular risk outcomes across the whole european continent. One big factor is an increased consupmtion of high claoric, high saturated fat, high salt food plus a good amount of alcohol intake (especially beer!). This made Croatia the most overweight country in the european union. The healthcare system is also lacking in many different regards. It's really a shame, because the traditional croatian cuisine also involves many classic mediterranian influences (fish, olive oil, beans..), which is among the healthiest diet patterns you can find. 

That said, croatia is insanely beautiful and the people are pretty chill- I visit as often as possible because I also live only a few hours drive away. Enjoy your trip! 

Edited January 12, 2024 by undeather

[Monkey_in_suit]

9 hours ago, undeather said:

A LDL-Cholestrol of above 200 puts you in the 99th percentile - meaning that you are in the top 1% of people with high "bad"-cholesterol. This directly translates to an high amount of Apo-B particles in your blood, which are the atherogenic (atherosclerosis causing) parts of the LDL-molecule. This is a significant risk factor you should deal with, but it's not a cause for concern in the short run. Cardiovascular risk factors like cholesterol are functions of time and magnitude - meaning that they increase your risk of a stroke/heart attack to the extent of how long and strong (higher/lower numbers) they exert influence on your body. 

Also very important to consider is that there are many risk factors that go into that equation. If your blood pressure is normal, you don't have diabetes, are not obese, don't smoke - then your risk of getting into serious problems in the next 10 or 20 years is very low (I am assuming you are in your 20s/30s). That said, I am sure that it is in your interest to live a long and healthy life - therefore it's important to start working on this right now! 

The first and most important step towards better blood lipids/cholesterol is lifestyle modification! 
How does your diet look like? Are you overweight? Are you sedentary or is there some form of exercise routine in your life? 
I have seen that you are from Croatia, which is known for having one of the worst cardiovascular dietary patterns in central Europe.

Also, are there any early age heart attacks/strokes in yoru family history? Especially before the age of 60?

I am 30 years old. Everything else with my health is perfectly fine. I am not obese(190cm/75kg),I drink alcohol rarely, go to gym 2/3 times per week and I do weightlift there. My diet is not perfectly clean but I would say it's better than vast majority of people's diet. I eat red meat and processed food rarley. Only I don't eat enough vegetables. 

Downsides are a lot of stress because I have stressful job and bad sleep because of that. Also bad sleeping schedule as I go to sleep at 5am and wake up 1/2 pm. My job is sedentery also.

My uncle had heart attack in mid 50s and my grandma stroke in mid 70s.

I said to my doctor that stress is probably main reason for those numbers but she said it can't be the only reason.

Last few years my number were on higher side but never this bad. My last test was april 2022 and LDL was 129 mg/dL.

 

[undeather]

14 minutes ago, Monkey_in_suit said:

I am 30 years old. Everything else with my health is perfectly fine. I am not obese(190cm/75kg),I drink alcohol rarely, go to gym 2/3 times per week and I do weightlift there. My diet is not perfectly clean but I would say it's better than vast majority of people's diet. I eat red meat and processed food rarley. Only I don't eat enough vegetables. 

Downsides are a lot of stress because I have stressful job and bad sleep because of that. Also bad sleeping schedule as I go to sleep at 5am and wake up 1/2 pm. My job is sedentery also.

My uncle had heart attack in mid 50s and my grandma stroke in mid 70s.

I said to my doctor that stress is probably main reason for those numbers but she said it can't be the only reason.

Last few years my number were on higher side but never this bad. My last test was april 2022 and LDL was 129 mg/dL.

 

Okay - very interesting! Thanks for sharing!

