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Talking 'bout Trump's Cholesterol (and Yours, Too)

What's worrisome (or not) when it comes to the numbers

lab worker holding a Cholesterol Ldl test tube

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Doctors are starting to focus more on the "bad" cholesterol, otherwise known as LDL.

Much of the news surrounding President Trump's physical has focused on his rising cholesterol numbers. And if that unwanted increase is generating more back-and-forth on LDL and HDL than you’ve heard since the 1980s, maybe that’s not such a bad thing — given that keeping on top of your levels is critical to preserving your health as you age.

As for Trump’s widely publicized results? His total cholesterol rose from 169 to 223 and his level of LDL (or “bad”) cholesterol increased from 94 to 143.

It’s that increase in the second number that doctors find most worrisome. “It’s this bad cholesterol we’ve shifted over time to focus on,” says Seth Martin, a preventive cardiologist at Johns Hopkins Medical Center. “It going up to 140 is a causal factor in plaque buildup in the arteries, and that’s the underlying problem leading to heart attack or stroke. That is what needs to be addressed.”

Experts say that in general, total cholesterol should be somewhere below 200, with the LDL level under 100. But Martin says, “In our center, with a high-risk person, we wouldn’t be happy with staying just barely under those limits.”

As for “good” cholesterol, or HDL, the most current thinking is to pretty much ignore this reading, says Martin. “We don’t even focus on good cholesterol these days because the studies have shown that you can try to alter it with a variety of different drugs but doing so doesn’t help to improve outcomes."

LDL cholesterol, on the other hand, is what “very clearly causes heart disease.” And that’s because while our bodies need cholesterol, a waxy substance produced by the liver, to build cells, too much of the unwanted variety can build up in and clog arteries. This can lead to blood clots, which in turn can cause strokes or heart attacks.

If, like the president, you need to get your LDL down, doctors recommend the following steps. 

  • Change your diet. The National Institutes of Health’s Medline site recommends the cholesterol-lowering TLC eating plan, which is similar to the better-known Mediterranean diet — with healthy fats, a bounty of veggies and lean proteins. The key with any diet, experts say, is lowering your intake of saturated fat (the American Heart Association recommends limiting it to 5 to 6 percent of your daily calories) and trans fats. Increasing the amount of fiber you consume by working in more whole grains, beans, peas, fruits and vegetables can also be beneficial.
  • Exercise. Regular moderate aerobic activity each week not only cuts your bad cholesterol but also controls blood pressure and strengthens your heart. All of that adds up to a lower chance of heart attack or stroke. Aim for 30 minutes of moderate exercise, such as brisk walking, most days of the week.
  • Lose weight. Slimming down if you’re overweight can help lower LDL and is key if you have other risk factors, like high triglyceride levels or a large waist measurement.
  • Take drugs. Statins are the gold standard in controlling your bad cholesterol and don’t necessarily need to be considered only when diet and exercise have failed. (They may be prescribed if you have an LDL as low as 70 but have other risk factors for heart attack or stroke.) Trump is already on a powerful type of this drug — Crestor, the brand name for rosuvastatin — and his doctor said the dosage will be increased. Martin says that for any higher-risk patient he would also consider two drugs more recently acknowledged by the American College of Cardiology as effective LDL busters: Zetia, which blocks cholesterol absorption, and the new, pricey and highly effective injectable PCSK9 inhibitors.

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