Heart Health: Optimal Cholesterol &Blood Pressure

Diseases of the vascular system stem from damage to our arteries.  There are many ways to damage an artery and only one repair mechanism – laying down cholesterol plaque. This plaque, while often the culprit for increasing blood pressure and the mechanism of most heart attacks and strokes, it is not the underlying cause.  We look to get at what’s damaging your blood vessels in the first place.

Heart attacks are the number one killer of Americans.  Half of them have elevated cholesterol, the other half does not.  Why are we failing as a medical system to prevent this?

When I worked on the Navajo Reservation, they suffered tremendously with heart attacks and diabetes.  But, in the 1970’s doctors working there didn’t see heart attacks.  What can we learn from traditional habits and populations around the world (know as blue zones) that don’t suffer like we do from what are now know as diseases of excess?

A third of the American population has elevated cholesterol levels beyond what’s considered a “healthy” range. For many, this drives damage to arteries and the subsequent build up of cholesterol plaque.  But, we need cholesterol to maintain energy, healthy cells, and hormones.  So we look deeply at your cholesterol in ways that most physicians overlook, which can give us clues to how to shift your lipids towards a health promoting profile.

According to many studies (including several from the Centers for Disease Control and Prevention), people with high LDL cholesterol have approximately double the risk for heart disease compared to people with ideal levels. But less than 50% of adults with high LDL cholesterol are getting any treatment to address their dyslipidemia and thus reduce their cardiovascular risk. And most don’t know what is driving this increase. Typically, dyslipidemia (high cholesterol or high triglycerides or both) is a result lifestyle habits – such as consuming too many highly-processed foods and insufficient exercise. The notion that most of us have a genetic predisposition to heart disease isn’t the case.  Genetics are a rare cause of very elevated cholesterol numbers. No human is genetically programed to thrive on a modern diet of processed foods.  Lifestyle changes should be the primary approach to bring lipids into a normal range and prevent further complications, regardless of a decision to use medications or not.

While lipid-lowering drugs (such as statins) have been prescribed to millions of adults, they are sometimes not a good treatment option given potentially serious side effects.

Definition Of Elevated Cholesterol

Dyslipidemia, sometimes also referred to as hyperlipidemia, is characterized by an elevation of plasma cholesterol, triglycerides (TGs), or both, or a low high-density lipoprotein level (HDL) – all of which are known risk factors for cardiovascular disease (CVD).

The most common type of dyslipidemia is due to high LDL (also called “bad cholesterol”) levels, which is rarely genetically inherited. Most frequently, it is a consequence of unhealthy eating habits and other diseases. Low levels of HDL “good cholesterol“ along with high levels of triglycerides have similar root causes compared to high LDL cholesterol (namely genetics, poor diet, and obesity).

We can start to get at the root cause of an unhealthy cholesterol by looking at lipid, or fat, metabolism:


  • Lipid metabolism is essential for survival, and lipids are involved in many critical functions such as energy storage, creating cellular structures, production of hormones & steroids, supporting brain function, and promoting the absorption of fat-soluble vitamins A, D, E and K.
  • Lipid absorption occurs when fats are consumed from the diet, followed by breakdown in the liver and in adipose tissue. Both of these processes are regulated by changes in glucose, insulin and glucagon hormones. As it turns out, eating sugar and processed carbohydrates are the main driver of an unhealthy cholesterol problem, not eating foods that contain cholesterol.
  • Thus, eating a healthy, anti-inflammatory diet that has a balance of fatty acids is so important for resolving cholesterol issues.

High Cholesterol – Conventional Treatment Approaches

The goal of treating dyslipidemia is to avoid other diseases such as atherosclerotic cardiovascular disease (ASCVD), acute coronary syndromes (heart attacks), stroke, transient ischemic attack, or peripheral arterial disease.

Treatments for dyslipidemia will typically start with significant lifestyle changes — such as dietary changes and increasing exercise — sometimes along with taking several drugs to treat very high cholesterol or triglyceride levels.

The American Heart Association (AHA) guidelines recommend using drug treatment for certain groups of patients who are at especially high risk including prescription drugs such as statins, bile acid sequestrants, ezetimibe, niacin, fibrates, or omega-3 fatty acids.

Advanced Lipid Testing

We often start with looking deeply at your cholesterol and markers of damage to your lipids.  Looking at cholesterol particle number and size, as well as oxidized lipids and your omega fatty acids, is a much more accurate way to assess what’s happening to your blood vessels.  We also use imaging to see if there is already cholesterol plaque.

Natural Approaches To Addressing Arterial Disease and Blood Pressure

All treatment of high blood pressure, heart disease, and cholesterol should start with lifestyle modifications.  This is the recommendation of the American Heart Association and all other associations that make recommendations for managing arterial diseases.  Most doctors and patients do not take advantage of the power of natural approaches thinking that they are ineffective.  Most of the time, the appropriate changes for you have not been tried. At Deena Neff, MD, we actually do them, and stress them throughout your treatment here, regardless of whether you have made the decision to take a medication or not. 

We at Deena Neff, MD specialize in cardiovascular and metabolic issues.  If you are concerned about your cardiovascular risk due to elevated lipid levels or blood pressure, family history, or are looking to optimize your health span, we invite you to schedule a complimentary phone consultation to explore your best next steps. If other treatment approaches have failed to address your cholesterol or blood pressure, you might need a more personalized approach to finding out just what is driving the damage to your blood vessels and create lasting health.