Your Cholesterol Questions Answered with Dr. Kerunne Ketlogetswe on Facebook Live
20
September

By Adem Lewis / in , , , , , , , /


– Hello and welcome to another
Facebook Live broadcast with MedStar Health. My name is Caryn Zengel, and I’m here today with
Dr. Kerunne Ketlogetswe, Cardiologist at MedStar
Heart and Vascular Institute. I’m really excited about today’s topic, because we’re gonna be
discussing something very, very important, high cholesterol. So if you’ve been wondering
what those numbers mean, or what is good versus bad cholesterol, stick around, share
this with your friends, and please ask your questions
in the comments below. Thank you so much for joining us today, I really appreciate it. – Thanks for asking me
to speak today Caryn. I’m really glad to be here. It’s heart month, and
there’s no better time to raise awareness about heart disease amongst our patients and let people know about their risk factors
for heart disease, and what they can do to lower their risk factors for heart disease. And cholesterol is one of
the leading risk factors for heart disease, and so I’d love to help talk to our people about what we can do to lower our cholesterol. I’m a non-invasive cardiologist, so I practice out of
MedStar Harbor Hospital. But beyond that, I call myself
a preventive cardiologist. My work and my mission is to help people lower their risk for heart disease, and educate them about
the things they can do to make their hearts and
themselves healthier. – Great, thank you. So we do have a few questions for you. So we’ll get into it. Let’s just get into those
numbers that I mentioned. What do they mean? – Great, so when people get
their cholesterol checked, they get what we call a lipid profile. And there are four main numbers that come out from your lipid profile. The main number is the total cholesterol. That measures all the
cholesterol in your blood. The next number is the LDL or
the bad cholesterol number. LDL is a type of cholesterol
that forms plaque or a clot within the artery wall, and that’s why we call
it the bad cholesterol. Another number that comes
up in your lipid profile is your HDL or high-density lipoprotein. That’s the good cholesterol. This you can think of as
your helper cholesterol that scavenges the bad
cholesterol from your blood. And so it reduces the
amounts of bad cholesterol in your blood. Another measure is something
called your triglycerides. Triglycerides are a kind of
fat that is found in the body. Triglycerides when you eat
food and your excess calories that aren’t used get
changed into triglycerides that can be then stored
as fat in your body, and so it’s another type. So your lipid profile will
come up with four numbers, and each one has different significance. – Okay great. So when is it considered
to be high cholesterol. – That’s a great question. Depending on your age
and your risk factors, we’ll sort of stratify
what numbers we look at. So a total cholesterol,
we want that number to be less than 200. If it’s above 200, it
can be borderline high. If it’s above 240, that is
considered exceedingly high. You LDL, or that bad cholesterol,
we really want that number to be as low as possible,
especially in people who have established heart disease. So we want that number
to be as low as possible. In most people, numbers
between 100 and 130 are considered acceptable. Although there’s a lot of debate
in terms of what we accept as acceptable because if
you look at comparisons with primates, or in rural populations, or populations that don’t consume
the typical American diet, their natural cholesterol levels are living more in the 40s to 50s, and that’s probably where we
should be living naturally. And it’s just that our
lifestyle drives it higher. The HDL cholesterol, or
the good cholesterol, that’s the number that
you want to be elevated. So if it’s less than 40 in
men or less than 50 in women, that’s considered low. If it’s above 50, that’s
considered better. And if it’s above 60,
that is actually the best. And it can actually be
considered protective, because now you have higher levels of this good cholesterol around. For your triglycerides we want that number to be less than 150. – Okay, great, thank you. So what causes high cholesterol? – A lot of factors play into causing you to have high cholesterol. There are some factors
that you can’t control. For example, you may have
a genetic predisposition that affects the way
that your body makes LDL, or clears LDL from the body. And that can raise those
bad cholesterol levels. Or you may have genetic factors
that decrease the amounts of good cholesterol that
you have in your body. But there are a lot of other factors that can cause people
to have high cholesterol that you can impact, okay? So one of the main ways that
