One Diagnosis, Two Perspectives: Managing Cholesterol with Your PCP and Cardiologist

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Questions for the PCP: Anand Srinivasan, MD

Q. What cholesterol numbers are you most concerned about during a routine checkup?

Anand Srinivasan, MD, Internist/Primary Care Provider: In general, I tend to focus first on LDL (“bad” cholesterol) since elevated levels are directly linked to an increased risk of heart disease and stroke. High LDL can contribute to plaque buildup in the arteries, which is something we aim to prevent early.

Triglycerides are next on my radar, especially if someone has other risk factors like diabetes or obesity. Elevated triglycerides can also raise cardiovascular risk, and they sometimes point to issues with diet or lifestyle that we can work on together.

While I also look at HDL (“good” cholesterol), I usually get the clearest picture of any issues we need to address by looking at LDL and triglycerides.

Q. When do you recommend lifestyle changes vs. starting medication?

Dr. Srinivasan: I always start with lifestyle changes, as high cholesterol levels can often be reduced through diet and exercise. But when I feel the cholesterol levels on paper could progress and cause blood vessel blockage, that’s when I approach the topic of medications.

Q. How do you talk to patients who are hesitant about taking cholesterol medications?

Dr. Srinivasan: I truly prefer that they are not on medications. But when further testing shows that the patient’s cholesterol plaque could start to narrow their blood vessels, I encourage them to look at things from a different angle.

Q. When do you refer patients with high cholesterol to a cardiologist, and do you collaborate with them in caring for patients?

Dr. Srinivasan: I refer to my cardiology colleagues when I am unable to get the cholesterol levels down to an acceptable range, or when I feel the cholesterol accumulation could start to impede blood flow.

We are lucky to have over 100 cardiologists across the region. In the Englewood Health Physician Network, we truly function as a team. I am in direct frequent contact with the cardiologists who help me manage our patients.

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Questions for the Cardiologist: Jennifer Wellings, MD

Q. What’s your approach to patients who have high cholesterol?

Jennifer Wellings, MD, Cardiologist: I chat with patients about what high cholesterol is, what may have caused it, and what it may mean for the future, specifically as a risk factor for developing plaque in the arteries.

I also ask patients about other factors that may increase that risk further, such as family history of heart problems, high blood pressure, and smoking. We then discuss what changes we can make to lower the cholesterol.

Q. Are there more advanced cholesterol tests you use beyond standard panels?

Dr. Wellings: Yes, in some cases, I order more advanced blood tests that go beyond the standard lipid panel. These tests can provide additional information regarding a patient’s cardiovascular risk, especially for patients with multiple risk factors for developing heart disease such as a family history.

For example, I may check Apolipoprotein B (ApoB), which gives a more accurate count of the cholesterol particles that can build up in the arteries. Another marker is Lipoprotein(a), or Lp(a), which is a genetic factor that can increase the risk of heart attacks but isn’t measured on routine tests. These blood tests can help us tailor prevention and treatment strategies more precisely for each patient.

Q. How do you manage patients who don’t tolerate statins well?

Dr. Wellings: We usually try at least two statins. Sometimes if a patient has side effects from one statin, the other option will work better. If multiple statins are causing side effects, then other non-statin medications in pill form or via an injection can be used to effectively lower cholesterol levels.

Q. How do you work with primary care doctors to provide the best care for any patient referred to you for high cholesterol?

Dr. Wellings: I continue to work with primary care providers throughout the journey of treating a patient with high cholesterol. Bloodwork is drawn either by the cardiologist or PCP, and values are reviewed closely by both team members to ensure the patient is reaching their ideal cholesterol numbers.