Here is what I would recommend: 
- Don't stress out about this!  You are young, live an above average lifestyle and your previous blood test (2022) shows that you propably do not suffer from an inherited lipid-disorder (hypercholesterinemia). 
- From a medical perspective, I want you to do a checkup at an internal medicine doctor (if that is possible under your current circumstances). He should do an ultrasound of your carotid arteries and the heart. 
- I also want you keep an eye on your LDL! Defintitely do another screening in 3-6 months and see if it changed! There are plenty of potential reasons why your LDL almost went up 100 points in the span of that short period of time. While stress plays a role in LDL-synthesis, I agree with your doctor that this is unlikely only due to increased stress. I would put my money on a mixture of causes (increased stress, circadian changes, foods that screw with fasting mechanisms and lipids in the short term..)
- As for your diet, you hinted that you don't enough vegetables. This immediatly makes me think about you not getting not enough fiber, which is important because you might be a so called "cholesterol/fat hyperabsorber" and fiber blocks this absorption process to some degree! You don't have to go crazy on this, you can still enjoy your meats - but I recommend adding some fiber-containing foods to your diet (vegetables, beans, lentils, fruit, nuts..). You could also start adding "Psyllium Husk" to your protein shakes if you take them.
- If you eat a lot of saturated fat (butter, ghee, fatty meats..), you could start experimenting with replacing it with better fats like olive oil or leaner cuts! Again, don't go crazy on it!
- The big red flag is your stress level & sleep though! Stress, especially long term stressors and through activating the cortisol axis, can definitely elevate your LDL-C. Poor sleep quality is also known for scewing with your lipid-metabolism! Often, as well I think in your case, bad sleep is triggered by a stressful life. You should think about implementing some sort of techniques that help you dealing with the work-stress. This is a complex topic and might contain anything from a simple meditation-technique to breathwork you regularly do during worktime (alternate-nose breathing) or some form of active recovery like Yoga/Tai Chi or Qigong. There are also some supplements you can look into, which could improve your sleep (Melatonin 300mcg, Magnesium Threonate (300–400 mg), Apigenin (50 mg))

- Medications: I personally would not perscribe you a drug right now. This could be a temporary increase that will get better with time!

Cheers

[Monkey_in_suit]

On 12. 01. 2024. at 7:13 PM, undeather said:

Okay - very interesting! Thanks for sharing!

Here is what I would recommend: 
- Don't stress out about this!  You are young, live an above average lifestyle and your previous blood test (2022) shows that you propably do not suffer from an inherited lipid-disorder (hypercholesterinemia). 
- From a medical perspective, I want you to do a checkup at an internal medicine doctor (if that is possible under your current circumstances). He should do an ultrasound of your carotid arteries and the heart. 
- I also want you keep an eye on your LDL! Defintitely do another screening in 3-6 months and see if it changed! There are plenty of potential reasons why your LDL almost went up 100 points in the span of that short period of time. While stress plays a role in LDL-synthesis, I agree with your doctor that this is unlikely only due to increased stress. I would put my money on a mixture of causes (increased stress, circadian changes, foods that screw with fasting mechanisms and lipids in the short term..)
- As for your diet, you hinted that you don't enough vegetables. This immediatly makes me think about you not getting not enough fiber, which is important because you might be a so called "cholesterol/fat hyperabsorber" and fiber blocks this absorption process to some degree! You don't have to go crazy on this, you can still enjoy your meats - but I recommend adding some fiber-containing foods to your diet (vegetables, beans, lentils, fruit, nuts..). You could also start adding "Psyllium Husk" to your protein shakes if you take them.
- If you eat a lot of saturated fat (butter, ghee, fatty meats..), you could start experimenting with replacing it with better fats like olive oil or leaner cuts! Again, don't go crazy on it!
- The big red flag is your stress level & sleep though! Stress, especially long term stressors and through activating the cortisol axis, can definitely elevate your LDL-C. Poor sleep quality is also known for scewing with your lipid-metabolism! Often, as well I think in your case, bad sleep is triggered by a stressful life. You should think about implementing some sort of techniques that help you dealing with the work-stress. This is a complex topic and might contain anything from a simple meditation-technique to breathwork you regularly do during worktime (alternate-nose breathing) or some form of active recovery like Yoga/Tai Chi or Qigong. There are also some supplements you can look into, which could improve your sleep (Melatonin 300mcg, Magnesium Threonate (300–400 mg), Apigenin (50 mg))

- Medications: I personally would not perscribe you a drug right now. This could be a temporary increase that will get better with time!

Cheers

Thanks a lot!

Next week I will do checkup with internal medicine doctor.

[Monkey_in_suit]

Here are new results after 4.5 months. They are better

Any advices @undeather , @Michael569 and others?

I guess statins are not necessary now?

 

Complete Blood Count

Red Blood Cells: 4.40 mill/mm3 (Ref. Range: 4.50 - 5.90)

Hematocrit: 37.9% (Ref. Range: 37.0 - 53.0)

Hemoglobin: 12.6 g/dl (Ref. Range: 13.0 - 17.5)

Mean Corpuscular Volume: 86.1 fl (Ref. Range: 80.0 - 100.0)

Mean Corpuscular Hemoglobin: 28.7 pg (Ref. Range: 25.0 - 35.0)

Mean Corpuscular Hemoglobin Concentration: 33.3 g/dl (Ref. Range: 31.0 - 37.0)

Red Cell Distribution Width (RDW): 14.4% (Ref. Range: 0.0 - 14.0)

Platelets: 157 thousand/mm3 (Ref. Range: 150 - 440)

Mean Platelet Volume (MPV): 14.3 fl (Ref. Range: 8.5 - 12.5)

White Blood Cells: 4.3 thousand/mm3 (Ref. Range: 3.8 - 10.6)

 

White Blood Cell Differential

Segmented Neutrophils: 49.2% (Ref. Range: 44.0 - 70.0)

Eosinophils: 6.5% (Ref. Range: 0.0 - 7.0)

Basophils: 1.4% (Ref. Range: 0.0 - 1.0)

Lymphocytes: 34.4% (Ref. Range: 20.0 - 44.0)

Monocytes: 8.5% (Ref. Range: 5.0 - 11.0)

Absolute Neutrophils: 2.10 thousand/mm3

Absolute Lymphocytes: 1.50 thousand/mm3

 

Observations

Mild anisocytosis: Confirmed with smear

Presence of macroplatelets

Mild poikilocytosis

 

Lipid Profile

Total Cholesterol: 159 mg/dl (Ref. Range: 0 - 200)

Triglycerides: 53 mg/dl (Ref. Range: Normal: up to 150, Borderline: 151 to 199, High: 200 to 499, Very high: over 500)

HDL Cholesterol: 40 mg/dl (Ref. Range: Over 40)

LDL Cholesterol: 108 mg/dl (Ref. Range: Optimal: Less than 100, Near optimal: 100 to 129, Borderline high: 130 to 159, High: 160 to 189, Very high: 190 or higher)

 

Electrophoretic Lipidogram

Prebeta Lipoprotein (VLDL): Normal

Beta Lipoprotein (LDL): Normal

Alpha Lipoprotein (HDL): Slightly decreased

Chylomicrons: Absence

 

[Michael569]

@Monkey_in_suit whatever you've been doing the past 4 months, continue doing that, your lipids have improved significantly. Still not there at the ideal but so much better! 

 You could consider a statin for a short term while you continue working on the root cause or some form of supplement with decent evidence of cholesterol reduction. 

Also i think there is something else going on. Can't tell if you're low on iron, folate or b12 but something is pushing down your red cell profile, hemoglobin and hematocrit. Worth having that looked into in case you feel tired a lot. 

Edited May 31, 2024 by Michael569

[undeather]

10 hours ago, Monkey_in_suit said:

Here are new results after 4.5 months. They are better

Any advices @undeather , @Michael569 and others?

I guess statins are not necessary now?

 

Complete Blood Count

Red Blood Cells: 4.40 mill/mm3 (Ref. Range: 4.50 - 5.90)

Hematocrit: 37.9% (Ref. Range: 37.0 - 53.0)

Hemoglobin: 12.6 g/dl (Ref. Range: 13.0 - 17.5)

Mean Corpuscular Volume: 86.1 fl (Ref. Range: 80.0 - 100.0)

Mean Corpuscular Hemoglobin: 28.7 pg (Ref. Range: 25.0 - 35.0)

Mean Corpuscular Hemoglobin Concentration: 33.3 g/dl (Ref. Range: 31.0 - 37.0)

Red Cell Distribution Width (RDW): 14.4% (Ref. Range: 0.0 - 14.0)

Platelets: 157 thousand/mm3 (Ref. Range: 150 - 440)

Mean Platelet Volume (MPV): 14.3 fl (Ref. Range: 8.5 - 12.5)

White Blood Cells: 4.3 thousand/mm3 (Ref. Range: 3.8 - 10.6)

 

White Blood Cell Differential

Segmented Neutrophils: 49.2% (Ref. Range: 44.0 - 70.0)

Eosinophils: 6.5% (Ref. Range: 0.0 - 7.0)

Basophils: 1.4% (Ref. Range: 0.0 - 1.0)

Lymphocytes: 34.4% (Ref. Range: 20.0 - 44.0)

Monocytes: 8.5% (Ref. Range: 5.0 - 11.0)

Absolute Neutrophils: 2.10 thousand/mm3

Absolute Lymphocytes: 1.50 thousand/mm3

 

Observations

Mild anisocytosis: Confirmed with smear

Presence of macroplatelets

Mild poikilocytosis

 

Lipid Profile

Total Cholesterol: 159 mg/dl (Ref. Range: 0 - 200)

Triglycerides: 53 mg/dl (Ref. Range: Normal: up to 150, Borderline: 151 to 199, High: 200 to 499, Very high: over 500)

HDL Cholesterol: 40 mg/dl (Ref. Range: Over 40)

LDL Cholesterol: 108 mg/dl (Ref. Range: Optimal: Less than 100, Near optimal: 100 to 129, Borderline high: 130 to 159, High: 160 to 189, Very high: 190 or higher)

 

Electrophoretic Lipidogram

Prebeta Lipoprotein (VLDL): Normal

Beta Lipoprotein (LDL): Normal

Alpha Lipoprotein (HDL): Slightly decreased

Chylomicrons: Absence

 

You are doing AMAZING! Good job, man!
You just cut your cardiovascular risk in half - whatever you are doing seems to work incredibly well! 