you can have high cholesterol is if you consume a diet
that’s high in saturated fat. Where does saturated fat come from? So saturated fat is
found in animal products, so if you eat meat, and butter,
and full-fat dairy products, and cheese, those are high
in cholesterol and fats. The ones you really want to
avoid are the trans fats. Those are the fats that have been modified and are really implicated
in raising LDL levels. So that you will find in processed
foods, in packaged foods. In fact, the FDA is gonna
ban the incorporation of these trans fats by 2021. You will no longer be allowed
to manufacture trans fats or to be sold in the foods that we buy. – That’s great. So what are some ways that people can manage high cholesterol? – Fabulous question. When people think about
managing cholesterol, they often jump to thinking
that we have to use medications. But the cornerstone of any
lipid management strategy is through lifestyle. I like to really push that point, that lifestyle, lifestyle, lifestyle. And by that, we mean
things that you can do in the way you operate
on a day-to-day basis to lower your cholesterol levels. So for example, we tell people to reduce the amounts of saturated
fats we eat, right? So remember what I said,
the animal products, we said about full-fat dairy, butter. So if you can reduce your
intake of saturated fats to less than 7% of your
total caloric intake, you can actually reduce your
LDL or bad cholesterol levels by up to eight to 10%, right? Really avoid and don’t eat trans fat. We tell people to exercise, right? So aiming to achieve 30
minutes of brisk exercise most days of the week
can lower your LDL levels and actually boost your HDL levels. We tell people if you smoke, quit, right? What smoking does is smoking
affects your vessel walls, and makes it easier for that
LDL or bad, lousy cholesterol to make those plaques in your arteries which lead to narrowings
in the blood vessels. Worse yet, the plaques can
then rupture or burst open and cause the acute heart attacks. And if you quit smoking, within a year you’ve reduced your risk to half of that of a current smoker. We also tell people that to
lower their LDL cholesterol in addition to diet,
exercise, and not smoking, is to maintain a healthy weight. So if your BMI, or your
body mass index is above 30, it increases your risk of having high LDL, which in turn increases your
risk for having heart disease. – Great, thank you, those are great tips. Let’s talk a little bit
more about medication. Can you highlight a few
medications that are available? And how do they work? – So again, the cornerstone of
any lipid management strategy is diet and exercise. But sometimes those aren’t enough, and we have to use medications to bring people’s cholesterol levels down. There are different ways
some of the medications act. So some medications work by
inhibiting certain enzymes or key steps in the way that cholesterol is produced in the body. A key example of that would
be statin medications. So people have probably heard
of those medications the most. Statins are a potent way
to lower your LDL levels. Our strongest or our most potent statins can lower your LDL levels by up to 50%. And that reduction in
LDL is then associated with a lower risk of having heart disease. In addition to blocking the way that LDL is produced in the body, you can affect the way that LDL
is recycled within the body. So if you increase receptors
for LDL in the cells that can sponge up more of
those circulating LDL levels and lower your LDL, then
that’s a really effective way. And so some of our
newer blockbuster drugs, drugs like Repatha, some
people may have heard of, an injectable medication,
which we really reserve for our highest-risk patients, or patients who can’t take statins. Those medications really lower LDL levels to levels that we haven’t seen before, you know, unprecedentedly low levels, and really lower the
risk of heart disease. There are some medications that block the way that your body
absorbs cholesterol. So when you eat food it can
block cholesterol absorption. So there are medications
like bile acid resins and fibrates which can
block the way we absorb. Medications can decrease
triglyceride levels. So there’s a whole host of
medications that we can use. And your doctor can really advise you as to which medications are best for you and the kind of lipid abnormality or cholesterol problem that you may have. – Thank you. So we have some questions
from our audience. So let’s talk a little bit
more about triglycerides. So Will asked, thank you Will, how do triglycerides factor into the mix of different types of cholesterol, and what are some good tips
to lower your triglycerides? – That’s a great question Will. So like I said, triglycerides
