Ask Us Anything About… Cholesterol Screening

Barbara Schindo – Good afternoon and thank you for joining us today. You’re watching, Ask Us Anything About… Cholesterol Screening, I’m Barbara Schindo. According to the American Heart Association, nearly one in three of every American adult have high levels of so called, bad cholesterol. Bad cholesterol can contribute to fatty build up in the arteries, ultimately, heightening your risk of heart disease, heart attack or even stroke. But there’s good cholesterol and bad cholesterol, it can be a little bit confusing. What’s the difference and how to you know your levels of each when you should be concerned. Lucky for us, joining us today, we have an expert to help us figure all of this out. Dr. Patrick Fitzsimmons is an interventional cardiologist with Penn State Health. Dr. Fitzsimmons, thanks so much for joining us this afternoon to talk about this.

Dr. Patrick Fitzsimmons – Good morning, how are you guys?

Barbara Schindo – Good, good. I want to say for anybody who’s watching this with us, whether you are watching this live or you’re watching this on playback, and you have a question about cholesterol, cholesterol screening for Dr. Fitzsimmons. Please feel free to put your question in the chat right below this video and we will get an answer for you. So, Dr. Fitzsimmons we’ll start with the basics, what is cholesterol?

Dr. Patrick Fitzsimmons – Cholesterol basically, the basic sense is just kind of fat running through the bloodstream is the best way to look at things, and that’s broken down too many, many different avenues. It’s certainly affected by what you eat and what you do, but your liver processes of the food that we eat and then kind of puts out all this kind of fats into the bloodstream. Now, fats in some ways are good because you do need that for your brain to function, for your heart to function, your body to function. But ultimately, like high levels are deleterious to the arteries of your heart, which is kind of where the blood is flowing through and really puts you at risk for a heart attack and stroke.

Barbara Schindo – So, let’s talk a little bit more about this. This you know, as you said, there’s both good fat and bad fat, which would lead me to believe that if cholesterol is fat running through your body, that there’s both good versions of it and bad version. So, what’s the difference between good cholesterol and bad cholesterol?

Dr. Patrick Fitzsimmons – So, good cholesterol is, you know, if you get your blood test, it’s the HDL and those are what’s called high density lipoproteins and they actually remove fat from arteries from the, from the body. So, you know, your HDL, your good cholesterol, you always wanted to be high on your cholesterol screening or your panels, bad cholesterol or LDL is low density lipoprotein and that actually deposits. So, when you have high levels of LDL that will deposit into the arteries and that’s the bad thing that leads to strokes and heart attacks if you think about it, like the plumbing in your, you know, in your kitchen, it’s kind of like rust development on the pipes. so ultimately, you know, you get too much rust, it can simply impede the flow of the, of the water, and, you know, prevent pressure from, you know, building up into the system and therefore, if it breaks off then it can cause problems.

Barbara Schindo – I’m glad that you already mentioned a term I was gonna bring up, which is high cholesterol, but you mentioned it in relation to good cholesterol, so if people hear the term high cholesterol, they might, they might think that means it’s automatically bad, but the term high cholesterol doesn’t necessarily mean it’s bad.

Dr. Patrick Fitzsimmons – That’s correct. So, you know, it’s actually you get when you have a lipid profile that’s done, you know, they give you a total cholesterol reading, right? So, a lot of people get like freaked out, oh my gosh, my total cholesterol is way too high and like, you know, and they’re losing their mind and they come in and they’re in panic mode. Um but then it really gets down to, like, the breakdown of that. So. if you have, I’ve had people that have high cholesterol, but total cholesterol, but their good cholesterol is so high, it’s a negative risk factor for heart disease, that’s actually a good thing. So, I’ve had some people come in that are panicked because their cholesterol is 250 but, you know, it’s really driven by their good cholesterol and I tell them, well, you know, you might be able to go out tonight and actually have a cheese fries and a steak sandwich because I think you’re gonna be okay. You know, other folks come in obviously with the high bad cholesterol, then it’s a different discussion.

Barbara Schindo – So, when you, sorry, I got sidetracked by my own thoughts here. When you, when you are saying, when, people have too much bad cholesterol, you know what does that mean? When what does it mean when you what are the risks associated if you’re you know, you get your lipid panel done and your physician says you have we will have really high levels of the LDL or the bad cholesterol. What is, what are the risks associated with that?