Statins are never out of option, especially in presence of other risk factors or already manifest cardiovascular disease.
One could argue that by decerasing your cholesterol even further, you will gain additional benefits.
That said, judging from your blood lipids alone, I don't see a reason to put you on lifelong medication. 
We don't take statins short term.

As Michael already mentioned - there is a slight aberration in your red blood cell/hemoglobin count (which show a very light anemia) - it's common and nothing really to worry about - but might veil some sort of defficiency (most likely Iron! - which would explain the mild anisocytosis/poikilocytosis). Definitely check it out with your GP!



 

Edited June 1, 2024 by undeather

[MarkKol]

What did you do?

[Michael569]

11 minutes ago, undeather said:

We don't take statins short term.

#iwaswrong

What's usually the minimum you'd put a patient on statin for? 

[Yimpa]

1 hour ago, undeather said:

We don't take statins short term.

Why not?

[undeather]

1 hour ago, Michael569 said:

#iwaswrong

What's usually the minimum you'd put a patient on statin for? 

5 minutes ago, Yimpa said:

Why not?

Statins are one of those medications that really start showing a benefit after years of use. 
The number needed to treat (meaning the number of patients you need to put on a statin to prevent one cardiovascular event) really ramps up after 1-5 years. The longer people are on it, the stronger the effect size - which makes sense, since it doesn't really remove the plaque already build up in the arteries but slows down/stops it's progression. You see the same effects with blood pressure or diabetes medication - same principle at work.  That's why some doctors (not me) think about giving statins to 20-30 year olds - because they want to prevent ANY atherosclerosis in the long run. If you give someone a statin for, let say, 2 months, then the effect will be miniscule/non existent, while you expose the patient to potential side effects (which are rare and usually subside after you stop taking the drug - but still!)

If I put a patient on a statin, then that's usually a life long decision! It's very important to know that >90% of my patients who actually get on that drug are either a) severely high risk - usually after a myocardial infraction or stroke or b) suffer from a genetic disposition (familial hypercholesterolemia)

if someone wants to stop the drug, then we can do that as well - but I will make sure he/she knows the consequences - so they can make that decision with informed consent. 

[Yimpa]

@undeather very cool, thank you for the explaination! My mom was hesitant to start using them a couple years ago, but she’s doing much better now!

[Monkey_in_suit]

@undeather @Michael569  @MarkKol

Interesting that my diet is actually little bit worse as I moved to Argentina recently so I was indulging in local cusine sometimes.

On the other hand my stress level,anxiety level and sleep schedule is better. I didn't work so much last month and my job is high stress job.

But also I do feel tired and low in energy too much which confirms anemia. Also I was struggling with anemia in childhood.

What would you guys suggest for anemia? Any suplement and any specific diet?

As I am in new country I don't have my GP and here in Latin America considering my past experiences I don't trust doctor as much as in Europe so I would try to do on my own what is possible and consult with doctor if it is necessary only.

 

 

[Michael569]

6 hours ago, Monkey_in_suit said:

What would you guys suggest for anemia? Any suplement and any specific diet?

Diagnosis first. Make sure you actually have anaemia by getting your full iron panel medically invested.

Depending on the severity you may need to go on high dose for a few weeks up to few months. But always start with diagnosis because iron overlord can be quite harmful.

If you don't have a GP over there, could you maybe pay a private clinic? 

With regards to the diet, have you lost any weight recently?

[Monkey_in_suit]

On 02. 06. 2024. at 8:04 AM, Michael569 said:

Diagnosis first. Make sure you actually have anaemia by getting your full iron panel medically invested.

Depending on the severity you may need to go on high dose for a few weeks up to few months. But always start with diagnosis because iron overlord can be quite harmful.

If you don't have a GP over there, could you maybe pay a private clinic? 

With regards to the diet, have you lost any weight recently?

Private clinic is an option although I will go back to Europe for few weeks this summer so probably will do Iron panel there.

I lost few kilos but I was already skinny before. Now 190cm/71kg and few months ago I had 75kg