What is Cholesterol?

CHOLESTEROL is a soft, waxy, fat-like substance found in your bloodstream and in all your body’s cells.  It's normal to have cholesterol and it is necessary for life. Your liver makes enough cholesterol to meet the body's needs.  Cholesterol is an important part of a healthy body because it's used for producing cell membranes and some hormones, and serves other needed bodily functions. But too much cholesterol in the blood is a major risk for coronary heart disease (which leads to heart attack) and for stroke. Hypercholesterolemia is the medical term for high levels of blood cholesterol.

There are two kinds of cholesterol, a so-called "good" and a so-called "bad" kind. The good kind, HDL, helps remove the bad kind, LDL, and bring it back to the liver. LDL cholesterol transports cholesterol to the body's cells. It's like an oil truck that delivers fat to the cells. The cells have receptors that serve as docks for the LDL trucks. When the cells contain an excess of cholesterol from too much animal and dairy fat in the diet, the dock space is no longer available and the undeliverable cholesterol piles up in the blood. Hypertension and smoking are the two prime causes of "breaks" in the (endothelial) lining of the arterial walls, and the LDL cholesterol trucks drive through these cracks and deposit their cargo into the tissue spaces. In time these deposits thicken and harden, causing a narrowing of the blood vessels. If these deposits break away, they are called clots and can cause heart attacks, strokes, pulmonary embolisms, etc. When the arteries around the heart become clogged, the blood supply is restricted to the heart and causes angina pectoris.

Eating foods with saturated fat will cause the liver to make more cholesterol, especially LDL. A saturated fat is any fat that is solid when refrigerated (such as butter, lard, or margarine). Animal foods that supply saturated fat (such as red ' meat) are worse than eating a food that is high in cholesterol but virtually free of saturated fat (boiled shrimp and crab legs are good examples of foods that are high in cholesterol but free of fat. Boiled eggs are also high in cholesterol but low in fat). The cholesterol content in beef and turkey are about the same, but saturated fat is much higher in the beef, making turkey the desirable choice. Plants contain no cholesterol, but some are extremely high in saturated fats, such as coconut, palm, palm kernel oil and cocoa butter that are used in many processed foods. These vegetable fats can be worse for you than animal fats, so beware of products whose label boasts "cholesterol free", or "made with 100% vegetable shortening". Unrefined beans, grains, vegetables, seeds, and nuts contain mostly unsaturated fats. The favored unsaturated oils include olive oil, safflower oil, and sunflower oil.

NINETY-SEVEN PERCENT OF ALL HEART AND CIRCULATORY DISEASES CAN BE AVOIDED AND AN ESTIMATED 80% CAN BE REVERSED with proper diet, nutritional therapies, lifestyle changes and exercise.

Your "CORONARY RISK FACTOR" is calculated by dividing your HDL cholesterol into your total cholesterol. Ideally the ratio should be less than 3.0 and certainly less than 4.0.

Total cholesterol/HDL  =  Ideally less than 4.0

The higher the number, the greater the risk of developing cardiovascular disease.

REMEMBER: MAINTAINING A GOOD HDL TO CHOLESTEROL RATIO WILL NOT ONLY PREVENT CAR­DIOVASCULAR DISEASE, BUT CAN ALSO REVERSE THIS CONDITION, EVEN IN ITS ADVANCED STAGES.

What your cholesterol levels mean?

Your test report will show your cholesterol levels in milligrams per deciliter of blood (mg/dL). To determine how your cholesterol levels affect your risk of heart disease, your doctor will also take into account other risk factors such as age, family history, smoking and high blood pressure.

A complete fasting lipoprotein profile will show:

• Your total blood (or serum) cholesterol level
• Your HDL (good) cholesterol level
• Your LDL (bad) cholesterol level
• Your triglyceride level

Your Total Blood (or Serum) Cholesterol Level

Less than 200 mg/dL: Desirable
If your LDL, HDL and triglyceride levels are also at desirable levels and you have no other risk factors for heart disease, total blood cholesterol below 200 mg/dL puts you at relatively low risk of coronary heart disease. Even with a low risk, however, it’s still smart to eat a heart-healthy diet, get regular physical activity and avoid tobacco smoke. Have your cholesterol levels checked every five years or as your doctor recommends.