are your body’s way of storing excess calories
as fat in the body. Some people may have
conditions such as diabetes or thyroid conditions that can raise the triglyceride levels. So whenever we see people who have elevated triglyceride levels, we wanna make sure that one of
them isn’t a secondary cause or that hasn’t been
caused by that problem. Diabetics can also have higher
levels of triglycerides. Ways that you can lower your triglycerides other than medications are
the same for everything, diet and exercise. So again, reducing your
amount of saturated fat intake and your intake of trans fats can really lower your triglyceride levels. When we treat cholesterol, assuming that your cholesterol problem is not just primarily your triglycerides, our focus always number
one, first and foremost, is to bring your LDL level first down. That’s the first priority. Because we know of the causal link, meaning we know that high LDL
leads to cholesterol deposits and leads to heart disease. So we always focus on that
as a primary strategy. Often, the medications
that we use to treat that will also lower the triglycerides. But if they still remain elevated, then there are other
medications we can add on top to lower the triglycerides. There are some foods that you can eat which can help bring down
your triglyceride levels. So consuming foods that are
high in omega-3 fatty acids can lower your triglyceride levels. Omega-3s are found in
things like fatty fishes, like salmon, mackerel, tuna, are places where you can
find omega fatty acids. If you eat foods that
have high insoluble fiber it can block absorption of triglycerides. So things like oats, oat bran, barley, also help to lower triglyceride levels. – Thank you. Roseanne is asking, let’s get
back to numbers a little bit. Roseanne is asking, would
you consider 210 to be high. – Yes, with a caveat, it all depends. But I consider any cholesterol
above 200 to be elevated, and I work to bring that number down. Even if your number’s 210,
there are still things that you can do through lifestyle alone that can bring your cholesterol numbers into a more normal or a better range. But above 200 is considered abnormal. – Okay. Barbara’s asking, how much does sugar play a role in heart disease? – Sugar plays a role because it increases your risk for obesity, right? And sugar often leads to
people to have excess weight. With excess weight often comes an increased waist circumference, so that central obesity
that we talk about. Higher sugars also affect the
way that those LDL plaques are deposited within the artery wall. So that’s how sugar can play an effect. And of course diabetes in and of itself, if you’re considered diabetic,
is a potent risk factor, or one of the major risk
factors for heart disease. So that’s how sugar can play a role. – Thank you, we have another
question from Marion. I have high cholesterol but
I’m allergic to statins. Every statin used has
caused liver enzymes. Recently, a cardiologist
suggested Welchol, but had to be taken off
due to negative impact. Do you have any suggestions for her? – Yeah, so as someone
who does a lot of work with high cholesterol and
people who are intolerant or cannot take statins,
it’s a long approach. So it depends on what
you’ve been tried on before. One of the side effects for
this cholesterol medication is people often develop muscle symptoms. And another side effect
that people can have is that it can raise some
of your liver function tests or cause them to be mildly abnormal. So that may have been the problem that you were experiencing. I often find that even
people who come to me and are labeled as statin intolerant, I can usually get them on some kind of a cholesterol medication. And it’s often a trial and error, right? So I often start people
on a very low dose. I start once or twice a week, and see if people can tolerate it. And then I gradually and
very, very slowly up titrate. And I often find that I can
lower people’s cholesterol even taking a cholesterol
medication three times a week for example at a very low
dose can get people to target. Some people that still doesn’t work, and there are other medications that your provider can look at. For example, Zetia, you may have heard of, is a medication that can
help lower LDL cholesterol. Welchol, like you mentioned,
can also help lower it. There are, like we said,
medications that can help bind cholesterol from
the food that you eat within the intestine that can be tried. And like we said, these newer medications, especially if you’re
somebody who we are trying to aggressively lower
your cholesterol levels because you have heart disease
or cardiovascular disease, you may have an indication,
or meet criteria for one of these newer
injectable medications as well. – Thank you. Hope that helped Marion,
