Have A Healthy Heart

Now that we can control HIV, heart disease has become a bigger issue. In the United States, one in every three women will develop heart disease. Unfortunately, HIV and some antivirals may increase this risk. There are many risk factors for heart disease. Some you can control, others you can not. Two factors you can't control are age (women over 55 are at increased risk) and having a family history of heart disease. Everyone should be monitoring their cholesterol levels, but individuals with one or both of these "uncontrollable factors" should pay extra attention to their labs and also minimize "controllable factors" such as smoking, physical inactivity, obesity, and a high fat diet.

Cholesterol is a waxy, fat-like substance that is found everywhere in your body. Your body needs some cholesterol to make hormones, vitamin D, and bile acids (to help digest fat), but it only needs a little bit to do these things. The cholesterol that is left over is deposited in your arteries, causing them to become narrow and "clogged" - very similar to a drain pipe that gets clogged from years of goo building up on the sides.

When your health care provider checks your cholesterol, the lab will show three different values: your total cholesterol, your LDL, and your HDL. The LDL is your "bad" cholesterol. It stands for low density lipoproteins, otherwise known as the "Little Devils". These LDLs sole function is to carry cholesterol to your arteries and give it to the cells in the walls of your arteries, gradually narrowing them over the years. Ideally, you want your lab value for your LDL to be less than 100 mg/dL. Levels greater than 160 mg/dL greatly increase your risk of a heart attack, even if your total cholesterol is okay.

The HDL is your "good" cholesterol. It stands for high density lipoproteins. The HDLs carry the cholesterol out of the bloodstream and back to the liver. You want your lab value for your HDL to be greater than 60 mg/dL. Levels less than 40 mg/dL may increase your risk of developing heart disease.

Your Total Cholesterol lab value is based on a mathematical formula that uses both your LDL and your HDL, in addition to some other fats in your blood. In general, your total cholesterol should be less than 200 mg/dL. It is important to look at your total cholesterol value in conjunction with your HDL and LDL values because if your total cholesterol value is slightly high, it's probably okay if your HDL value is also high, but not if your LDL value is too.

Cholesterol levels should be checked after fasting. You should not eat (or have coffee with cream) for at least nine, preferably twelve, hours before your blood test. If you're on HAART, you should have your cholesterol checked at least every six months.

If your LDL and/or total cholesterol are high, there are many ways to try to decrease it - exercise, diet, omega-3 oils (from fish or ground flax seeds). Sometimes diet and exercise alone are not enough to bring your cholesterol down to a safe level. Some people need to take medications to lower their cholesterol. If your provider gives you a new medication to lower your cholesterol, please remember to check with your pharmacist to make sure there or no drug interactions. In some cases, high cholesterol can be caused by certain antiviral medications (HAART). If your levels are very high, and your health care provider thinks it might be related to your HIV medications, they may try switching you to a different HAART regimen.

As important as cholesterol is in heart disease, there is one factor that is even more important, and it's one you can control - smoking. Cigarette smoking is a huge risk factor for heart disease. For example, is you are a 45 year old woman with normal blood pressure, and a sky high total cholesterol of 280, you have a 14% chance of having a heart attack. However, if all you do is quit smoking, you will reduce your risk to 1%. If you smoke, the most important change you can make in your health is to quit. There are several resources in Washington to help you. One is the Quit Line 1-877-270 STOP (7867). They can offer free telephone counseling and many other resources. King County also has a great smoking cessation program that offers counseling, printed materials, nicotine replacement therapy, and other helpful resources. To access these services, call Whitney Taylor at the Public Health Department (206) 205-5818.

The bottom line: make sure your health care provider is monitoring your cholesterol at least every six months if you're on HAART or have a history of high cholesterol, and once a year if you're not on HAART and have normal levels. If you're total cholesterol and/or LDL are high, talk with your provider about other risk factors and what you can do to decrease your levels. And QUIT SMOKING!

By Laury McKean , R.N.

Ten un Corazon Saludable