Dr. Patrick Fitzsimmons – Yeah. So, the bad things about, you know, LDL or bad cholesterol levels, the higher the level is the higher the risk. So, you know, and we’ve determined that over time depends on what, you know, your risk factors are, and if you’ve had prior heart disease, kind of what your level should be, but the higher the level it promotes not only deposition of plaque in the arteries, which is that kind of rust that can occur inside the pipes, but also it, you know, cause inflammation. And we know that inflammation is also a process that promotes, you know, both heart attack and stroke. So, the higher the level the, essentially the higher the risk.

Barbara Schindo – Okay, and Dr. Fitzsimmons, we do have some questions coming in in the chat from some of our viewers here. So, the first question we’re going to take is from Robin and Robin is wondering, she said, my LDL is 141 and my H. D. L. Is 160 total to 220. Are these numbers concerning? I know you don’t you probably don’t treat robin directly but with these numbers.

Dr. Patrick Fitzsimmons – So, you know you’re in the you’re in the you know the level for, I’m assuming like some of the some of these things are assumptions, right? So, I’m assuming you don’t have diabetes, assuming you don’t have heart disease. So you’re or prior strokes. So. your level what your goal would be with the L. D. L. Is 130. So really, you’re not that far away. So, is it alarming? And like would I be like overly concerned? Like oh my gosh, you need a lot of medicines and things like that. Not necessarily like with where that level is. You know you could probably manage with conservative management depending on your diet. And then exercise you know, and a lot of people don’t realize that you know diet and exercise can have a risk reduction of up to up to 25 to 30% almost as much as medications. So if you think about that you’re you know 141 if your goal is 130 you know, by really following like a Mediterranean diet and trying to, you know, walk up to 45 minutes a day of continuous walking, you’re, gonna get to goal without adding medication to your, you know, that’s something you have to take every day. So, is it alarming? No, it’s okay. It’s like, it’s I think it’s like a lot of us, we all I struggle with the same things, right? I struggle with my diet. I struggle with that. I’m no different than anybody else. You know, it’s kind of like preaching to the choir, right? But you know, so there’s a little bit of work to do. Do you do is it’s super alarming. No, I think that, you know, you can probably get there with some mild, you know, lifestyle modifications.

Barbara Schindo – Okay, Dr. Fitzsimmons. Thank you for that. And Robin, thank you for your question and you know, I agree with you. It’s hard, it’s we all know that diet and exercise, having, you know, having regular exercise and trying to eat healthy is always good recommendations. But I just like you and probably everybody else sometimes, you know, it’s hard to, it’s hard to say no to the pizza cheeseburgers.

Dr. Patrick Fitzsimmons – We all struggle. I mean, it’s funny. You know, patients that come in, I feel like I’m no different than anybody else. Right? Even though I deal with this every day, the challenge that I have is the same thing. Like, you know, you’re working a 9 to 5 job or you’re you know, trying to pay a mortgage, how, you know, when you’ve got kids running to soccer practice or, or you know, ballet or whatever, and you know, you’re trying to like do all these things and unfortunately a lot of times, health for yourself is put on kind of the back burner and I always tell people, you know, it’s challenging. Gotta you gotta move that up the lines so that, you know, take care of yourself so that you can take care of other people in your family.

Barbara Schindo – Thank you, thank you for joining us and watching, Ask Us Anything About… Cholesterol Screening with Dr. Patrick Fitzsimmons, an interventional cardiologist at Penn State Health. If you are watching this, whether you’re watching this now with us live or you’re watching this on playback and you have a question about cholesterol for Dr. Fitzsimmons, just please type your question in the comment field below this video and we will make sure to get an answer for you and also please feel free to share this video. So, anybody you know who, who may be concerned about their cholesterol are wondering how to get a cholesterol screening. This can be very helpful. So, let’s go back, we were talking a little bit about diet and exercise, and I think that will relate right to another question that we have from another viewer here. A viewer named Steve and Steve is asking, he’s asking specifically about energy drinks, but I think this can also speak a little bit better to wider to diet. You know, our will are, you know, will this affect cholesterol if you if you drink energy drinks or you know,

Dr. Patrick Fitzsimmons – believe or not, you’re gonna get a pass on energy drinks. Energy drinks has low effect on cholesterol. The biggest effect with energy drinks is gonna be on blood pressure, raising blood pressure, which is a risk for heart disease. And potentially depending on the glucose content of the energy drink. You know, you could affect obviously your sugar and potentially diabetes. So those are the biggest factors with an energy drink, but cholesterol itself probably not gonna have much effect on it.

