Dr. Muhammad Zohaib Siddiq
Cardiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am a 41-year-old male who weighs 138 pounds and would like to reduce my blood cholesterol levels. My cholesterol levels have remained elevated for the past five to six years. And for the last two years, I have been on weight training regularly, and I follow a strict diet that includes eating four eggs, three chapatis, 130 gms of chicken breast, two fruits, four almonds, curd, whey protein, and I take omega-3 fish oil capsule 1350 mg once daily. I also take one multivitamin tablet, whey protein (30 gms), and creatine (3 mg). I use less oil and spices in food. I walk around 3 km to work every day. Despite regular workouts and following a strict diet, my lipid profile has worsened in the latest report. I have a few questions. Why is my lipid profile not improving despite regular weight training and following a low-fat diet? Do you suggest any lifestyle changes, or should I continue my routine workouts? Shall I change my diet as I already take a healthy diet? And my main concern is whether I should take four eggs daily? Shall I continue taking multivitamins and omega-3 fish oil capsules daily? Kindly give your suggestions.
Hi,
Welcome to icliniq.com.
I went through your query and understood your concern. I will check your reports and get back to you. Thank you.
Patient's Query
Hi doctor,
Thank you for your reply. I want to add that my father died at the age of 59 due to cardiac arrest. Thank you.
Hi,
Welcome back to icliniq.com.
Elevated blood cholesterol levels are due to increased cholesterol production in the liver. Even if you eat reduced amounts of foods rich in fat and exercise, a few factors are needed to reduce the cholesterol production in the liver. In addition to a family history of sudden death, you should be careful with maintaining cholesterol levels (LDL- low-density lipoprotein). So I suggest you to follow a few instructions mentioned below. Adapt to lifestyle changes like avoiding sedentary activities such as sitting in the office or at home for a long time, adopting physical activity, and exercising daily, such as jogging or walking for 30 minutes. Consume a Mediterranean diet. Take one whole egg and egg white from another egg. One egg yolk contains enough cholesterol required by the body for a whole day. Multivitamin has no role if there is no deficiency. So I suggest you to tablet Vitamin D if there is a deficiency. The role of Omega-3 fatty acids (nutritional supplements) in preventing cardiac disease is controversial. Kindly consult a specialist, talk with them and take the medications with their consent. I hope this was helpful. Take care.
Patient's Query
Hi doctor,
Thank you for your suggestions. I will eat only one egg daily from now. Also, I have a few questions. Can I start with a cardio workout, like jumping rope, for 30 minutes? If I maintain these cholesterol levels, is there still a risk? Is there any medication to control cholesterol levels? What other tests are there to know the risks better? What must be the test frequency of lipids half-yearly? Kindly answer.
Hi,
Welcome back to icliniq.com.
The role of egg yolk in raising blood cholesterol levels is still controversial. There are a lot of other nutrients in yolk which are good for health. So you can take two whole eggs. Yes, jumping, jogging, cycling, brisk walking, swimming, or a combination of these is good. Yes, despite lifestyle changes and following a strict diet, if the levels remain elevated, it may cause harm. I suggest you to take the tablet Rosuvastatin (statin) 10 mg daily. Other tests to know the risk are coronary artery calcium score. It is the CT (computed tomography) scan of the heart. Moreover, I suggest you to get an ECG (electrocardiography) and echocardiography done as your father died of sudden cardiac arrest. Was your father a known cardiac patient? Kindly follow up with the answer.
Patient's Query
Hi doctor,
Thank you for your reply.
No, he did not have cardiac problems. He was a healthy person with no diabetes or BP.
Thank you.
Hi,
Welcome back to icliniq.com.
Then what happened to him?
Kindly follow up with the answer.
Patient's Query
Hi doctor,
Thank you for your reply.
On the day of the incident, my father went to bed after dinner, and within a few minutes of lying in bed, my mother noticed an abnormal noise coming from him. She tried to wake him up, but he did not respond. My brother rushed him to the hospital, and when he arrived at the hospital, the doctor declared him dead.
Thank you.
Hi,
Welcome back to icliniq.com.
It seems like cardiac arrest. Has he ever undergone an ECG (electrocardiography) or echocardiography?
Kindly follow up with the answer.
Patient's Query
Hi doctor,
Thank you for your reply.
No, and he did not undergo any medical tests either. As there was less awareness at that time.
Thank you.
Hi,
Welcome back to icliniq.com.
Some cardiac diseases cause cardiac arrests in sleep, such as Brugada syndrome and long-QT syndrome type 3. So I suggest you to get an ECG (electrocardiography) and echocardiography done.
