CHOLESTEROL

THE CHANGING STORY BEHIND HDL, THE “GOOD” CHOLESTEROL

We all believe that the lower the total cholesterol (less than 200 mg/dl) and the higher the good cholesterol (more than 35 mg/dl), the better it is. Cholesterol is the main culprit behind the hardening of our blood vessels (arteriosclerosis). And we thought that high levels of good cholesterol protects us from arteriosclerosis and cleans our blood vessels from accumulated cholesterol plaques. However, current scientific clinical studies have shown that it isn’t so. 

Too much good cholesterol is just as bad as too low good cholesterol. It significantly increases the risk of premature death from heart diseases and even certain cancers.

Cholesterol is a vital, organic, sterol structured fatty substance and 75% of it is basically made by the liver. Some of the cholesterol (25 %) could come from our diet. Cholesterol is essential ingredient for metabolic and hormonal functions of our body. Cholesterol is important structural elements of every cell’s walls in the body, especially brain and nerve cells. Cholesterol is the precursor of steroid hormones, sex hormones, vitamin D, other fat soluble vitamins and bile acids for the bile. Cholesterol can’t be used as a fuel for energy, like other fats by the body.

Cholesterol, just like triglycerides and other body fats, is not water soluble and therefore cannot circulate in the blood without binding itself with water soluble proteins (lipoproteins).

Cholesterol is classified according to lipoprotein molecules size and density, which is defined as ratio of lipid-to-proteins. Thus, cholesterol is divided in to two types:

High Density Lipoproteins (HDL - good Cholesterol)

Low Density Lipoproteins (LDL - bad Cholesterol)

The American Heart Association has issued new guidelines for the drug treatment of high cholesterol, stressing that first, other conditions such as hypertension, diabetes and obesity should be corrected with proper medications, diet, exercise and lifestyle modifications before drug treatment. If cholesterol levels still remain high, then cholesterol treatment with statin medication should start. Statin drugs are generally safe but are not completely without side-effects. Muscle pain, muscle weakness, liver dysfunction, mental confusion and insomnia have been reported as side-effects of statins. There is abundant evidence in the medical literature that the benefit of statins outweigh possible side effects. Nearly all statins are now available in cheaper generic forms in the market. A prospective clinical study published this year in the medical journal JAMA, found that among 326,981 VA patients whose average age was 81, the use of statins was associated with 24% fewer deaths from heart disease during a seven year follow period. I personally take low dose atorvastatin (Lipitor) every day, even though my cholesterol level is normal.

Current, desirable and healthy cholesterol levels should be as follows: total cholesterol  < 200 mg/dl; HDL (good) cholesterol level: 40- 60 mg/dl; LDL-bed cholesterol level, around: 100 mg/dl.

Recent studies have shown that very low levels of LDL or “bad” cholesterol may also cause the increased risk of hemorrhagic stroke. For people with LDL less than 50, the risk of hemorrhagic stroke increases nearly three times.

Do you know what your cholesterol levels are? It is obvious that we need a personalized recommendation from our doctors, more than a general rule, to deal with high and low levels of HDL, LDL and total cholesterol.