Common Myths Surrounding High Cholesterol

common myths
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High cholesterol is an important risk factor to developing cardiovascular disease. It is also a sometimes misunderstood condition, since it usually has no symptoms and there are many treatments available for it – depending on cause and severity. There are many rumors out there circulating about high cholesterol levels. Some of them are very true, however, most of them are not. Listed below are the most common myths surrounding high cholesterol:

I don't have to worry about heart disease if my total cholesterol is less than 200.

Although cholesterol is one of the major contributors to heart disease, it isn’t the only one. High blood pressure, a family history of heart disease, and diabetes are other factors that could contribute to cardiovascular disease. Additionally, your total cholesterol may be OK, but your LDL cholesterol may be high and your HDL cholesterol may be low - predisposing you to cardiovascular disease. 

High cholesterol only happens to older adults.

It may seem that high cholesterol levels are prevalent in older individuals, but they can occur in younger people, too. If you are healthy, the American Heart Association recommends getting your cholesterol checked starting at age 20. In the age of fast food and video games, high cholesterol also has been noted in children as early as their preteens. Therefore, especially if high cholesterol is hereditary in your family, your healthcare provider may check lipid levels earlier than 20 years of age.

If my cholesterol is high, I will have to take medication.

Not necessarily. Depending on your health history and how high your cholesterol levels are, your healthcare provider may try lifestyle modifications first before medication is considered. This would include smoking cessation , low fat diet , and moderate exercise .

Sometimes, this may lower your cholesterol levels. If it doesn’t work, this would be when cholesterol-lowering medication would be considered.

I don’t feel sick, so I am OK.

Heart disease is a potentially life threatening disease, especially if you don’t see your physician on a regular basis. In fact, many individuals are not even aware that they have heart disease until they have their first heart attack or stroke, unless they go in for a routine office visit. Therefore, it is extremely important to see your healthcare provider on a regular basis in order to make sure that your heart is healthy. You usually will not have symptoms with high cholesterol levels, just like high blood pressure and diabetes, which are other silent conditions that could lead to heart disease.

Home cholesterol tests and health fair screenings are highly accurate.

Yes and no. This really depends on what type of cholesterol test is used and if the kit is used correctly. For instance, there are some screening tests that only test your blood for total cholesterol levels.

While this may be effective in determining whether or not someone has high cholesterol, it doesn’t give a breakdown of the subgroups of lipids that compose the total cholesterol level: HDL, LDL, and triglycerides. For example, one might have a high total cholesterol level. However, if one was to analyze the subgroups of lipids and the individual was found to have high HDL cholesterol (“good” cholesterol), this is actually protective against heart disease. Additionally, before you get your cholesterol checked at a heath fair screening or with a home cholesterol test, make sure you haven’t eaten anything in 8 hours. If not, some aspects of your lipid profile - especially triglycerides - may appear higher than they actually are.

Natural products are good replacements for cholesterol medication.

Although there are many herbs, vitamins, and other natural products have been seen to lower lipid levels, their effect is usually modest. Some herbal supplements, on the other hand, have not been proven to lower cholesterol levels. Therefore, if your healthcare provider has determined that you need to be on medication to lower your cholesterol levels, don’t substitute this with herbal remedies. Additionally, be sure to consult your healthcare provider if you would like to take an herbal supplement along with your cholesterol lowering medication, since an adverse interaction may occur.

If I go on a statin drug, I could develop rhabdomyolysis or damage my liver.

This isn’t a myth, but both are rare side effects to taking statin medications. Statins, also known as HMG-CoA reductase inhibitors, are commonly used to lower cholesterol levels because they work on all facets of cholesterol: LDL, HDL and triglycerides. Additionally, they have other beneficial effects, such as decreasing inflammation. A study published in Lancet in 2002 analyzed roughly 10,000 high-risk patients who had been taking statins for five years. Out of those patients, only 11 cases of elevated liver enzymes and 2 cases of rhabdomyolysis were reported. This should be compared to the 211 nonfatal heart attacks, 137 strokes, and 117 coronary deaths statins helped prevent.

Diet and exercise alone should help lower my cholesterol. 

In some cases, following a healthy diet and moderate physical activity can help lower your cholesterol. However, in some cases, it doesn't help - no matter the amount of exercise or type of healthy diet followed. In these individuals, high cholesterol levels may be genetic. Scientists have been intrigued with this and have identified several genes as possible contributors to high cholesterol levels. Although exercise and dieting is probably helping your health in other ways, it may not cause your cholesterol and triglyceride levels to budge. In these cases, your healthcare provider may prescribe cholesterol-lowering medications to help lower your lipids.

Sources:
Heart Protection Study Collaborative Group. MRC/BHF heart protection study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomized placebo-controlled trial. Lancet 2002;360:7-22.

Dipiro JT, Talbert RL. Pharmacotherapy: A Pathophysiological Approach, 9th ed 2014.

Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (PDF), July 2004, The National Institutes of Health: The National Heart, Lung, and Blood Institute.

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