Optimal blood cholesterol levels

Dear Ask The Doctor: Hi Doctor, I am 29 years old male. In a routine blood test and health checkup my results were as follows BP 100 by 70 sitting. Pulse 68 Fasting B Sugar 98 Post Lunch BS 115 HBA1C 5.46 TSH 2.21 IU ML T3 82 ng dL T4 6.70 G DL APOLIPOPROTEIN A1 126 mg dL APOLIPOTROTEIN B 82.70 mg dL Serum Creatinine 1.04 mg Calcium 8.61 mg dL Blood Urea Nitrogen 16.5 mg dL IRON 52.43 UG DL TOTAL IRON BINDING CAPACITY 280.50 UG DL HEMOGLOBIN 14.6 PLATELETS 242000 ESR 04 mm Hr Total Cholesterol 198.5 HDL Direct 54.9 LDL Direct 122 Trigycerides 140.3 VLDL 28.06 Hs Creactive Protein 1st reading 3.06, 2nd reading 2.98 mg L Lipoprotein A 57.7 mg dL Homocystein 10.6 Now, upon some reading on the internet, I learnt thatmy LDL levels, LPa levels, CRP and Homocystein levels are all evelated. Is it true? I am very concerned as they are said to be cardiac markers. I was then told by my family doctor that nothing can be done about CRP and LPa as they are genetic in nature. He, however advised me to start ECOSPRIN AV 75 ecosprin 75mg and atorvastatin 10mg combo drug daily for life. Another friend of mine who is a general physician, says it is not warranted for my age and on results I should employ diet modification. I am already following a low fat diet, even though I am a non vegetarian. I do not have any sweets at all. occasional chocolates, soft drinks at times only. I never have smoked. I dont drink. I exercise about 20 minutes 4 times a week including skipping and weights. my father had bypass about 5 years ago when he was 62. my mother is no more as she was suffering from a disease related to adrenal glands and was on steroids. she had a cardiac arrest at 45 years age. i am the only child to my parents. now, i am worried about the cardiac results along with my cholesterol. Is the drug warranted in my case based on my results? I am confused as I have differing opinions from two different doctors. If I should take medication,will there be any adverse effects of the medication in future? any precautions I should take? I started the medication and took for about 5 months and stopped it when my friend asked me to. but I am confused as to what I should do. Please help. I suffer from anxiety attacks and I am currently taking Serta 25 mg daily for about 3 months advised by the same doctor...and some ayurvedic drugs for my sinusitis. I shall appreciate a detailed answer. Thanks a lot. Ali

Dear Aliasgar:A CRP level of <5 is regarded as normal. Your homocysteine level is not considered elevated for a male of your age group. Your Lipoprotein A level is high, although this is not regarded as a conventional risk factor for cardiovascular disease, because it varies with ethnic origin. A desirable total cholesterol level is <200mg/dL, and an optimal LDL cholesterol level is <100mg/dL but between 100 and 129 is considered above or near optimal. Triglycerides should be <150mg/dL and a HDL cholesterol level of >60mg/dL is considered protective against heart disease. Therefore with your current blood results, medication is not indicated at the present time. Dietary and lifestyle modifications would be advised for a 3 month period and a repeat fasting lipid sample after this period. If your levels do not improve with strict diet and lifestyle modifications, lipid-lowering medication may be commenced as appropriate.