Kindly follow up with the results.
Patient's Query
Hi doctor,
Thank you for your reply.
Thanks for sharing a clear understanding of this complex subject. I will modify my diet, exercise, and undergo tests as you suggested. Also, I have two questions,
1. How should I take Rosuvastatin, and for how long?
2. And what precautions should I take while taking this medicine?
Kindly answer.
Hi,
Welcome back to icliniq.com.
Your LFTs (liver function tests) and HbA1c (glycated hemoglobin) levels are normal. This medicine can cause derangement of liver function and mildly increase the chance of acquiring diabetes. But your test reports are normal, and you can start taking one tablet of Rosuvastatin (statin) 10 mg daily in the evening. Also, repeat fasting lipid profile after two to three months. And then after every six months and then yearly. Your target LDL (low-density lipoprotein) should be less than 100 mg/dL.
Kindly consult a specialist, talk with them and take the medications with their consent.
I hope this was helpful.
Patient's Query
Hi doctor,
Thank you for your advice.
I feel satisfied as you clarified all my doubts.
Thank you, and all the best.
Hi,
Welcome back to icliniq.com.
You are most welcome.
Kindly follow up if you have any doubts.
Take care.
Patient's Query
Hi doctor,
Thank you for your reply.
I have a doubt. I took the COVID-19 vaccination last year, so is it safe to start taking Rosuvastatin right now?
Kindly suggest.
Hi,
Welcome back to icliniq.com.
Yes, you can start the medicine.
Thank you.
Patient's Query
Hi doctor,
Thank you for your advice.
I am relieved now.
Thank you.
Hi,
Welcome back to icliniq.com.
You are most welcome.
Take care.
Patient's Query
Hello doctor,
According to earlier consultations regarding my elevated cholesterol levels, I started taking one tablet of Rosuvastatin 10 mg daily 1, reduced consumption to two whole eggs and one white egg from four whole eggs daily. Continued consumption of chicken breast 130 gms daily, did weight training and started HIIT (jumping) for 15 minutes daily. Started going for walks for 20 minutes daily. However, I have a few questions,
1. As the LDL values started reducing (from 167 mg/dL to 67 mg/dL within 50 days), shall I stop taking the tablet and continue doing HIIT and recheck the values?
2. As you check the LDL/HDL ratio levels, can you please tell me if the levels have lowered drastically?
3. If I continue taking the medication, will it become harmful if the LDL/HDL ratios are further reduced?
Also, kindly give your suggestions after looking at the past and present treadmill test results.
Past performance four years ago: workload achieved 14.7 METS with 175 bpm (96 %) and BP: 170/80 mm/Hg.
Present performance one year ago: workload achieved 10.0 METS with 173 bpm (96 %) and BP: 160/90 mm/Hg.
I have attached my reports for your reference.
Kindly give your suggestions.
Hi,
Welcome back to icliniq.com.
It is good to know your LDL dropped to the normal range and your exercise test is normal. And I have answers to your questions,
1. I suggest you to continue taking the tablet Rosuvastatin but reduce the dose to 5 mg and repeat the lipid profile after three months. Continue the suggested lifestyle changes.
2. No harm is expected with these low LDL levels.
3. The treadmill tests are normal. No need to repeat the treadmill test.
I hope this was helpful.
Take care.
Patient's Query
Hello doctor,
Thank you for your advice.
I continued taking one tablet of Rosuvastatin 5 mg daily, taking three whole eggs, and consuming chicken breasts 130 gms. Also, I continued weight training, HIIT (jumping) daily for 15 minutes, and walked for 20 minutes daily. In addition, you set me a target of less than 100 mg/dL since I have a family history of cardiac arrest. I achieved this target in the last laboratory test but missed today's test. My LDL first decreased to 66 mg/dL but then increased to 122 mg/dL. I have attached my reports for your reference. And I also have two questions,
1) As the LDL values increase, should I take a 5 mg or 10 mg tablet, Rosuvastatin?
2) Is it harmful to continue taking Rosuvastatin for an extended period?
Please give your suggestions.
Hi,
Welcome back to icliniq.com.
The LDL level of 122 mg/dL is not bad, yet the ideal range is less than 100 mg/dL (attachment removed to protect the patient's identity). So I suggest you to take Rosuvastatin 10 mg daily. And also, reduce the intake of eggs to one whole egg daily; the additional two eggs you take should contain egg white only, as egg yolk contains cholesterol.
If Rosuvastatin (or any other statin) is taken for a long time, they cause no harm.
I hope this was helpful.
Take care.
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