200–239 mg/dL: Borderline-High Risk 
If your total cholesterol falls between 200 and 239 mg/dL, your doctor will evaluate your levels of LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides. It's possible to have borderline-high total cholesterol numbers with normal levels of LDL (bad) cholesterol balanced by high HDL (good) cholesterol. Work with your doctor to create a prevention and treatment plan that's right for you. Make lifestyle changes, including eating a heart-healthy diet, getting regular physical activity and avoiding tobacco smoke. Depending on your LDL (bad) cholesterol levels and your other risk factors, you may also need medication. Ask your doctor how often you should have your cholesterol rechecked. 

240 mg/dL and over: High Risk 
People who have a total cholesterol level of 240 mg/dL or more typically have twice the risk of coronary heart disease as people whose cholesterol level is desirable (200 mg/dL). If your test didn’t show your LDL cholesterol, HDL cholesterol and triglycerides, your doctor should order a fasting profile. Work with your doctor to create a prevention and treatment plan that's right for you. Whether or not you need cholesterol-regulating medication, make lifestyle changes, including eating a heart-healthy diet, getting regular physical activity and avoiding tobacco smoke.

Your HDL (Good) Cholesterol Level

With HDL (good) cholesterol, higher levels are better. Low HDL cholesterol (less than 40 mg/dL for men, less than 50 mg/dL for women) puts you at higher risk for heart disease. In the average man, HDL cholesterol levels range from 40 to 50 mg/dL. In the average woman, they range from 50 to 60 mg/dL. An HDL cholesterol of 60 mg/dL or higher gives some protection against heart disease.

Smoking, being overweight and being sedentary can all result in lower HDL cholesterol. To raise your HDL level, avoid tobacco smoke, maintain a healthy weight and get at least 30–60 minutes of physical activity more days than not.

People with high blood triglycerides usually also have lower HDL cholesterol and a higher risk of heart attack and stroke. Progesterone, anabolic steroids and male sex hormones (testosterone) also lower HDL cholesterol levels. Female sex hormones raise HDL cholesterol levels.

Your LDL (Bad) Cholesterol Level

The lower your LDL cholesterol, the lower your risk of heart attack and stroke. In fact, it's a better gauge of risk than total blood cholesterol. In general, LDL levels fall into these categories:

• Optimal is less than 100mg/dL
• Near Optimal/Above Optimal is 100-129 mg/dL
• Borderline High is 130-159 mg/dL
• High is 160-180 mg/dL
• Very High is 190 mg/dL and above

Your other risk factors for heart disease and stroke help determine what your LDL level should be, as well as the appropriate treatment for you. A healthy level for you may not be healthy for your friend or neighbor. Discuss your levels and your treatment options with your doctor to get the plan that works for you.

The Cholesterol Heart Profilers is a great starting point for learning about prevention and treatment options for your specific cholesterol levels. This free, confidential online service creates a printable report with the key information you need to fully understand your cholesterol levels, health risks and treatment options. You'll get a personalized cardiovascular disease risk profile, along with a summary of treatment options, potential side effects, success rates and a list of relevant medical journal articles and research studies, all summarized in plain English.

Your Triglyceride Level

Triglyceride is a form of fat. People with high triglycerides often have a high total cholesterol level, including high LDL (bad) cholesterol and low HDL (good) cholesterol levels.

Your triglyceride level will fall into one of these categories:

• Normal: less than 150 mg/dL
• Borderline-High: 150–199 mg/dL
• High: 200–499 mg/dL
• Very High: 500 mg/dL

Many people have high triglyceride levels due to being overweight/obese, physical inactivity, cigarette smoking, excess alcohol consumption and/or a diet very high in carbohydrates (60 percent of more of calories). High triglycerides are a lifestyle-related risk factor; however, underlying diseases or genetic disorders can be the cause.

The main therapy to reduce triglyceride levels is to change your lifestyle. This means control your weight, eat a heart-healthy diet, get regular physical activity, avoid tobacco smoke, limit alcohol to one drink per day for women or two drinks per day for men and limit beverages and foods with added sugars. Visit your healthcare provider to create an action plan that will incorporate all these lifestyle changes. Sometimes, medication is needed in addition to a healthy diet and lifestyle.

A triglyceride level of 150 mg/dL or higher is one of the risk factors of metabolic syndrome. Metabolic syndrome increases the risk for heart disease and other disorders, including diabetes.

From the American Heart Association, 2009