Smoking increases bad cholesterol

Roger S. is a 57-year-old writer. He’s generally conscious about his health; in fact, he’s a vegetarian. He does not drink alcohol. He exercises regularly. It came as a big surprise when he found out that he had alarming levels of total cholesterol and the bad type of cholesterol or LDL. Aside from possible genetic predisposition, the only risk factor that his doctor could think of was his heavy smoking. He used to smoke two packs daily.

With painstaking efforts, Roger gradually reduced his smoking, and took the medicine his doctor prescribed. After three months, he completely licked the habit. Repeat cholesterol tests done two months later showed normal results.

Scientific data show that smoking is not only a risk factor in itself but it can cause or worsen other risk factors like abnormal cholesterol levels. Smoking is found to alter the lipid profile in the body. It increases the levels of the bad cholesterol (LDL), while decreasing the levels of high-density lipoprotein (HDL), the good cholesterol.

The latest survey reported by Tobacco Free Asia revealed that 33 percent of the country’s adult population currently smokes and another 13 percent used to have the habit.

But the bigger problem, according to health experts, is that passive smokers in the country are estimated to be at approximately 35 million. They are the non-smokers who inhale second-hand smoke. More than 20,000 deaths from various causes are attributed to smoking every year, with the number of smoking-related deaths expected to rise steeply over the next few years.

The American Heart Association notes that smokers’ risk of heart attack is more than twice that of non-smokers. Cigarette smoking is the biggest risk factor for sudden cardiac death. Smokers who have a heart attack are more likely to die and die suddenly, within an hour, than non-smokers’.

Smoking is associated with the world’s top killers: lung cancer, chronic obstructive pulmonary disease and heart diseases. The good news though is that it is within one’s control to change or modify this risk factor. In other words, millions of lives can easily be saved just by the decision not to light another stick of cigarette.

An abnormal level of cholesterol is considered a major risk factor of heart disease which smoking can aggravate. Cholesterol, a fat-like substance, clogs up on the walls of arteries and blocks blood flow to the heart, causing the hardening of arteries, and eventually heart attack.

LDL cholesterol is the main source of build-up on the blood vessel walls. HDL cholesterol carries cholesterol back to the liver and prevents build-up on the blood vessel walls; hence, it’s called the good cholesterol.

Treatment guidelines recommend lifestyle changes, including smoking cessation, as the primary treatment for high cholesterol. Heart experts though concede that not everyone can reach target cholesterol levels through lifestyle change alone.

"Smokers are not expected to quit at the snap of a finger and fastfood aficionados can’t be expected to become vegetarians instantly," says Dr. Gregorio Patacsil, Jr., past president of the Philippine Heart Association.

Patacsil adds that long-term adherence to dietary and other lifestyle changes are difficult to implement, even in well-monitored patients. This is where drug therapy comes in.

Statins are the most potent cholesterol-lowering drug in the market today, and one of the most scientifically documented drugs of this class is simvastatin. One of the major studies on simvastatin is the 20,000-patient Heart Protection Study (HPS) published in the Lancet.

The study shows strong evidence that simvastatin, taken religiously for several years, cuts the risks of heart attacks and strokes in the high-risk population, particularly diabetics. Heart experts believe that with its regular use, a lot of heart-related deaths may be prevented.

Statins, however, come at a high cost. The cost of statins poses a challenge for high-risk patients with an average income. Therapharma, a division of Unilab, has introduced an affordable brand of simvastatin (Vidastat). This move has paved the way for the reduction of prices for these types of drugs which redounds to the benefit of patients.