Lipidologists and Treating Your High Cholesterol

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Lipidologists are doctors that help manage your cholesterol and find treatments that will fit your needs. In the United States, nearly one-third of individuals over the age of 20 have high cholesterol, a risk factor for both heart attacks and stroke. It is no surprise then that a new type of medical specialist has emerged to treat the legions of patients who have this potentially life-threatening cardiovascular condition. These new specialists in the medical field are called lipidologists.

A lipidologist is a doctor who has received additional training in cholesterol management, cardiovascular risk assessment, and intervention. In addition to a medical degree, a lipidologist has a written certificate attesting to the completion of this special training.

Lipidology Emerges as a Medical Specialty

This field is still very young, but growing, with 625 certified lipidologists in the U.S. by 2015 and 100 more taking the exam each year. The American Board of Clinical Lipidology, the group that oversees this certification curriculum, recognized its first graduating class in 2005. However, lipidologists have yet to be recognized by the American Board of Medical Specialties, a governing organization of medical specialty groups.

Nevertheless, the field of lipidology, or the study of fatty substances in the blood, is certainly a growing specialty. The National Heart, Lung and Blood Institute, a division of the National Institutes of Health, has developed a National Cholesterol Education Program (NCEP). This program was formed in an effort to address how cholesterol works and how to check and maintain healthy cholesterol levels. Currently, most individuals only learn about their cholesterol levels by having a blood sample drawn during a yearly checkup.

When to Consult a Lipidologist

According to the American Heart Association, the ideal level of total cholesterol should be less than 200 milligrams per deciliter (mg/dL) of blood. Cholesterol levels between 200 and 240 mg/dL are considered a moderate health risk, while levels higher than 240 mg/dL are a major risk for cardiovascular disease. Of the different types of cholesterol, the low-density lipids (LDL) should be below 100 mg/dL; the high-density lipids (HDL) should be above 60 mg/dL.

For most people battling high cholesterol levels, a primary care physician will first suggest lifestyle changes, such as adhering to a low-fat diet and increasing physical activity levels. The NCEP recommends trying a three-month lifestyle change before starting any cholesterol medication.

If these lifestyle changes are not enough, the NCEP then recommends beginning an LDL-lowering drug therapy program under the guidance of a primary care physician. If this medication regimen has not effectively lowered cholesterol levels to a healthy level within 12 weeks, the group then advises seeing a lipidologist. A cardiologist should be consulted if the primary care physician or patient has immediate concerns about heart disease, or if the patient has other risk factors, such as high blood pressure or diabetes. Patients should also check with their insurance company to confirm that an appointment with a lipidologist will be covered.

Lipidologists May Order More Sophisticated Testing for Cholesterol

A lipidologist will likely recommend advanced cholesterol testing. Standard cholesterol testing identifies three lipid categories: HDL, LDL, and triglycerides, another type of fat found in the body. Advanced cholesterol tests provide a magnified look at cholesterol subclasses, providing 13 measurements of cardiovascular risk.

These 13 measurements include cholesterol particle size, a newly discovered risk factor for heart disease, and levels of apolipoprotein B100, a protein that helps the body deliver and remove cholesterol to cells.

Using this advanced cholesterol test, the lipidologist can then provide specialized interventions. For example, some individuals may require medication designed to enhance the transfer and removal of LDL cholesterol. Other individuals may simply require more specialized dietary changes, such as limiting salt, increasing soluble fiber, or consuming less than 7% of total daily calories from fat.

A lipidologist, depending upon the needs of the individual, may also recommend an MRI to determine the amount of fat present in the muscle tissue. Research suggests that high muscle lipid levels are associated with obesity, type 2 diabetes and other risk factors for cardiovascular disease.

Though certified lipidologists have been through specialized training for cholesterol management, the same medical tests and treatments they recommend can also be prescribed by a primary care physician or a cardiologist. In fact, the National Heart, Lung and Blood Institute recommends that a lipidologist work in conjunction with a patient's primary care physician registered dietician, nurse, and pharmacist. This will allow each team member to be aware of all the recommendations provided to the patient. The patient can also encourage communication between team members by keeping a cholesterol management journal, which records dietary changes, exercise, medications, and test results.

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