Veggies lover still high

Eating fruits and vegetables like a cow, but the cholesterol level turns to be high    
If you are a healthy person who eat fruits and vegetables regularly and exercise regularly, but in a physical examination, you find that you have high cholesterol. This means that the detected cholesterol is the total cholesterol. Nowadays, if we want to measure the cholesterol level whether it is high or not, we will not use the total cholesterol value for determination, but will consider the following sub-component of cholesterol as followed; the good cholesterol (HDL) value must be over 40, the bad cholesterol (LDL) value must not exceed 100 and the triglyceride value (TG) must not exceed 150. In case that a person who eat fruits and vegetables regularly, it is possible that the high cholesterol is the good cholesterol, which does not need to take the lipid-lowering drugs.

In case that the detected high cholesterol is the bad cholesterol (LDL), is it necessary to take the lipid-lowing drugs? Nowadays, doctors around the world use the criteria of the American National Cholesterol Education Program (NCEP) to make decisions regarding a need to prescribe the lipid-lowering drugs. The principle includes the risk assessment of coronary heart disease, those people with high risk e.g. cardiovascular disease, or diabetes may need to start their lip-lowing medication early.  There are 2 steps to determine how high or low your risk is. 

The first step is to answer whether there is a disease or not, if any one of the following criteria are met. It is considered a disease. 
1. Having clinical signs and symptoms of Ischemic Heart Disease (IHD).
2. Having Carotid Artery Disease (CAD in the neck) with paresis
3. Having Peripheral Arterial Disease (PAD)
4. Having Abdominal Aortic Aneurysm (AAA)
5. Having diabetes (considered to be equivalent to ischemic heart disease)

The second step is to consider, if the disease is not as described above then the risks can be determined by counting the risk score with criteria as follows.
•    Smoke +1 point.
•    High blood pressure (> 140/90 or taking antihypertensive drugs) +1 point. 
•    Low HDL (<40 mg/dl) +1 score, but if high HDL (> 60 mg/dl) -1 point.
•    A family history of an early death at young age of direct relatives from ischemic heart disease (male <55 years, female <65 years) gain +1 point.
•    Older age (male> 45 years, female> 55 years), get +1 point.
Based on the risk score, if the score is 0 or 1 point, it is considered very low risk. But if the score is 2 points or greater, the next step is to look at the Framingham risk score which is a standard method for assessing cardiovascular risk, then compare scores to consider treatment choices for high LDL with brief principles as follows,

Group 1. People with or equivalent conditions to ischemic heart disease (CHD) or Framingham's ten-year risk score > 20; Target LDL = <100 mg/dl, initiate lifestyle modifications when LDL => 100 mg /dl., initiate medication therapy when LDL => 130 mg/dl.

Group 2. A primary risk factor scores above +2 and Framingham's ten-year risk score of 10-20%; target LDL = <130 mg /dl, initiated lifestyle modifications when LDL => 130 mg /dl., initiate medication therapy when LDL => 130 mg/dl.

Group 3. A primary risk factor scores above +2 and Framingham's ten-year risk score <10%; target LDL = <130 mg /dl, initiate lifestyle modifications when LDL => 130 mg /dl., initiate medication therapy when LDL => 160 mg/dl.

Group 4. A primary risk factor score of 0 or +1; target LDL = <160 mg/dl initiate lifestyle modifications when LDL => 160 mg/dl, initiate medication therapy when LDL => 190 mg/dl (optional criteria may be used by starting medication therapy when LDL => 160 mg/dl)

In case of people who eat fruits and vegetables regularly without the risk of developing the disease, these group of people can be classified in the fourth group which does not need to take any lipid-lowering medication, but if the LDL value is greater than 160, then lifestyle modifications are needed to be made and medication therapy are needed when the LDL value was greater than 190 mg/dl.

Reference: 
1.    Scott M. Grundy; James I. Cleeman; C. Noel Bairey Merz; H. Bryan Brewer, Jr; Luther T. Clark; Donald B. Hunninghake*; Richard C. Pasternak; Sidney C. Smith, Jr; Neil J. Stone, for the Coordinating Committee of the National Cholesterol Education Program, Endorsed by the National Heart, Lung, and Blood Institute, American College of Cardiology Foundation, and American Heart Association. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines (NCEP Report). Circulation. 2004;110:227-239.
2.    WHO Global Database on Body Mass Index. Accessed on May 11, 2009 at http://apps.who.int/bmi/index.jsp?intro ... tro_3.html
3.    WHO expert consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. The Lancet, 2004; 157-163.