Winning the genetic lottery worked for me. Extensive periods of physical inactivity, far from ideal eating, and being way overweight all contributed to by long stressful work hours never caused my cholesterol indices to be anything other than excellent. Those factors may contribute to or even be causal of cholesterol issues in some, but for whatever reason, they haven't been in me.

At the time of my first heart attack my total cholesterol was 180, but higher LDL than HDL (not desirable). Started statins (Vytoren) and my total cholesterol was lowered to 95, but still higher LDL. Added Niaspan and the ratio of LDLHDL improved. I now take generic lipitor and total cholesterol hovers in the 100-115 range with good ratios. Simvastatin did not have the same results of lowering total C., Crestor worked but is expensive, and for now I am sticking with generic lipitor and Niaspan. Before the second heart attack my total C. was less than 100, I was exercising every day, I just had a stress test that showed I was in the top 1% for folks my age range and I still ended up in surgery with more stents ............ sometimes you just can't outlive your genetics.

Interesting. My diet is not so restrictive on carbs. I generally run 20%prot, 35-40%fat, 40-45 carb. I eat lost of beans, and get most of my fat from nuts, olive oil and avocados. The beans and vegetables have lots of carbs, as does the 12-15 grams of sugar or honey I put in my morning coffee. I eat no feedlot beef. I also avoid food-like substances, including milk-like substances ("creamers"), and saccharide-like substances in my morning coffee.

For me: weight loss (216 to 185) and improving fitness (resting HR from 90-100 to 45-50).

Those two eliminated a whole host of ailments - cholesterol, high blood pressure, gout attacks, kidney stones, pre-diabetic - they all went away.

Losing weight works for almost everyone, the more the better. Interventional studies show that the diet used to accomplish the weight loss is not nearly as important as the weight loss itself. Whatever works, IOW. I dropped my cholesterol and improved all my lipids simply by losing about 13 lbs., no change in diet or exercise other than eating less. I was already exercising plenty. Smaller portions is what I do. If you get your BMI well below 25, that should do it. If you're already down there, that's a different problem.

wow that sounds easy. side effects of Lipitor?

Lipitor has the same side effects as other statins. Possible muscle pain or weakness. Some people do better on it that others, and everybody is different.

I don't know what your situation is, and what questions your doctor asked, but IME many doctors can be mentally lazy, and formulaic. If you have high cholesterol, they put you on a statin, and give you the canned lecture about diet and exercise. That's fine as far as it goes, and many people do have high cholesterol because of diet, lack of exercise, and the resulting overweight. But many perfectly fit people who exercise, eat well, aren't overweight, and have very low body fat also have high serum cholesterol.

So the key is to ask plenty of questions, and work with the doctor to experiment and find the least invasive (drugs) program that works for you. That may be very different than what works for anyone else. I wouldn't be surprised if your doctor pushes hard on a statin, and that's probably smart to start. But once your numbers are OK, then you want to find the best way to keep them there.

BTW- here's something you may find enlightening on a related subject.

yeah, I agree. I'm thinking about jump starting with the pharmaceuticals and then try to back off. hey thanks for the Woody link, always good to start the day with a chuckle!

rumrun

I have had no side effects from taking Lipitor at all. I get a blood test about twice a year, and it shows no problems. I know that some people cant take a statin drug, my wife is one of them.

I am also lucky and have had no side effects in over 15 years. Same deal here blood test twice a year. I have three family members that had to stop taking Lipitor due to leg muscle pain.

and when should I get a followup test to see if its working? 1 yr? 6mos? sooner?

My Cholesterol was well over 200 but is now down to 125. I did this through a diet of lean meats and vegetables, biking, loosing 60 pounds and Lipitor. At my next appointment I am going to talk with my doctor about stopping the Lipitor.

This why the doctor gets the big bucks. So ask him/her.

The internet and forums are decent places to get general info, but humans are all different and specific info has to be tailored to the individual.

Generally doctors do followups early and often to see if the new regimen is working, then back off once everything is stable. By that logic, you'd want close monitoring again when you start making changes.

The most important thing is to have good dialog with the doctor. Make sure he knows you're active and wish to remain so, and set goals and strategies based on your individual needs. ASK QUESTIONS (the ones you're asking here) and don't leave until you have answers. Some doctors don't like patients who ask too many questions, but the good ones prefer patients to be more involved in their own care. So if your doctor doesn't want to give you enough time or attention, find a new one.

I guess that this might start a bit of a controversy but have any of you read and believe or don't believe the book "The Cholestrol Myth"? Among other things they say that you can have too low cholestrol numbers. They also say that the numbers them self are not all that important. They like the triglycerides to HDL ratio better than HDL/LDL.

Bill

There's truth to that. The linkage of cholesterol to heart attack is based largely on a statistical correlation. That data is pretty good as far as it goes, but statistical correlation isn't the same as causation. Of course there are the arterial plaques so something is going on, but the exact process isn't as well understood as some would have people believe.

As pointed out, many feel that triglycerides may be as important, if not more important than cholesterol, and there's also data supporting histamines and radicals as important factors. Th science continues to evolve, and keep in mind that it wasn't that many years ago that there's wasn't the separation of HDLP and LDLP as being good and bad.

One of the problems with health science is that there's a tendency to try to make decisions based on incomplete understanding of how things work. It wasn't all that long ago that the "experts" urged that folks move away from saturated fats like butter to less saturated fats like those in margarine, whet we now call transfats. That turned out to be brilliant advice.

Living things do need cholesterol. Our steroidal hormones are based on it, and our cell membranes need it.

That's an interesting point on the correlation vs. cause-and-effect. There are too many people who don't differentiate between the two very well, and some of them are authors of published studies.

That said, I'm betting that Cholesterol is just like all those other things that our body absolutely needs, yet too much of which is bad for us. Things like water and oxygen...

The ratios are the first thing my doctor points to. With a family history of heart issues I'll take the Lipitor.

LongT, my PCP said that I actually have too low a "good" cholesterol level now. I wasn't put on any statin or other medication for the levels I reached, came very close. When I developed the Stage 3B kidney failure it stopped him from prescribing anything for cholesterol, and it wasn't exceptionally high, thankfully. The strict nutrition plan I was put on and the amount of exercise I began lowered everything to my current levels.

My M-I-L was put on a statin a few years back, she did not handle it well at all and after talking with her doctor she was taken off of the statin and uses nutrition to keep things under control. My wife is in the same class so it may well be genetic.

I am grateful for the improvement with careful nutrition and cycling/exercise. I have a family history of heart disease, my father and grandfather passed away young from heart attacks, my grandmother had a stroke young, too. I will not get back in the same boat with obesity (hit 278lbs), poor nutrition and sloth, the kidney disease is scary stuff, too.

Bill

4 years ago my readings were:
Chol 277
HDL 38
Triglyceride 151
Direct LDL 188.

Doctor recommended Simvastatin due to family history, 3 months later, with no change in diet or exercise the readings were:
Chol 177
HDL 38
Triglyceride 159
Direct LDL 100.

The last lab tests this past Fall were:
Chol 158
HDL 45
Triglyceride 102
Direct LDL 93.

Still no significant change in diet or exercise, only $48/year spent on Simvastatin.

Your triglyceride numbers are affected by sugar intake, there are 2 kinds of LDL and only one of them is bad, and HDL which is good.

The commonality between most successful diets is the elimination of sugar and processed foods and for us this includes no wheat / gluten (my wife is a celiac) and adopting a higher fat, lower carb diet.

Coronary issues are caused by chronic inflammation, processed foods and too much sugar raises triglycerides and this increases the inflammatory factors in the circulatory system.

We don't avoid saturated fats... we thrive on them. Almost all our carbs come from vegetables and we can eat a lot of those every day and stay below the carb thresholds we have set for ourselves, the majority of the calories come from fats which include coconut oil, butter, nuts, lard, and olive oil.

Neither of us had any noteworthy issues and my numbers are as good or better on a higher fat diet than it was when I was eating more carbs... my wife's numbers have improved even more (her blood pressure has come down) and she has lost 50 pounds in 6 months with no calorie restrictions and no big change in her activity level.

I cut my intake of processed foods--canned, frozen, fast food and ate heart-healthy, organic fruits and veggies as well as chicken and fish (cut out the red meat). When I ate out, I only ate Subway turkey sands with no cheese or mayo. I cut my sodium too as my BP was high. I ate oatmeal for breakfast almost everyday, jazzing it up with various fruits, cinnamon, and other spices for variety. I even cut out cream for coffee. I started to ride again, too. I also began to walk and trail run. My BP dropped and my total cholesterol dropped but my HDL went up (good!). I dropped 15 lbs. from diet change alone, more came off with the added exercise. I never had to take any drugs. Yes, I went at it hardcore but then again, I didn't want to die early.

Statin.

@ I-Like-to-Bike ... THANKS

diet and exercise does work but specific suggestion is oats and flax every morning.

I had a decent diet and did 4500mi the year before I had a heart attack and my cholesterol was around 165. My HDL was very low in spite of all my exercise. If genetics are against you, no manner of exercise may help. I am now a no-oil vegan and my cholesterol has dropped to 105 and when my stent was put in my doc noticed my other bad artery was significantly better than it was previously. I would suggest a big change in diet and if possible, upping your exercise but if it doesn't have a major affect in 6mo I'd certainly follow your docs advice on drug therapy. Truthfully, if I were you, I'd get on statins now and add better diet and exercise and then see if I could get off them at some point.