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Q
Cholesterol Conundrum?

For all of my adult life I have had an HDL that is 50 percent of my LDL. I am now 63, and my LDL is 288 and my HDL is 145. This seems high, but my cardiologist says not to take medication. My blood pressure is fine, and I am of normal weight. I am on your anti-inflammatory diet, and it has done wonders for my arthritis. Any suggestions regarding the cholesterol issue? My doctor is stumped.

A
Answer (Published 9/10/2009)

High (over 60) HDL (high density lipoprotein, the "good" cholesterol) is protective against heart disease while high LDL (low density lipoprotein, the "bad") cholesterol usually increases the risk. Your cholesterol numbers are unusual, so I discussed your situation with Stephen R. Devries, M.D., preventive cardiologist and associate professor of medicine at Northwestern Memorial Hospital in Chicago.

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Dr. Devries noted that an HDL of 145 is exceptionally high and is usually - but not always- associated with relative protection from vascular disease. He said that some people with very high levels have a type of HDL that is inefficient at removing the "bad" LDL from plaque deposits in arteries that can cause heart attacks and strokes.

Dr. Devries added that your situation is complicated by your extremely high LDL. He emphasized the importance of following the Mediterranean diet, which has been shown to decrease the risk of heart problems by more than 70 percent. The Mediterranean diet consists of high-quality fresh fruits and vegetables, nuts, legumes, unrefined cereals, olive oil, fermented dairy products such as yogurt and natural cheese, and fresh fish as daily staples. The diet doesn't eliminate red meat but limits it to about one meal a month; similarly, poultry, eggs and sweets are permitted but are not daily fare. Instead, they are eaten about once a week. Moderate amounts of wine are part of the diet. I recommend following my anti-inflammatory diet, which is based on Mediterranean food preferences, and is even more protective.

As far as further treatment of your LDL is concerned, Dr. Devries said that any decision depends on your other risk factors for vascular disease, especially your family history. A family history of longevity and absence of vascular disease would argue against further treatment.

Andrew Weil, M.D.

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