Articles
Your Health Alert
Week 5
Tuesday, November 17th,, 2008
Daily Camera, Boulder, CO
WHAT? CHOLESTEROL IS GOOD?
Yes, some types of cholesterol are good. We all know that high cholesterol levels in our blood are associated with heart attacks and strokes. But there are many different types of cholesterol, and some of them are very good for you.
The standard lipid panel (blood test), that is most commonly ordered, only measures LDL, HDL, total cholesterol, and triglycerides. But there are really 17 different types of cholesterol that need attention (I check all of them and more, in the advanced lipid panel of blood and urine). We know that LDL is bad, and HDL is good, but many of us are confused about their significance. And most of us don’t know anything about the other types.
The difference between these types of cholesterol is the size and density of the lipoproteins. Chylomicons are the smallest, followed by very low density lipoproteins (VLDL), intermediate density lipoproteins (IDL), and low density lipoproteins (LDL).
Most of us are told that the LDL is the most important part of the lipid panel. However, LDL is certainly not the best predictor of heart attacks and is a very poor predictor of strokes. To make matters worse, in the standard lipid panel, the LDL is wrong 50% of the time, and up to 50% off because it is calculated from other measurements instead of being measured directly.
The most important measurement is really the HDL. It is known as the good cholesterol because it can take cholesterol out of plaque, and back to the liver by a process called macrophage reverse cholesterol transport. There is a definite association between heart attacks and strokes with a HDL that is too low.
I usually do not use the standard cutoff levels for cholesterol to assess risk. For someone with atherosclerotic plaque my numbers are Total Cholesterol <150, Triglycerides <100, HDL>60 (not the 40 the lab tells you), LDL <50, VLDL <20, IDL <20, real LDL <50, TC/HDL <3.0, TG/HDL <3.5. So you might want to dig out your last lipid tests and see how you stack up against my numbers. I know they are more stringent, but I believe we need to be more aggressive because this disease is killing 2/3 of Americans with the standard treatment and benchmarks we are using now.
However, there is one other type of cholesterol that I have not even mentioned, and 22% of you have high levels of it. It is so bad that we call it “the heart attack cholesterol.” Come back next week and I will tell you all about it.
Joe Turnbow, M.D.
Copyright 2008, Heart Attack Prevention Strategies P.C. All rights reserved.