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What To Know About Cholesterol!

by Samuel Snyder, D. O.

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About The Author
 
           hat is it?

           Cholesterol is actually not one thing. It is a family of
          molecules produced in the liver. They are fatty
        compounds linked with rings of carbon atoms in various
       configurations. Cholesterol serves important positive 
      functions in the body. Without them, the body would not be
     able to make various hormones, including testosterone and
    estrogen, the sex hormones. Cholesterol also transports
   other molecules to and from the liver to be metabolized.
There are a number of types of cholesterol, of a range of sizes and densities. For practical purposes, we will talk about the main two types—Low Density Lipoprotein, or LDL, and High Density Lipoprotein, or HDL.
The problem with cholesterol

HDL is the “good" cholesterol. The higher the level in the bloodstream, the better. But LDL is the “bad” cholesterol. The higher the level of LDL, the higher the risk of hardening of the arteries, especially of coronary artery disease. High LDL cholesterol, along with smoking and uncontrolled high blood pressure, is a major risk factor for coronary artery disease. On the contrary, high HDL is considered protective from CAD.
LDL can be high because of diet, or because of heredity. Diets high in saturated fat—animal fat—can predispose to high LDL. Family history of high LDL is a strong predictor of high LDL.
What are safe levels of cholesterol?
The ideal number for cholesterol is not really known. Currently, we think that total cholesterol levels should be less than 200 mg/dl. HDL should be at least 40 mg/dl, and the higher the better. We used to think LDL could safely be as high as 160 mg/dl. Now, for people with no other risk factors for heart problems, a level no higher that 130 is now considered desirable. For people with risk factors—smoking, hypertension, family history—levels should be no more that 100. The most current standards for those with established coronary disease, or diabetes or kidney disease, are for LDL levels of 70 mg/dl. Some experts think that that was the natural cholesterol of people before the advent of modern civilized diets.
What can we do about high cholesterol?

We know that reducing cholesterol reduces the risk of coronary artery disease and heart attack. Changing lifestyle helps. Reducing saturated animal fat in the diet is important, and can reduce total cholesterol by 10 to 15 per cent. Vigorous aerobic exercise can reduce LDL a little. But more importantly, it can raise HDL, and that can protect against the bad effects of LDL.
But there is only so much that lifestyle modification can do for cholesterol, and you can’t change your genes. Many people can only get their cholesterol levels under control with medications.
Statins are a class of medications that are very successful in reducing LDL. Technically, they are called HMG co-A reductase inhibitors. Examples include Zocor™, Lipitor™, and Crestor™. Some of the newer statins can also raise HDL, at least a little. For people with established heart disease, it has been shown that statins can actually save lives. Niacin can be used to raise HDL, but has no real effect on LDL.
These drugs are effective when used under medical supervision. They should be part of a program that also addresses other cardiovascular risk factors, to help reduce overall risk.
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Dr. Samuel Snyder is Associate Professor and Chair of Internal Medicine at Nova Southeastern University College of Osteopathic Medicine. He is a Fellow of the American College of Physicians, the American Society of Nephrology, and the American College of Osteopathic Internists. He is board certified in both Internal Medicine and Nephrology. He writes scientific and popular articles and lectures widely on a wide range of medical subjects.