Mr. Brown enters the Physician’s office in a relaxed mood and takes the offered seat across from me. Mr. Brown is 57 years old and enjoys a sedentary lifestyle that he refuses to change, but he is still concerned about his cholesterol levels.
‘Me,’ I say. Mr. Brown, how are you today?
Mr. Brown: Good afternoon, sir. (clears throat) I’m not in a rush today because I want to know my cholesterol levels and learn more about living a healthy lifestyle. However, as I previously stated, I do not want to alter my lifestyle if today’s results are favorable radically. However, as I expressed earlier, I do not want to change my lifestyle drastically if today’s results are high. (Smiles) I hope the results are normal today.
Me: (Smiles back to Mr. Brown) I understand you perfectly well sir. Therefore, today I will start by telling you what a normal cholesterol panel should look like before I release your result to you so that you understand the interpretation made. Mostly, cholesterol levels are measured in milligrams of cholesterol on every deciliter of blood (mg/dL). According to Mayoclinic.org (2016), the following are the general guidelines.
Total cholesterol (mg/dL)
Less than 200
Between 200 and 239
240 and above
LDL cholesterol (mg/dL)
Less than 70
Best for individuals with diabetes or heart disease
Less than 100
Optimal for individuals at risk of heart disease
Between 100 and 129
Close to optimal in cases where there are no heart diseases, but high if heart disease is present
Between 130 and 159
Borderline high if heart disease is not present, but high if heart disease is present
Between 160 and 189
Very high in cases with heart diseases, but high in absence of heart disease
190 and beyond
HDL cholesterol (mg/dL)
Less than 40
Between 40 and 59
60 and beyond
Less than 150
Between 150 and 199
Between 200 and 499
500 and beyond
Mr. Brown: (Relaxed) I see. So what are my current results and their interpretations?
Me: Your current results indicate that you have 210 mg/dL total cholesterol, 160 mg/dL LDL, 33 mg/dL HDL and 145 mg/dL triglycerides.
Mr. Brown: From the values you showed me earlier, this mean that my total cholesterol level is at borderline high, LDL levels are high, HDL levels are poor, but my triglycerides levels are desirable?
Me: That is right Mr. Brown. That is the true interpretation of your results, which mean that you still have to manage the levels so that you live a better life.
Mr. Brown: What are triglycerides?
Me: these are fat forms circulating in the blood as part of fat tissue in the blood. Usually, high levels of triglycerides are associated with coronary artery disease.
Mr. Brown: I do not have to worry about that because my triglycerides levels are desirable. What then are LDL and HDL?
Me: Low-density lipoprotein cholesterol (LDL) is the bad cholesterol because if it builds up on the walls of the arteries it increases the risk of heart disease. On the other hand, high-density lipoprotein cholesterol is the good cholesterol that protects against heart disease through eliminating the LDL from the body so it does not build up in the arteries.
Mr. Brown: does it mean that the total cholesterol is a combination of all these forms of cholesterol?
Me: Total cholesterol is defined as a measure of the total amount of cholesterol in the body, which is based on the LDL, HDL and triglycerides levels (CDC, 2015).
Mr. Brown: Where is cholesterol produced?
Me: While 20% of the cholesterol in a person’s blood stream comes from the eaten food, 80% is made by the body. Mr. Brown: What causes high cholesterol?
Me: There are many factors that affect the levels of cholesterol, which may be controlled while other factors cannot. Controllable factors include diet, physical activity and weight. Uncontrollable factors include genes, and age and sex.Mr. Brown: Are there treatments for reducing high cholesterol?
Me: LDL cholesterol is the most dangerous and medications are targeted to reduce its levels. Statins are the most common medications to lower LDL and triglycerides and raise HDL cholesterol. These drugs include simvastatin, rosuvastatin, pravastatin, pitavastatin, lovastatin, fluvastatin and atorvastatin.Mr. Brown: Are there any side effects associated with medication for treating high cholesterol?
Me: Yes. These drugs are associated with side effects such as intestinal issues, damage to the liver, and inflammation of the muscles. In addition, the drugs may increase the risks for high blood sugar and type 2 diabetes. Care should also be taken if the drugs are administered together with other drugs because they may interact. Mr. Brown: In this case, the benefits of lowering cholesterol must be outweighing the risks of taking medication?
Me:Mr. Brown: Are there any options available for a person to try and reduce his/her cholesterol without taking medication?
Me: Yes. One can reduce his or her cholesterol without taking medication by checking on his or her lifestyle to ensure that he or she gets proper diet and enough physical exercises. Foods from animal sources like meat, eggs and cheese have high levels of cholesterol. Physical activity reduces weight gain, thereby raising the levels of LDL and lowering HDL. Mr. Brown: I am worried that I am at risk of heart disease. What is your advice?
Me: Your cholesterol levels are not desirable, but there is no reason for you to worry because you have the option or reducing the high levels of LDL and increasing HDL cholesterol. You can start by mild exercises and making sure that your diet has foods containing low cholesterol. Mr. Brown: What do you recommend?
Me: Now that we know your cholesterol levels, it will be important to start with a lifestyle change, although not drastically to try and bring the levels back to normal. I know that you do not want to change your life style drastically, but excluding foods that are sources for cholesterol and involving in mild physical exercises can bring your levels downMr. Brown: Do I have to necessarily change my lifestyle?
Me: It is not advisable to start on medication before trying other options available to you. You have made it clear that you like sitting and eating snacks as you watch sports. The most important thing to note is that all your favorite activities are what have contributed to the increase in your cholesterol levels, and the first approach would be to try and change them little by little by incorporating at least 30 minutes of mild physical activity like walking and concentrating on healthy snacks as you watch your favorite program.
Mr. Brown: (Happy) Thank you so much for this session, I did not have enough information about cholesterol, he causes and dangers associated. From the information you have provided, I confirm that I have understood that my high levels could be as a result of my lifestyle because none in the family has ever resulted such levels. I like my current activities, but I also understand that I can change my lifestyle slowly as I really want to lead a healthy life.
CDC. (2015). LDL and HDL: “Bad” and “Good” Cholesterol. Retrieved online on 30th April, 2017 from https://www.cdc.gov/cholesterol/ldl_hdl.htm
MayoClinic.org. (2016). Cholesterol test. Retrieved online on 30th April, 2017 from http://www.mayoclinic.org/tests-procedures/cholesterol-test/details/results/rsc-20169555
Webmd.com. (2016). Understanding Cholesterol Numbers. Retrieved online on 30th April, 2017 from http://www.webmd.com/cholesterol-management/guide/understanding-numbers#1