Cholesterol is an important indicator of overall health and cardiac risk. Cholesterol testing is often required in assessing risk for a new life insurance policy. In the United States, cholesterol is big business, with cholesterol-lowering medications consistently appearing among the 100 most prescribed medications in the country. Having a background in pharmacy, this knowledge is not new for me. In fact, I had given lipid panels little thought, beyond knowing that cholesterol levels of 200 or below are best, but a recent visit to my own doctor had me questioning some of my own preconceived notions about cholesterol.
I recently went to a new family practitioner, and had returned for a follow-up to my initial visit to review all of my new-patient blood work. She sat across from me, looking over my labs, and mentioned that my cholesterol was a little elevated. My generally healthy thirtysomething self was a little taken aback by this information, but not nearly so much as what she followed up with. “However, your HDL is fantastic, so let’s not worry about this,” she said. WHAT? With my high level of good cholesterol, my risk ratio was extremely low, which made my total cholesterol number less important. Fascinated by this information, I did what any good writer does: I came home and began researching.
Cholesterol is your Friend!
Cholesterol has long gotten a bad rap, due in part to direct-to-patient advertising campaigns that drug companies have been using in recent years. In fact, our bodies need cholesterol to be healthy. Cholesterol is required for hormone production, and is used by the body to produce cell membranes and protect nerves. High density lipoproteins have antioxidant effects, helping to prevent and fight disease. So exactly what is all the negative buzz about, anyway?
Is Cholestral Naughty or Nice?
Cholesterol is a waxy substance that circulates in the bloodstream and in all the cells of the body. Cholesterol can’t be dissolved in the blood. It has to be transported to and from the cells by carriers called lipoproteins. Most of us know there is “bad” and “good” cholesterol. Low-density lipoproteins (LDL) carry the cholesterol throughout the body to its organs and tissues. If there is too much cholesterol circulating in the blood, over time, LDL cholesterol particles begin to oxidize or shrink in size. These smaller particles can then enter the blood vessel wall and begin to build up beneath the blood vessel lining. Deposits of LDL cholesterol are known as plaques, and plaque buildup can eventually crowd the blood vessels, obstructing blood flow. LDL cholesterol levels below 100mg/dL are considered optimal.
On the other hand, high-density lipoproteins (HDL) are referred to as “good” cholesterol. HDL cholesterol particles act as cholesterol scavengers, picking up excess blood cholesterol and returning it to the liver for disposal. High levels of HDL cholesterol reduce your risk of developing heart disease by removing dangerous cholesterol from the bloodstream. In addition, HDL cholesterol has anti-inflammatory and anti-clotting, and antioxidant properties, making it necessary for optimal health and disease prevention.
Further, even patients who have a low-to-normal LDL cholesterol level may actually be at risk for heart disease if their HDL cholesterol is also below normal. Desired HDL levels in men and women are those above 60mg/dL. In a lipid panel, triglyceride levels are tested along with LDL and HDL levels as a means of assessing risk of heart disease. Triglyceride is a form of fat produced by the body. Elevated triglycerides may be the result of excess weight, physical inactivity, cigarette smoking, excess alcohol consumption and a diet very high in carbohydrates (60 percent of total calories or more). High triglyceride levels appear to increase the risk of stroke, heart attack, and heart disease. Normal triglyceride levels should be below 150mg/dL.
Unfortunately, many of us fixate on the total number, and haven’t been looking at the breakdown. Lipid panels often include a cholesterol risk ratio, as mine did. A ratio of less than 3.2 indicates a low risk for developing heart disease. Many clinicians, mine included, feel this is a much better indicator of risk than total cholesterol. In my case, while my total cholesterol was considered borderline high, my HDL level was so high that my risk ratio was only 1.3.
Regardless of risk, patients should be aware of their baseline cholesterol levels, and should discuss the complete results with their healthcare provider. Keep an eye out next month for more information on lowering your LDL and triglyceride levels and raising your HDL.
Shannon Fields is a freelance writer and a Certified Pharmacy Technician at Innovative Pharmacy Solutions.