I had a heart attack and subsequent quadruple by-pass surgery. At the time my total cholesterol was 253. I was placed on 20 mg of Pravachol daily. I have become essentially a vegetarian, and after six months of Pravachol therapy, my total cholesterol was 271. Needless to say this is very frustrating and depressing. Why is my cholesterol higher?

Thank you for your question. What you describe is a common problem and although frustrating there are other approaches that will yield the desired results. Since you already have coronary artery disease that required bypass surgery, your cholesterol target is actually based on your LDL cholesterol.

The LDL cholesterol is a fraction of the total cholesterol that is most likely responsible for the formation of blockages in your arteries. When you have your cholesterol level checked you have probably been told that you need to have a twelve to fourteen hour fast before checking it. There are many reasons for fasting.

Firstly, this will allow the dietary fats in your blood stream to be absorbed by your body and not affect the overall calculation for the LDL-cholesterol. Secondly, it will allow for fractionation and analysis of your different kinds of cholesterol -- LDL, HDL, and triglycerides. Your LDL cholesterol target is less than 100 (this translates generally to a total cholesterol level of approximately 170).

The total cholesterol may actually rise if your contribution of HDL cholesterol (or the good cholesterol) rises in response to your exercise and dietary changes. Many times even though patients have changed to an entirely vegetarian diet, physicians still see high levels of cholesterol. The current theory is that the patient’s genetic makeup that determines how the body metabolizes and creates cholesterol is dictating a higher level than necessary. Please consult with your physician to make sure that all the therapeutic lifestyle changes including dietary changes have been prescribed: regular exercise about 1 hour per day for five to six days a week, smoking cessation, and reduced stress.

In addition, your physician might consider another medication or combination of medications to lower your cholesterol level. There are several drugs of differing strengths. Although frustrating, you are doing exactly the right thing by asking questions. Please don’t give up. With the new guidelines to control cholesterol to reduce the possibilities of another cardiac event, there have been not only many new drugs, but also physician specialists that only deal with problems of cholesterol. Please let us know how things work out.

Dr. Fung

-- Dr. Gordon Fung, MD, MPH, is a cardiologist and associate clinical professor of medicine at the University of California at San Francisco Medical Center at Mt. Zion.

First published May 3, 2005
Last updated May 6, 2008
Copyright © 2005 Consumer Health Interactive