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Published: September, 2006; Vol 3, Num 4

 

Cholesterol, It’s a Sticky Subject

By Mark Dempsey

High or low, good or bad, to eat or not to eat and family history? These are the questions that must be asked when we assess cholesterol.

Total Cholesterol (mg/dL)
Desirable
200 or less
Borderline high
200 to 239
High
240 or more
LDL Cholesterol (mg/dL)
Optimal
100 or less
Near optimal
100 to 129
Borderline high
130 to 159
High
160 to 189
Very high
190 or more
HDL Cholesterol (mg/dL)
Optimal
60 or more
Good
40 or more
Bad
39 or less
Triglycerides (mg/dL)
Borderline high
150 to 199
High
200 or more

Cholesterol – Friend or Foe?

Without this waxy substance in our blood, we couldn’t survive. However, too much can lead to heart disease, the number one killer of men and women in the United States and Canada.

Cholesterol is found naturally in all parts of the body and is vital in the formation of cell membranes. It aids in the production of hormones like estrogen and testosterone, vitamin D and bile acids that assist in the digestion of fat.

Cholesterol comes from two major sources: the liver, which is the body’s major cholesterol producing organ, and animal products such as meats, poultry, eggs and dairy products. Generally, the liver produces enough cholesterol to satisfy all of the body’s needs so too much dietary cholesterol can lead to undesirable levels.

Cholesterol and other fats do not dissolve in the blood. Cholesterol is transported through the blood in the form of water soluble carrier molecules called lipoproteins. These are comprised of an outer shell – phosphalized – and an inner core of lipid which includes cholesterol. Excess cholesterol has a tendency to deposit onto the walls of our arteries, particularly the coronary arteries that lead to our heart. It is these deposits that cause "hardening of the arteries" or atherosclerosis.

Left untreated, atherosclerosis is a condition that causes progressive narrowing of the arteries. Narrowing may reach the point where the artery becomes severely or completely blocked. If the blockage occurs in a coronary artery, severe chest pain (angina) or a heart attack may result. If the blockage involves an artery in the brain, a stroke may ensue.

Types of Cholesterol

Low-density lipoprotein (LDL) is the major cholesterol carrier in the blood. If too much LDL cholesterol circulates in the blood, it can slowly build up on the walls of the arteries feeding the heart and brain. Together with other substances, it can form plaque, a thick, hard deposit that clogs the arteries. LDL cholesterol is called "bad" cholesterol. Lower levels of LDL cholesterol reflect a lower risk of heart disease.

About one-third to one-fourth of blood cholesterol is carried by high-density lipoprotein (HDL). HDL carries cholesterol away from the arteries. HDL cholesterol is known as "good" cholesterol because a high HDL level seems to protect against heart attack.

Exams and Tests

“Adults should have a fasting lipoprotein profile every five years,” says Mary Jane MacArthur, Director of the Health Promotion Division of the LHSFNA. “Testing the levels of your good cholesterol (HDL), bad cholesterol (LDL) and triglycerides (a form of fat in the bloodstream) is essential for your doctor in determining whether medication is necessary or if a change in your diet and lifestyle would be sufficient.”

Risk Factors

Some risk factors for high cholesterol are controllable:

  • High blood pressure (greater than 140/90 mg/dL)
  • Diet: too much saturated fat can stimulate production of cholesterol in the liver, thereby increasing production of LDL, increasing the risk for coronary artery disease (CAD)
  • Physical activity: a lack of exercise lowers HDL levels and increases obesity and insulin resistance in diabetes; proper exercise will benefit the circulatory system, increase blood flow and may lower cholesterol
  • Smoking: can lower HDL levels and increases the risk for CAD
  • Excess weight: eat fewer calories and burn more calories by becoming physically active

Other risk factors are not controllable but should be understood:

  • Age: blood cholesterol levels naturally begin to rise after age twenty; as the body ages, its ability to rid itself of excess cholesterol decreases
  • Gender: men tend to develop higher cholesterol at a younger age than women; however, after menopause and hormonal change, women’s cholesterol levels tend to increase at the same rate as men
  • Heredity: genes partly determine the amount of cholesterol the body makes and high blood cholesterol can run in families

Treatment

Cholesterol lowering drugs are often prescribed when LDL levels remain high after adoption of a cholesterol-lowering diet for six to twelve months. Some people may start drug therapy immediately because of very high LDL levels or a family history of heart disease.

Drugs that lower blood cholesterol work in different ways. Some may achieve better results than others. It is important to let the doctor know all medicines that are being taken before a cholesterol lowering medicine is prescribed. Any side effects must be reported immediately.

To gain maximum benefits from medicines prescribed to lower cholesterol levels, it is necessary to follow a cholesterol-lowering diet, lose excess weight, exercise regularly and quit smoking.

More information is available at the National Heart, Lung and Blood Institute. The LHSFNA has a useful health alert – Don’t Get Stuck with High Cholesterol – that is available in English and Spanish through the Fund’s online Publications Catalogue.