Barbara Schindo – Okay, that’s good news. Good news for the energy drink drinkers. As at least related to cholesterol. So, let’s talk about when you should start getting screened for, when should you start getting regular cholesterol screenings. And how do you go about doing that?

Dr. Patrick Fitzsimmons – Yeah, usually, you know, believe it or not, it’s actually fairly young. So, heart disease kills about one in every two Americans, both men and women, which is a lot. Right? You know, and if you think about it, you know, Barbara, I’m gonna pick on you a little bit because you know, women usually know women are great about this, right? They know that like breast cancer kills people too. Right? So, you get a mammogram right? As a screening test and you know, most women will know like breast cancer kills one in every eight women but in heart disease it kills one in every two. We don’t have we don’t have a mammogram. Right? The only thing that we actually have is cholesterol screening, you know? So typically, you know, the recommendation is earlier is better. So typically, as young as 25.

Barbara Schindo – Wow. So. I started getting screening, I think it was my early thirties is when my that’s when my my PCP said you know it’s time to start getting your regular…

Dr. Patrick Fitzsimmons – and cholesterol will kind of go up as you age. So just getting one done and being like it was 15 years ago and now I’m fine is not the right answer. So, you know, once a year is probably reasonable certainly as we get older, you know, above the age of 30 or 35, you know, but it also depends on your family history. Like if you have a family history for you know, early heart disease or hyper lipid cholesterol problems, you know, you should be screened at an earlier age.

Barbara Schindo – Okay. And for the folks who are watching this who maybe don’t have, don’t see a regular physician, they don’t go for yearly checkups. Would you recommend that you know, something they start doing.

Dr. Patrick Fitzsimmons – Yeah, I mean, I think that you know the good thing about if you find something early, you’re less likely to see me, that’s the way I put things right. So, you know, if you’re seeing me in the emergency department, it’s probably not the best day of your life. You know, it’s probably better to get screened both for blood pressure, get screened for diabetes and get screened for with lipids you know, at least you know, once a year with your primary care physician. I mean that’s gonna really help to prevent things. I mean in America we’re not great with prevention. But you know, doing the right things if you found, like I said, cholesterol lowering, if you if you get it either down with diet and exercise or with medications, your risk reduction for stroke and heart attack is upwards of like 25% If you, so that’s just with exercise and diet, right? So, if we add medications to that, your risk reduction is in the 40% range their additive. So that that’s, you know, a profound impact on one’s health when you’re talking about lowering the risk of heart attack and stroke.

Barbara Schindo – And I feel like we have been hearing so much lately about, you know, exercise as medicine, exercise is a very important prevention tool. So, I’m glad that you brought that up.

Dr. Patrick Fitzsimmons – Yeah, it’s important too because believe it or not, when you exercise that there’s a lining of the arteries called the endothelial and studies have been shown that when you exercise, it basically conditions the endothelial. So you know, it makes it just like working out, you know, it’s gonna have less blockages, it’s gonna be more reactive as you get older lowers blood pressure. So, exercise has a huge profound impact on patients’ longevity as well as the risk.

Barbara Schindo – Okay, and I want to go back to another part of the answer to our last question. I feel like we’re on the same wavelength, you keep saying things that I’m already thinking of asking you part of your answers. So, you said something like it’s better to get screened before people wind up seeing you before they wind up seeing you in. Yeah, so my question, my question is, when is it that somebody should be concerned to the point of seeing a specialist you know, an interventional cardiologist like yourself.

Dr. Patrick Fitzsimmons – Yeah, I think it depends on a lot of things. One, you know, obviously symptoms, you know, with men, it’s, you know, typically easier, men follow the textbooks, you know, kind of chest pain, shortness of breath, radiation down the left arm with women a little bit more challenging women don’t always follow the textbooks and we know that, you know, women present later. They’re usually misdiagnosed more often. A lot of times it can be just shortness of breath or change in the ability to exercise. That’s why exercise is also important. I tell all my patients, you know, get out and walk around the track. You don’t have to be a marathon runner; you don’t have to be Arnold Schwarzenegger. But if there’s a change in what you’re able to do one week to the next, that could be an indication that something is going on, right, and that might be prompt you to say, hey, they need to go into primary care or hey, I need to see Dr. Fitzsimmons. Right? So, you know, those are the things that are triggers that you should see a healthcare provider.

