Suggest Treatment For Elevated HDL And LDL Levels

Posted on Mon, 6 Mar 2017

Question: I am a 69 yr old male with no previous health problems. I have lost weight from 235 to 210 during the past 2 years since retiring. I swim one mile almost daily. My blood pressure is typically 130 over 60. In January, my HDL was 46 my LDL was 137. I have been on a dose of 20 mg of Lisinopril for 2 years. The NP at Duke wants me to take a 40 mg dose of atorovastatin. I am complying. However I am eager to lower my LDL and get rid of the statin. Would a once daily dose of Red Yeast Rice of 600 mg be useful? I am also starting to add avocado and more fish to my diet.

Answered by Dr. Ilir Sharka (56 minutes later)

Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

Regarding your concern, I would explain that total cholesterol or LDL values are not a true indicator of your cardio-vascular risk related to your blood lipid profile.

Total cholesterol /HDL ratio and LDL/HDL ratio are a more confident indicator of your cardiovascular risk.

In your case LDL/HDL calculated ratio is about 3, (normal range is below 3.5), which means that you are not at any increased cardio-vascular risk related to dyslipidemia. So, there is no reason to take any medication to lower your LDL levels.

I would just recommend some modifications to your diet (reduce saturated fat like butter, red meat and sweats and try to eat more food reach in omega 3 fatty acids like olive oil, fish, fish oil, walnuts, etc.).

Aerobics is very helpful in reducing LDL levels. You should try it.

Hope you will find this answer helpful!

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ilir Sharka (40 minutes later)

Thank you. I am trying to be compliant with the Nurse Practitioner at Duke Primary Care. I know she is just following Duke's and her physician supervisor's guidelines. I think I will re-visit her in April and negotiate. I feel certain I can lower the LDL number so I will be within Duke's guidelines. Then I think she will agree to stop the statin.

I am very concerned that the statin could damage my liver. Do you feel that the extra statin from the red yeast rice presents an additional risk? Is it too much?

Thank you.
XXXXXXX XXXXXXX

Thank you! I think I will petition her tomorrow to reduce the dose.
XXXXXXX XXXXXXX

Answered by Dr. Ilir Sharka (9 minutes later)

Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

600mg of red yeast rice is not a high dose. It is not harmful to your liver. So there is nothing to be concerned off.

But, I would not recommend taking both the statin and red yeast rice.

You should take one of them.

If you choose to take the statin, I would recommend taking a dose of 10mg per day and increase up to 20mg. But 40mg is too much, considering your blood lipid profile.

Hope to have been helpful!

Wishing all the best,

Dr. Iliri

Brief Answer:
You are welcome!

Detailed Answer:
Dear XXXXXXX

I am glad to have been helpful to you!

Wishing good health,

Dr. Iliri

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar