Pulse: Health: The Heart of the Matter

A Penn doctor says you can lower your cholesterol without taking drugs or running 10 miles a day

For almost two decades now, there’s been a straightforward prescription for lowering cholesterol: diet plus exercise, and if that didn’t do it, a statin like Lipitor or Crestor, one of the myriad cholesterol-lowering drugs. My cholesterol has always been slightly high — around 250 for a decade or more — and I’d been told not to worry about it. But the medical establishment now looks at cholesterol levels a little differently, and recently I was prescribed a statin. I balked, though, at taking yet another medication. That’s when I heard about Dan Rader, the cholesterol maven.

[sidebar]Dr. Dan has an unwieldy title: director of preventive cardiovascular medicine and the lipid clinic at Penn’s medical school. Unofficially, he’s the point guy for a new approach toward people with borderline high cholesterol. For the past decade, Rader has been giving a plant-derived supplement — available over the counter — to patients who need to lower their cholesterol by 10 percent. The results have been stunning.

First, though, Rader — who has the kinetic manner of a guy with way too much to do — gave me a refresher course on cholesterol: “It has two components: HDL, the good stuff, and LDL, the bad stuff” — high-density and low- density lipoproteins. “Think of them as two boats carrying a cargo of cholesterol. LDL is the huge freighter that drops off cholesterol in the tissues, particularly the arteries” — forming plaque, which can cause heart attacks or strokes — “and HDL is the small tugboat that carries it back to the liver for disposal. The more risk factors for heart disease a person has, the lower you want the LDL levels.”

For years I’d been told that my total cholesterol (252) wasn’t bad because my high HDL (98) gave me protection. No more. “Forget the total!” Rader practically yelled. “It’s all about LDL now. A young, healthy person wants to shoot for an LDL under 130; diabetics and people with high blood pressure and a family history of heart disease should aim for under 100.”

Fine — but here’s the real news. Instead of a statin, Rader said I could try lowering my LDL with phytosterol, the plant-derived supplement. He assured me that rigorous studies have demonstrated that phytosterol blocks absorption of cholesterol in the intestine. You pop one pill — I ordered 100 for $20 from Endur.com — before each meal, and its contents rapidly attach to tiny intestinal molecules called “micelles.” Once the micelles are full of phytosterol, they can’t take on much real cholesterol, so when you chow down, a lot of the bad stuff glides through your digestive tract and never reaches the arteries. Later, the body excretes the phytosterol — it’s that simple. Even the NIH approves of these plant-derived products. If you end up needing a statin, the two can be taken concurrently to potentially reduce the dosage.

After four months on a regimen of one pill before meals, my LDL was down from 157 to an acceptable 116. No meds. No side effects. This is one of those rare instances where something that sounds too good to be true actually is.

Rader estimates that of the 40 million Americans with high LDL levels, 20 percent might profit from taking phytosterols. “That,” he points out, “is not a trivial number.”

Preventing Plaque Attacks: Many people with low cholesterol still show significant plaque buildup in their coronary arteries. My husband, whose total cholesterol registers an ideal 156, discovered this after a test called a HeartCam, a brief CT scan of the coronary arteries that measures that buildup. His doctor put him on a statin — not to reduce his cholesterol, but to keep plaque glued to his artery walls, where it won’t break away and become a floating time bomb. Rader often recommends the HeartCam to patients with low cholesterol who have a family history of heart disease. The scan is available at Presbyterian Medical Center; unfortunately, insurance won’t cover the $395 cost. — C.S.