Rheumatoid Arthritis and Cholesterol Education
September is designated National Cholesterol Education Month by the National Heart, Lung and Blood Institute (NHLBI). It is a good time to learn about cholesterol and lipid profiles, to get your blood cholesterol checked, to take steps to lowering it if it is high, and to learn about food and lifestyle choices that can help you reach your personal cholesterol goals.
High blood cholesterol affects over 65 million Americans and I am one of those people...so are each of my parents. In July, my rheumatologist prescribed a statin medication (a cholesterol-lowering drug). Often genetic, high cholesterol is a serious condition that increases one's risk for heart disease.
The higher the cholesterol level, the greater the risk for developing cardiovascular disease. In RA patients, that increased risk may even be more significant. We already know that just living with rheumatoid arthritis raises your risk of heart disease two to three times.
What is Cholesterol?
Cholesterol is a soft, waxy substance among the lipids (fats) found in the bloodstream and in all body cells. It is used to form cell membranes, produce hormones, and for other bodily functions. Fats, including cholesterol, cannot dissolve in blood and are transported by lipoproteins. Too much cholesterol in the blood (hypercholesterolemia) is a major risk factor for coronary heart disease.
Before having your blood drawn for a cholesterol check, do not eat any food. Drinking water is ok, but food will skew the test results. In the United States, cholesterol levels are measured in milligrams per deciliter (mg/dL) of blood. In Canada and the UK, they are measured in millimoles per litre (mmol/L).
High-Density Lipoprotein (HDL) or "Good" Cholesterol
Where "good" cholesterol is concerned, higher is better. HDL levels in the average man range 40-50 mg/dL. In the average woman, they range 50-60 mg/dL. A low HDL level, which is less than 40 mg/dL for men or less than 50 mg/dL for women, increases the risk of cardiovascular disease. Conversely, an HDL cholesterol of 60 mg/dL or higher gives some protection against heart disease."¨"¨Increasing physical activity and losing weight can help to raise HDL levels.
Low-Density Lipoprotein (LDL) "Bad" Cholesterol
We want to get our "bad" cholesterol levels as low as possible. The lower the level, the lower the risk of heart attack and stroke. The American Heart Association states that LDL cholesterol is a better gauge of risk than total blood cholesterol.
* less than 100 mg/dL is optimal ( < 2.59 mmol/L)
* 100-129 mg/dL is "near optimal" (2.59-3.34 mmol/L)
* 130-159 mg/dL is borderline high (3.37-4.12 mmol/L)
* 160-189 mg/dL is high (4.15-4.90 mmol/L)
* above 190 mg/dL is very high ( >4.92 mmol/L)
Triglycerides are a form of fat. People with high triglycerides often have high total serum cholesterol, including high "bad" cholesterol and low "good" cholesterol levels.
* less than 150 mg/dL is "normal" ( < 3.89 mmol/L)
* 150-199 mg/dL is borderline high (3.89-5.16 mmol/L)
* 200-499 mg/dL is high (5.18-12.93 mmol/L)
* above 500 mg/dL is very high ( >12.95 mmol/L)
Several possible causes of high triglyceride levels include being overweight/obese, physical inactivity, cigarette smoking, excess alcohol consumption and/or a diet very high in carbohydrates (60 percent or more of calories). Although underlying diseases or genetic disorders can be the cause of high triglycerides, more often they are related to lifestyle.
Total Blood Cholesterol Level
When it comes to total cholesterol level, a level which is less than 200 mg/dL is desirable. A level of 200-239 mg/dL presents a borderline-high risk for developing coronary heart disease. A high risk level would be results of 240 mg/dL and over. The American Heart Association says that "people who have a total cholesterol level of 240 mg/dL or more typically have twice the risk of coronary heart disease as people whose cholesterol level is desirable (less than 200 mg/dL)."
Treatment Options and Lifestyle Changes
Your doctor may recommend therapeutic lifestyle changes, including diet and exercise, in order to battle your high cholesterol. One common recommendation is to limit the consumption of saturated fats within your diet. Find more specific guidelines in the publication, Your Guide to Lowering Your Cholesterol with Therapeutic Lifestyle Changes (pdf).
How might you adapt your favorite recipes? The National Heart, Lung, Blood Institute has made available several resources including a bounty of recipes and other recommendations. In perusing the resources linked below, I loved the booklet of cooking "African American" style. These recipes sound like wonderful "back-home" southern cooking to me.
Statins or Cholesterol-Lowering Drugs
If diet and exercise are not enough to lower your LDL to a recommended level, then your doctor may prescribed a cholesterol-lowering drug. There are several different kinds, one of which is a statin. This is the kind of medication which my rheumatologist prescribed for me in July. We will be retesting in October to decide whether to continue or not.
There have been several small studies which look into the anti-inflammatory benefit of statin drugs in diseases such as RA. However, a recent large study failed to show any beneficial effect of statins in reducing disease inflammation in RA patients. This was certainly disappointing to read as I was hoping that the statin might do more than lower my LDL cholesterol.
In a different observational study, it was shown that patients (without RA) who took their statin medications as prescribed and stuck with it had a decreased risk of developing rheumatoid arthritis. To learn more, a well-designed clinical trial would need to be completed.
What should you do as an RA patient?
Talk to your doctor about cardiovascular health. Ask to have your cholesterol checked if it hasn't been within the past 3-5 years. Discuss treatment options or a prevention plan to lower your risk of developing heart disease. Whether you need cholesterol-regulating medication or not to lower LDL "bad" cholesterol levels, it is smart to make lifestyle changes which include eating a heart-healthy diet, getting regular physical activity and avoiding tobacco smoke.
Losing 45 pounds so far this year is a good start for me, although my cholesterol levels happened to get worse, not better. Hopefully I will not need to take the statin for a lengthy period of time, however both my parents are long-term users. In the meantime, I will continue to make lifestyle changes, not just for weight loss, but for heart health too now.
Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (pdf) National Cholesterol Education Program (NCEP)
Toms TE, Panoulas VF, Douglas KM, et al. Statin use in rheumatoid arthritis in relation to actual cardiovascular risk: evidence for substantial undertreatment of lipid-associated cardiovascular risk? Ann Rheum Disease 2010 Apr;69(4):683-8. Epub 2009 Oct 23.
Lodi, S., Evans, S. J. W., Egger, P. and Carpenter, J. (2010), Is there an anti-inflammatory effect of statins in rheumatoid arthritis? Analysis of a large routinely collected claims database. British Journal of Clinical Pharmacology, 69: 85-94. doi: 10.1111/j.1365-2125.2009.03560.x
Chodick G, Amital H, Shalem Y, Kokia E, Heymann AD, et al. (2010) Persistence with Statins and Onset of Rheumatoid Arthritis: A Population-Based Cohort Study. PLoS Med 7(9): e1000336. doi:10.1371/journal.pmed.1000336