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High cholesterol

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This morning my Thai wife went to the hospital to have her cholesterol checked.    She is 59 years old, not over weight and exercises daily.   So why are her numbers so bad?

Total Chol:           333

Trygl                    77

LDL                     224


The doctor put her on medication.


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Diet? my colleague is 40, skinny and play regular badminton but has horrific cholesterol figures. he puts it down to his massive seafood intake. 

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A bad diet is not likely to account with this combination of low triglyceride and high LDL. Since her triglycerides are not at all elevated -- in fact low, which is good - she probably has  a very healthy diet.


There are several possibilities here:


1. She could have a genetic condition (familial hyperlipedemia). This would be more likely if she has a family history on either side of heart disease, i.e. parents or grandparents who suffered a heart attack at comparatively early age,


2. The  LDL elevation may not be real. They usually do an indirect estimation of LDL and the technique for that is nto accurate when the triglyceride level is low (i.e. below 100). It would help to know her HDL.


3. The elevation may be real (or, perhaps, less than it seems on indirect estimation but still above normal range) but it may be due to the "good" type of LDL not the "bad" kind i.e. LDL-A particles not LDL-B particles. Again it would help to know the HDL.


I would start by getting a direct LDL measurement and do it quickly before the medication kicks in as once she has been on meds for a while you won't know if the results differ because of  direct measure or it is due to the effects of the meds..


If that is still elevated then I would suggest she consult a specialist in lipid disorders. Your average Thai doctor (and even some GPs in the west) would not have a clue about LDL-A vs LDL-B particles but a an up to date specialist would.


It is worth getting to the bottom of as there is a chance the medication is not really necessary and these drugs do have side effects.

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Just did my check 4 days ago and amongst the figures I noticed something I hadn't noticed on previous occasions - CHOLESTEROL - NON - H.D.L - Is this a better indication than the LDL / HDL ratio?


CHOLESTEROL - TOTAL - 197.0 mg/dL 
CHOLESTEROL- H.D.L. - 56.9 mg/dL 
CHOLESTEROL - NON - H.D.L 140.1 mg/dL
LDL / HDL 2.12


A quick search on the net, I found the following...

"High HDL cholesterol is helpful, but high non-HDL cholesterol may mean you're at an increased risk of heart disease. Fortunately, certain lifestyle changes involving diet, exercise, and not smoking may be able to get your non-HDL back in line."


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