Given anesthesiologists, gastroenterologists, immunologists, radiologists, urologists and so on, the field of medicine suffers no lack of “ologists.” One “ologist” you may not have heard of – the lipidologist – can help keep you from needing one you’re most certainly familiar with: the cardiologist.
Lipid specialist Dr. Deepak Honaganahalli focuses on cholesterol, though his work involves much more than just fatty acids. Honaganahalli, a UCHealth internal medicine physician and lipidologist, sees patients at UCHealth Primary Care Clinic – Greenwood Village. He says that, as the scientific understanding of the roots of atherosclerosis (plaque buildup in arteries) has deepened and preventative care ranging from statins to dietary changes have proliferated, lipid specialists can play increasingly important roles in keeping plaques from clogging arteries and causing heart attacks and strokes.
In the blood
Heart attacks are the leading cause of death in the United States; strokes come in at number five. Honaganahalli seems to have been born to do work to change that. While he was growing up in the state of Karnataka in southwestern India, his father was a biochemist at JJM Medical College, which stoked Honaganahalli’s interest in metabolism and biochemistry. Honaganahalli’s first encounter with the word “heart attack” was when his grandfather, who lived with his family, died of one when Honaganahalli was 9. The grandson went on to study medicine at JJM Medical College and has remained steeped in the advancing science of lipids in the bloodstream ever since.
That science predated Honaganahalli’s medical degree by decades. The famed Framingham Heart Study launched in 1948 and proved links between heart problems with unchangeable factors (such as sex, age and race) and modifiable ones (such as diet, high blood pressure, smoking, sedentary lifestyles, obesity, and high cholesterol). Identifying those factors fed into the development of the risk profiling done today, which has over time identified conditions such as diabetes and rheumatoid arthritis as making atherosclerosis worse.
As far as what to do about that risk, in the 1970s, Akira Endo discovered the first statin while researching molds that inhibit cholesterol synthesis in microbes. Now seven statins are on the market, Honaganahalli’s says, all designed to lower LDL (low-density lipoproteins), a.k.a. “bad” cholesterol. In addition, several other classes of medication that can come into play to prevent heart disease, he says.
Lipid specialists such as Honaganahalli develop personalized risk profiles for each patient and then work with patients to come up with customized plans to reduce the risk of developing serious circulatory problems. In addition to the factors mentioned above, one’s metabolism, genetic makeup, lifestyle and stress levels all come into play. In addition, different statins have different side effects and interactions with other drugs, so lipid specialists can pick out the medication that does the most good with the least collateral damage.
“We look at the person as a whole,” Honaganahalli said. “There’s so much fragmentation of care nowadays, this is one field in which we tie it all together to see a person’s overall risk.”
Diet and exercise are also part of Honaganahalli’s prescription. Exercise can mean any sort of physical activity, he says – be it walking somewhere you’d normally drive, taking the stairs, or working light dumbbells while watching TV. Diet factors in, too, though there’s no straight line between dietary fats and LDL in one’s blood. Eating fatty foods does increase LDL levels – but only about 30 percent of LDL in the bloodstream traces straight back to that cheeseburger. The liver manufactures the other 70 percent, Honaganahalli says, as it turns excess calories into fats for storage to be tapped during episodes of food scarcity so common in our evolutionary past and so rare in the Grubhub era. (The same thing happens in the cows that become the fatty beef in cheeseburgers, Honaganahalli points out: “Cows eat grass – where is the fat in grass?”)
So excess carbohydrates are often a big driver of blood cholesterol, and lipid specialists can test for triglycerides (another form of cholesterol) in ways that can show whether a low-carb diet or a low-fat diet is the better option. Diet is also a tool to help maintain a patient’s balance between LDL, triglycerides, and HDL, or “good” cholesterol, Honaganahalli says.
Another good reason to check in with a lipid specialist is to test for familial hypercholesterolemia, or FH. This is a genetic disease that affects one in 250 people, majority of whom don’t know they have it. Untreated the disease triggers high LDL levels that usher in a 20- to 30-fold higher risk of heart attack or stroke than that of those without the genetic defect, Honaganahalli says. The earlier one tests for FH, the better, he adds: a man with FH has a 50 percent chance of having a heart attack by the age of 50.
Honaganahalli says patients should consider five factors when thinking about seeing a lipid specialist.
Five factors for lipid specialists
First, know your cholesterol numbers. If your LDL “bad” cholesterol is 190 or above, you should see a specialist: you may have FH and a high risk of cardiovascular consequences.
Second, know your conditions. Certain medical problems – thyroid disorders, kidney disease, arthritis, certain infections, and diabetes, among others – can heighten the risk of atherosclerosis.
Third, know your risk. High blood pressure, inflammation, being a smoker, a family history of heart disease or stroke, and obesity are among the risk factors that can turn an LDL level that might otherwise be benign into a serious cardiovascular problem.
Fourth, know your medications. Particularly if you have diabetes – as mentioned, a major contributor to heart disease – it’s important to make sure you’re on the right statin.
Fifth, know your diet. As noted, what you eat can translate to LDL in different ways, and knowing what you’re eating will help a lipid specialist help you change your diet for the better.
“The good news is, cardiovascular problems are preventable,” said Honaganahalli. “The challenge is seeing the right person and getting high cholesterol and other risk factors addressed at the right time.”