Barbara Schindo – Okay, you are watching, Ask us anything about cholesterol screening with Dr. Patrick Fitzsimmons, interventional cardiologist with Penn State Health. If you have a question about your cholesterol or cholesterol screenings for Dr. Fitzsimmons, please feel free to put it in the comment field right below this video. Whether you’re watching with us here live now or you’re watching this later, we’ll get an answer for you. Speaking of exercise and medications and those things, we have a question that came in from Cathy and Cathy’s questions a little specific, but I think we can broaden it out about medications. So, she has some stats here. She has 153 LDL. and HDL is 124. She has tried four different statins, the type of medication that you would take for high cholesterol?

Dr. Patrick Fitzsimmons – Yeah, so statins will have a tendency to lower LDL and they will actually lower your total cholesterol. So, a lot of the statins will lower total cholesterol. HDL and LDL. Um and the profound benefit obviously with regard to two events is lowering the LDL or the bad cholesterol. So, statins are good. We also have newer injectable agents that if statins do not work for you which had just come out on the market really in the last like five years that are really good. As far as a lot of people have side effects. So, like, you know, 5 to 8% of people have muscle aches and pains, they don’t want to take the statin, you know, there’s a lot of bad press with, you know, is there an association with increase in risk of diabetes. Is there an increased risk with dementia as people get older. So, we do have other factors or other methods that we can do in addition to statins. Statins have the best data as far as not only safety, but long-term survival and risk reduction. So that’s where a lot of people start with statins. Typically, I get people that have either failed statin therapy or they are intolerant of statins and then people usually get referred to me for that.

Barbara Schindo – So, there are there are options for folks who aren’t seeing the kind of results that they were hoping for.

Dr. Patrick Fitzsimmons – Yes,  Okay HDL is probably the hardest the one to treat when your HDL your good cholesterol is low. There’s really not a good medication for that. The only things that have really been shown to help it is exercise will help to raise it about 10% and then also believe or not low dose alcohol. So, I don’t wanna tell everybody got a drink, but you know, three either beers a week red wine, a glass of red wine will help to raise your HDL and that’s probably some component as to why you’ve heard that in the press that you know, red wine you know makes me live longer. There is some truth to that you know.

Barbara Schindo – Now that’s interesting information to know and that’s you know if that’s something that might be helpful. I mean why not, why not give it a try Dr. Fitzsimmons. We do have another question who I what that I think is pertinent here. Jennifer is asking what can I do to increase my H. D. L. To increase my good cholesterol.

Dr. Patrick Fitzsimmons – What we were talking about. So, HDL is the hardest thing to raise believe it or not. We don’t have a medication that’s approved right now to do so you know, exercise can raise a 10% you know red wine, or you know 3-3-5 drinks a week. Not tonight. Not tonight and not this kind of drink. Okay. Exactly. So, either you know a shot of alcohol, a beer, or a single glass of red wine 3-5 days a week will help to raise HDL about 8-10%. So those are the only things that we really have right now that will help it. When you have a problem with really low HDL, it is a risk factor for heart disease. The other strategy that we typically have with really low HDL is to drive the entire cholesterol down and that will lower risk. And typically, we use the cholesterol statin drugs for that.

Barbara Schindo – Okay, well Dr. Fitzsimmons, thank you so much for making the time to talk with us here today. I learned a lot. I thought this was really interesting and helpful and I can’t believe I just realized I forgot to mention it’s heart month. So, that’s the reason why we’re talking about this now. It’s very timely. So, and you know, as you as you had mentioned, heart disease is very serious and affects a large number of people here. So, so very important information to have. So, thank you for those of us for watching. Ask us anything about cholesterol screening if there’s something that we missed in our chat here that you didn’t get answered and you’re still wondering, please still feel free to put your question in the comment line here, below the video and we will get an answer for you. And again, Dr Fitzsimmons. I really enjoyed talking with you. So, thank you for joining us today.

Dr. Patrick Fitzsimmons – Thank you. Have a good afternoon, guys.