Diet and Nutrition

High cholesterol

07/01/1998

Question:

Are some people just predisposed to having high cholesterol? One side of my family has high cholesterol which concerns me, but I have family history for 250 years and nobody has died from heart related problems and most have lived a long life (typically late 80's to 90's). When I first found out my cholesterol was high, 220, I changed my diet to a high grain, very low fat, and did all of the stuff you are suppose to do. After 14 months it was 208, I expected it to be about 120. My doctor commented that my HDL level was higher than normal. Are there some people who can tolerate higher cholesterol without as much concern as the general public? Also I was 31 years old, in great health, and very active. Blood pressure was low, 108/65.
The reason I'm asking this is because my mother is at about 350 and has been put on medication which is causing many side effects. The doctor is adamant about getting the level down, and he claims if she doesn't she'll die early. He rips her about her diet, yet my father who eats the same food, as well as chips & snacks is at about 170.

Answer:

An individual's blood cholesterol levels are determined by a number of factors. Genetics plays a large role in determining cholesterol levels. Some individuals with familial hyperlipidemia have a genetic disorder that contributes to high levels of cholesterol. In both normal individuals and individuals with a genetic cholesterol disorder, diet has a significant impact on cholesterol levels. A diet that is high in saturated fats and trans fatty acids (i.e. those found in margarine and many process foods that use "hydrogenated" products) causes a rise in blood cholesterol levels.
Several diseases also affect lipids. Individuals with poorly controlled diabetes may have high levels of both cholesterol and triglycerides. Several diseases such as liver disease and some cancers result in a lowered cholesterol. In this setting, a low cholesterol may be a sign of declining health.
The total cholesterol is a number which reflects a composite of several cholesterol containing products. The two which have received the most attention are the LDL (low density lipoprotein) and the HDL (high density lipoprotein). It is often important to know the levels of these two lipids in order to assess one's cardiovascular risks. LDL's tend to deposit cholesterol in blood vessel walls and contribute to the formation of placques, or blockages in arteries. HDLs tend to scavenge excess cholesterol and remove it from blood vessels. High levels of HDLs are desirable. HDL levels are increased by exercise, maintaining a normal weight and quitting smoking. A diet that includes fish and monosaturated fats (i.e. olive and canola oils) may also increase HDL. LDL levels, on the other hand, should be kept as low as possible. The lifestyle change most likely to affect LDL is a reduction of total fats, especially saturated fats and cholesterol in the diet. Decisions about treating an abnormal cholesterol profile is usually based on the LDL. An individual's ideal LDL level is determined, in part, by the number of risk factors already present that predispose to coronary artery disease - hardening of the arteries to the heart. The following are several risk factors that increase the risk of heart disease: being male or being a postmenopausal female not on estrogen, smoking, diabetes, high blood pressure, a low HDL <35), and a family history of early heart disease.
NUMBER OF RISK FACTORS/TARGET LDL:
Healthy, no risk factors-Target = <160
Healthy, 2 or more risk factors-Target = <130
Known coronary artery disease-Target = <100
In talking about your family history, you mentioned two important pieces of information. The first is that despite having high cholesterol, many people in your family lived to a healthy old age. Remember that cholesterol is just one of many factors that affect heart disease. Your family members may have had few of the other problems that predispose to heart disease as mentioned above. In addition, you have high levels of HDL. An HDL greater than 60 provides significant protection against heart disease. It is quite possible that if high levels of HDL also run in the family, this may have protected family members from experiencing high rates of heart disease.
Your cholesterol of 220 is considered borderline. A reduction with dietary changes to 208 is small, but significant. You may want to ask your doctor for a copy of your lipid profile so that you know exactly what your LDL and HDL levels are. I would recommend moderating your intake of fatty foods and eating generous portions of fruits and vegetables. This diet is not only heart healthy, but promotes optimal immune functioning and may provide protection from certain cancers as well. With your lipid profile, a see no need for an extremely low fat diet.
Your mother, on the other hand, has a severely elevated cholesterol level. Some individuals with cholesterol levels this high can see significant improvement with dietary therapy. In order to see a significant cholesterol reduction, however, close adherence to a very low fat diet would be extremely important. Many individuals are successful in doing this, but it requires a lot of discipline and support of family members who share meals with the individual. If Dad sits in front of the TV set with a bag of chips while your Mom tries to stick to her diet, she's going to have an uphill battle to fight. Your Dad is lucky in having a genetic predisposition to a low cholesterol. This is the factor that is providing him with protection against questionable dietary choices. That's the breaks.
For more information on cholesterol, visit one of the Websites listed below.

Related Resources:

American Heart Association - Cholesterol Topics

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Response by:

Jill Foster, MD
Assistant Professor
Department of Family Medicine
College of Medicine
University of Cincinnati