I am reading a lot about cholesterol levels. I have always had a total cholesterol level just above 200 (207-210). I heard that borderline levels over time does just as much damage to the arteries as high LDL with low HDL levels over a short period. Can you advise me about the science of a level just above 200 over time will do to me? I am a 41 year old female if that matters.
A screening test for total cholesterol which yields your level (200) can be reassuring but it is better to look at the HDL and LDL cholesterol components. If your HDL was below 40 them most doctors would consider that a risk factor no matter how low your total cholesterol was.
Cholesterol must be considered along with your other risk factors. A 40 yr old female whose mother died at age 50 of a heart attack, who smokes and who has hypertension should shoot for a LDL way below 100. Without those risk factors, current recommends would be less than 160 to less than 130 depending on who you talk to.
The National Institutes of Health has a nifty cardiac risk calculator which you can use.
A female age 40, smoker with slightly elevated blood pressure (145) and a total cholesterol of 200 with a HDL of 35 = 10 yr risk of developing cardiac disease of 4%
A female age 40, non-smoker with blood pressure of 120 and a total cholesterol of 200 with a HDL of 70 = 10 yr risk of developing cardiac disease of Here who really has the problem:
Male age 65, smoker, elevated blood pressure (145) on medications, total cholesterol of 280, HDL of 35 = 10 yr risk of cardiac disease greater than 30%
You asked about the science. There are many good studies which show that lowering cholesterol after heart attack will lower risk of a subsequent attack. These people, like the smoker dude above, are at such high risk of a subsequent attack (one in three) that you don't need to study many people or for very long to see benefits of an intervention.
Conversely to design a study to test the question; Should a 40 yr old woman with no risk factors and a medium low total cholesterol lower her cholesterol further?, would be difficult. The beginning risk is so low (less than one in 100), that you would have to study millions of women for years in order to get the predictive power out of the study. These are good questions but the experiment has not been done. Instead when doctors make recommendations, we are extrapolating conclusions from studies of sicker and higher risk people. So far most of these extrapolations have been correct when the studies are finally done but it is not most scientific.
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