thank you very much. Keep your questions coming everyone. We have another one from Melissa. This is going back to medicines. So can you explain some
options that are out there that don’t have any major side effects. – I wish I could say that
there are medications that don’t have side effects, right? But everything is a risk
and benefit balance, right? And this is why managing cholesterol is really a conversation about assessing what your risks are, looking
at your cholesterol levels, how they fit into your profile, and what we can do to lower it. Cornerstone always
being diet and exercise. And everyone always benefits
by working on those things first and foremost, and at all times, despite if we use medications. A lot of the medicines that we use have been studied extensively
in a lot of trials. And every medication is
going to have a side effect. Most of them affect a
minority of patients. And assuming that you’re
closely monitored, most people can tolerate
medications fairly well without side effects. – Okay, thank you. How often should you have
your cholesterol checked? – Great question. So recommendations are
that adults should begin having their cholesterol checked at age 18 and have it checked every five years. Some people, the recommendations
will be to check it more frequently once we’ve discovered an abnormal cholesterol panel, once we start lifestyle
modification or medications, then we check the levels periodically to make sure that the medications
are working as we expect and having the effect
that we want them to have. But every five years is
the general guideline. – Okay, thank you. If any of our viewers do
experience high cholesterol, should they be worried? What should they do? – Knowing your numbers
is one of the big pushes about how you prevent heart disease. So if you were found to
have high cholesterol, it is a marker, or something that tells us that you’re at an increased
risk for having heart disease. So if you know that you
have high cholesterol, you need to know that it can be managed, and it can be treated. Be concerned because of the
risk, and then become proactive about the things that you can do to help try and bring that
cholesterol number down. – Thank you. Let’s talk a little bit more
about risk and risk factors. What are the risk factors
for high cholesterol? – So the risk factors for
having high cholesterol are a sedentary lifestyle,
so if you don’t exercise, it increases your risk for
having high cholesterol. Eating an unhealthy diet, so eating foods that are high in those
cholesterol that we talked about, animal fats, saturated fats, right? Smoking is a risk factor
for having high cholesterol. Obesity or adiposity, so
carrying more weight or more fat than your frame was ever intended to do increases your risk for
having high cholesterol. And then there’s certain
genetic predispositions or risk factors that we can’t see but come from having a family history
of other people in your family who have high cholesterol levels and may be passed down on to you. – Thank you. So I’m a mom, there
could be some other moms watching right now. What about children, can
they have high cholesterol? – Absolutely, children can
have high cholesterol levels. And as we see more and more
children becoming obese, and as we start detecting
more and more diabetes in younger aged individuals, we’re seeing more and
more elevated cholesterol. The recommendation is that most children should have a screening cholesterol done somewhere between the ages of nine and 11, and then again in later adolescence just to rule out some of those causes. But the most often, the common
cause is genetic problems that cause people to abnormally produce, or process, or get rid of cholesterol. – Thank you. That appears to be all the
questions that we have for now. Is there anything else
that you’d like to share with our viewers that we haven’t covered? – I hope everyone can see
that cholesterol management is about changing your lifestyle, and that there are things
that you can do proactively to help lower your cholesterol. It’s heart month. Use this opportunity to
get to know your numbers. If you don’t know them, have them checked. Remember, having high
cholesterol is asymptomatic. You can’t tell when you
have high cholesterol unless it’s checked. So if it’s been a while since you’ve had your cholesterol levels checked, make sure to check in with your doctor and have your levels checked. – Thank you. We hope you learned something
today about high cholesterol. If you would like some more information or would like to schedule an appointment, please call 410-350-2106,
thanks again for joining us, and thank you for being here today. – My pleasure, thanks again.


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