Well, you can delude yourself with the 2-3 guys out there that tout despite mountains of evidence that high chol (LDL-C) does not link to CAD or you can deal with it.
Some people with low cholesterol get CAD, some people with high chol don’t get CAD. It is mostly a function of the oxydation status and the blood vessel wall.
A ‘‘smooth’’ vessel wall (from various genetic causes, membrane proteins, blood glucose, circulating cytokines and so on) will get much less chol integrated into it than one that is not so ‘‘smooth’’. If you vessel wall tend to be atherogenic, then you don’t need much chol to develop plaques, but if you have more it’ll just build up faster.
If you are a very lucky bastard you could be resistant to atherogenic chol…but that’s like betting you’re the one guy who won’t get lung cancer from smoking 3 packs a day for 20 years…you could be but I wouldn’t bet on it.
Luckily you’ve been trying to loose weight and adjust diet and training the first line recommendation for cholesterol therapies.
You will see 30-something fit military guys who run and train all the time, coming in the ER with and MI and it makes you wonder, hum diet and exercise…yeah.
But as it as been mentionned one of the single most important factor is genetics, how much cholesterol have you been programmed to produce.
Adding soluble fibers such as psyllium and oats can help reducing your numbers, usually nothing impressive but something in the arsenal nonetheless. Fishoils pretty much don’t do anything of significance for chol but are good for CAD and triglycerides nonetheless and are part of a heart healthy diet.
Now in terms of cholesterol lowering. The only very effective means of reducing serum cholesterol is through HMG-CoA reductase inhibition.
Various compounds do this. Statins being the most powerfull and effective at doing this (40-60% reduction) and are antioxidant agents for cholesterol.
Initially, statins were isolated from red yeast rice. People would eat red yeast rice and get a dose of Mevacor anyway, the compound was isolated and modified and synthetics are now very powerfull.
Tetradecythioacetic acid, a novel fatty acid being reseach shows a lot of potention as an hypolipidemic agent (trig and chol) and potentially as a fat loss agent and an anti-oxidant. However it is hypothesised to reduce chol through HMG-CaA red. inhibition and reduce trig through increase beta-oxidation.
So it basically blocks cholesterol formation through the same enzyme.
Ezetimbe could be an option, it blocks cholesterol absorption. It is clearly not as powerfull, about 20% reduction in chol and boost efficacy of statins by 15-20% if I remember correctly.
Then there are various bile sequestring agents that nobody takes anymore because of the ‘‘bowel symptoms’’.
Niacin is in the middle for chol lowering (number 1 for HDL boosting on the other hand). 10-20 % reduction in LDL and like 15-35 % for HDL boost.)
But the itchiness is a bitch at the beginning (trust me I know, an you look like you’ve been sunburned badddd) and the long acting one (less itchiness) you can’t take as much because of liver toxicity and you need to take an aspirine around 30 min before to diminish the itchiness and skin vasodilatiation.
It also does tend to increase blood glucose, not much but a bit (and mostly an issue in diabetics) (not supposed to be significant according to new research)
Then there are all the little moderatly effective things like green tea (EGCG) and myriads of other things being investigated and found lacking.
Personally, I do not see this situation as an either/or situation. I would do all the lifestyle changes (diet, fat loss, green tea, psyllium, oats, exercice - lots of cardio(sadly)) and on a medication to get the best cardioprotective environement to try and slowly reverse years of potential damage.
Hell, if I could get a statin I’d probably take one 5 mg of Crestor once every 2-3 days even without high chol just as an anti-oxydant and some little prevetion and maybe slow down progression of CAD.
Here on T-Nation we tend to pick an anti-mainstream approach to things and generally this gets people in, we feel we know better than every one else on the planet, more than all the ‘‘big pharma paid researchers’’ because someone took one or two articles from some PhD who was put down by ‘‘The Man’’ for telling ‘‘The Truth’’ and a few plausible sounding theories and there you go. Statins are evil.
Anyway, end of rant. Do what you feel is best for you, its your vessels and your heart. Remember, all these intervetions (excepts maybe high-dose newer gen. Statins wich could potentially reverse plaque formation) only slow down progression of disease.
So being 32 you don’t have many years before you reach the sudden death/angina threshold (should you have CAD/Stroke history in your family) (which usually is in the late 40s to 50’s). But on the good note, if its not sudden death, you could be thrombolysed, ballon ‘‘angioplasted’’, eventually stented and then CABGed and we are getting ever better at it so its not all bad.
Anyway, glad to hear you wanna do something about it.