U.S. President Donald Trump recently underwent his first physical exam since taking office and was declared in excellent overall health by the White House physician. Despite a clean bill of health, it also was noted that the President has a history of elevated cholesterol numbers, prompting HCA Today to dig further into the common condition.

Anil Purohit, MD, a non-invasive cardiologist at HCA Healthcare’s Grand Strand Medical Center, sheds some light on what it means to have elevated cholesterol levels and the number of Americans affected.

“Many feel that the number of people affected by high cholesterol is underestimated. It’s anywhere between 100 to 102 million Americans who are diagnosed with this condition,” said Dr. Purohit, who focuses on preventative cardiology at Grand Strand Heart and Vascular Care. “Unfortunately about 40 percent of the population are underdiagnosed and undertreated with prescribed medications.”

We asked Dr. Purohit a few more questions about cholesterol – the “good” and “bad” – and advice on ways to help reduce high levels below.

What is cholesterol?

It is a substance produced by the liver and released into the bloodstream. It is not all bad; it’s actually used for a wide variety of bodily functions. It’s responsible for maintaining the skin and developing hormones, for instance, so you need cholesterol in order to survive and for your body to keep building.

How does cholesterol travel in the blood?

It’s stored inside an envelope of lipids (fat) and is transported in particles called lipoproteins – low- density lipoproteins (LDL) and high-density lipoproteins (HDL). So, the cholesterol is transported through the blood to different organs and areas of the body that we need to build like skin and hormones.

What are normal cholesterol levels?

We say that a total cholesterol less than 170 is good. Anything between 170 and 199 is considered borderline and anything more than 200 is considered high. The total cholesterol is the HDL, LDL and a fraction of your triglycerides – another type of fat found in your blood.

Separately, a good HDL level should be as high as it can be – about 45 or greater; a low level would be anywhere less than 40 and borderline is between 40 and 45.

The LDL, which is considered the “bad” cholesterol, should be less than 110, however, that number varies depending on risk factors. If you have risk factors for heart disease, typically, we want to have that number less than 70.

Borderline LDL levels range between 110 and 129 and anything greater than 130 is considered high.

Those are the tried and true guidelines that we have been using. The guidelines have shifted over the years. Now, we target our cholesterol goals based on a patient’s risk factors: obesity, diabetes, high blood pressure, and age.

Why is LDL considered the “bad” cholesterol?

An estimated 73 million American adults have high levels of low-density lipoprotein, or “bad,” cholesterol, according to the Centers for Disease Control and Prevention. LDL deposits the cholesterol in the lining of the arteries, which are the blood vessels that connect different areas of the body. Our bodies are basically like a set of pipes that lead from one area to the other, all connecting through blood vessels. Due to the make-up of the LDL cholesterol, it has the propensity to develop build-up on the wall of the artery and starts a process called atherosclerosis, or plaque, most likely from cholesterol LDL deposits. The plaque can develop anywhere in the body. If it develops in the heart, it’s known as coronary artery disease.

Does having high cholesterol mean you’ll develop heart disease?

No, it doesn’t. Having high cholesterol certainly puts you at a much higher risk for heart disease, but it doesn’t necessarily mean that you’ll develop it, no.

Who’s most at risk for having high cholesterol?

The biggest determinant is your genetics. The others include:

  • sedentary lifestyle;
  • dietary choices – foods that have high saturated fat content are high in cholesterol;
  • tobacco use/smoking – causes LDL to be released into the blood stream; and
  • diabetes, which tends to cause fat distribution and LDL to increase.

Are there medicines that can help control the condition?

Yes, there are a class of medications called statins that are most commonly prescribed. We typically prescribe the class of statin based on each individual patient profile. There is the moderate to high intensity statin medications called Crestor or Lipitor. At the highest tolerable dose, they can reduce the cholesterol levels as much as 50 percent.  In moderate low doses, they can reduce bad cholesterol as much as 30-35 percent, while the lower potency doses can lower the cholesterol as much as 20 percent.

How long does it take for the prescribed medicines to work?

Many patients think their cholesterol results will automatically improve in a few months, but usually it takes anywhere between 6 months and 1 year to see some kind of effect. In my practice, if I haven’t seen anything in about 8 months, we may need to change the dose of your medications. So, it will take time; it’s not something that you’ll notice overnight.

What are other ways people can reduce their levels?

  • Regular aerobic exercise, 30-45 minutes, four times a week, at least at a moderate pace,
  • Eating more fruits and vegetables; it will increase your good cholesterol (HDL) while reducing your bad;
  • Tobacco cessation, no smoking – we know that smoking causes the good HDL to decrease;
  • Good healthy eating habits that include low saturated fats and;
  • Managing some of the other co-existing risk factors that can sometimes drive high cholesterol like diabetes.hca

Dr. Anil Purohit is a board-certified cardiologist Grand Strand Medical Center and the practice of Grand Strand Heart & Vascular Care, affiliates of HCA’s South Atlantic Division.