No Crystal Ball: It’s Risk Assessment

March 2, 2020

High cholesterol is a significant component of artery-clogging plaque and a major cardiovascular disease risk factor, said Dr. Jared Ellis, associate professor of family medicine at the College of Community Health Sciences at OLLI on Feb. 24.

Cholesterol is necessary to keep the body healthy, but too much can cause serious health complications, said Ellis, who also cares for patients at University Medical Center, which the College operates. It is created by the liver and is an essential part of the cell wall, as well as an ingredient needed to make bile, vitamin D and natural steroids.

The total cholesterol level is composed of three parts: HDL or “good cholesterol”, LDL or “bad cholesterol”, triglycerides or “the other bad one,” Ellis said.

“Having low good cholesterol is just as bad as having high bad cholesterol,” he said. “Imagine that good cholesterol is a mama cleaning up after her kids, a.k.a. the bad cholesterol. If mom gets sick and stops cleaning, the mess builds up.”

The mess is plague in the arteries that can lead to heart attack and stroke as well as other complications from cardiovascular disease. Ellis said that even having normal LDL levels can sometimes be deceiving. Particle size matters. Certain people have small, dense LDL particles that are more likely to cause cardiovascular disease.

Treatment starts with a risk assessment for atherosclerotic cardiovascular disease (ASCVD), Ellis said. The American College of Cardiology and The American Heart Association released a risk assessment calculator in 2013 that is currently the standard for physicians.

“This is not a crystal ball,” Ellis said. “We cannot predict your future, but we can estimate your risk level.”

Risk goes up with diabetes, high blood pressure, smoking, obesity and several other chronic conditions. Family history of ASCVD is also a major risk factor. Ellis said diet and exercise can help, but if the primary physician determines your risk is above a certain level, he or she may prescribe a medication. It is all about the risk. The more risk, the more benefit from diet, exercise and medications.

When choosing a medication, “It’s all about the outcomes,” Ellis said. “If a medication or diet doesn’t prevent a bad outcome, it’s useless.”

Ellis said a good example of this is niacin, which was very good at lowering bad cholesterol and raising good cholesterol, but it didn’t reduce the number of deaths, heart attacks or strokes. Other medications called “statins” show the greatest reduction in cardiovascular events, but sometimes others are needed in addition or instead.

Ellis’s lecture was part of the College’s Mini Medical School program, a collaboration of OLLI and CCHS. Mini Medical School provides an opportunity for adults and community learners to explore trends in medicine and health, and the lectures offer important information about issues and advances in medicine and research.