Cholesterol results and question

Medical Q&A [Moderated]
1

Good morning, docs.

I had a blood lipid panel performed yesterday and had a couple questions. I’ll post yesterday’s results, and also results from ~10 months ago.

Date: 12/6/2022. Blood taken while not fasted. Results (mg/dL):

Cholesterol, Total: 197
Triglycerides: 70
HDL Cholesterol: 48
VLDL Cholesterol Cal: 13
LDL Chol Calc: 136

Date:2/3/2022. Blood taken while fasted. Results (mg/dL):

Cholesterol, Total: 178
Triglycerides: 57
HDL Cholesterol: 45
VLDL Cholesterol Cal: 11
LDL Chol Calc: 122

I’m a bit concerned by the increase in most of these numbers, with unfortunately the increase in HDL being quite small. My primary care physician never seems concerned and basically just says to focus on healthy eating, I’m assuming since the LDL number is the only one out of the reference range (although total is getting close). I’ve largely been doing that the past 10-11 months, and during that time have lost ~35 lbs. Most of that weight loss was Jan-Sept timeframe, with a bit more lost recently: I went from 275 in early January down to 241-242 in early September, and am currently at around 239. Been eating lots of fiber, and limiting saturated fat. For reference, I am 6’1" tall, 40 years old. I’d guess somewhere close to 25-30% body fat, but its tough to say. I do have a family history of heart disease, and high cholesterol.

I’ve read the cholesterol articles, but still had a few questions and could use some guidance:
(1) Is there any reason to think that the cholesterol results are still showing transient changes due to the weight loss, and should I re-check in a few months?
(2) I know my weight is still well above what it should be, and I’d like to continue to lose fat. Was planning on eating at maintenance until mid Jan then another fat loss phase starting in mid Jan. But perhaps I should continue to focus on fat loss now, given these results?
(2) How concerned should I be by these numbers?
(3) Should I ask my PCP about medication at this point, or continue to try lifestyle changes.

Thanks in advance.

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2

First of all, great work with your weight loss so far!

Regarding the questions:

(1) Is there any reason to think that the cholesterol results are still showing transient changes due to the weight loss, and should I re-check in a few months?

Probably not.

(2) I know my weight is still well above what it should be, and I’d like to continue to lose fat. Was planning on eating at maintenance until mid Jan then another fat loss phase starting in mid Jan. But perhaps I should continue to focus on fat loss now, given these results?

The decision regarding whether to push for more fat loss now versus in a month or two is not the critical decision point, in my mind. I think that it is more likely that there may be some additional dietary substitutions/changes that can be made to produce more favorable changes in your lipid panel, whether you continue to lose weight in the short term or not.

(3) How concerned should I be by these numbers?

I think it is wise that you are tracking this, particularly given that things have increased a bit over the course of the year. However, these are not in “emergency” or “immediate alarm” territory.

(4) Should I ask my PCP about medication at this point, or continue to try lifestyle changes.​

So this is a more detailed conversation; unless we see those “immediate alarm”-type elevations, decisions around medication are not based on just the blood lipid test alone, but rather a more comprehensive risk assessment. This involves some of the other variables you mention like your age, other medical conditions, the specific nature of this family history you mention, blood pressure, blood sugar, blood lipids, and can also incorporate other specialized tests like Lp(a) or coronary artery calcium scores, if those are obtained.

This is typically more than we can feasibly do via the forum with people. In the short/medium term there are likely to be additional dietary substitutions that can be made (e.g., increasing intake of legumes like beans/chickpeas/lentils, fibrous foods like oats, berries, and other fruits/vegetables, and substituting unsaturated fats (e.g., fish, nuts) for animal-derived saturated sources (beef/other animal meats, butter, etc.).

In the event that you make more of these changes (or you feel you have already “maxed out” on them, and the labs do not seem to be moving in a desirable direction, we’d be happy to set up a consult via the support email inbox to discuss the overall risk assessment and the potential use of medications for your situation.

3

Thank you for that detailed response, Austin. Blood pressure was in normal range (I don’t remember the actual BP measurement), and glucose was 88 mg/dL.
I will continue to work on those dietary changes you recommended.