Just a few years ago, cholesterol was a word that few could pronounce or spell, much less have any regard for in their own lives. Today that’s all changed. So much so that when Vanna White spelled out CHOLESTEROL on Wheel of Fortune the category was “common household term”. And my wife and children were delighted when the question for “Best-selling health book of 1988″ on jeopardy! was “What is The 8-Week Cholesterol Cure?”
A tremendous amount of publicity aimed at both doctors and their patients resulted in massive public awareness of the need for cholesterol testing and control. Still, the average Westerner doesn’t completely understand what all the terms really mean. Now that you’re on the road to recovery from heart disease, it’s particularly important that you fully understand cholesterol and what you can do about it.
Actually cholesterol isn’t all bad. We need some of it for a number of the body’s functions: to manufacture adrenal and sex hormones, to produce bile acids used in digestion, to build cell walls and to form the protective sheath around nerves. Because cholesterol is so important, the body makes its own supply in the liver. In fact, if we never ate a single bit of cholesterol, we’d make all we need. Unfortunately some of us make more than we need, and we add fuel to the fire by eating a high-fat, high-cholesterol diet.
The result is an elevated cholesterol level in the blood. We’d like to see levels at no more than 5.2 mmol/1, and more ideally at between 4.1 and 4.6. The “mmol/1″ stands for millimoles of cholesterol per litre of blood. From now on, I’ll drop that designation and just provide numbers.
While the total amount of cholesterol in the blood is important, it’s also essential to know about individual constituents. A number of years ago, researchers found that the total cholesterol in the blood could be broken down into a number of fractions, determined by the lipoproteins which carry cholesterol through the blood. These lipoproteins can be likened to transport ships, since cholesterol itself does not dissolve in blood and needs to be shuttled around.
Low-density lipoprotein cholesterol (LDL) is the real culprit in heart disease. This is the “bad” cholesterol we hear about. For those who have had a cardiac event and hope for disease regression, LDL should be no more than 2.59. LDL carries cholesterol through the blood and deposits it in the arteries in a solid mixture of calcium, fibres and other substances collectively referred to as plaque. The formation of such plaque is called atheroma, and the disease is atherosclerosis. It is this atherosclerosis that we commonly call heart disease. Actually, the heart is usually healthy, but the arteries are blocked. So a more proper term is “coronary heart disease” (CHD), with the word coronary referring to the coronary arteries supplying the heart with blood. The higher the level of LDL in the blood, the greater the risk of heart disease.
Very-low-density lipoprotein cholesterol (VLDL) is the substance that the liver uses to manufacture LDL. Scientists refer to VLDL as a precursor of LDL. In other words, the higher the level of VLDL, the more LDL can be produced by the liver.
High-density lipoprotein cholesterol (HDL) is the protective fraction of cholesterol. HDL actually acts to draw cholesterol away from the linings of arteries. The higher the level of this “good” HDL cholesterol, the more protection against heart disease. Levels of HDL should be no lower than 1.3 to 1.4 in women and 1.2 to 1.3 in men. Levels of less than 0.9 are considered to be an independent risk factor for heart disease. That is to say, even if total cholesterol levels are in the desirable range, if the level of HDL is less than 0.9, heart disease can occur. In fact, it is estimated that about 20 per cent of all men suffering a heart attack have a perfectly normal cholesterol level of
5.2 or less, but their HDL falls under 0.9. Conversely, women tend to have a higher level of HDL, and even if their total cholesterol counts are high, they can be completely free of heart disease risk.
You may hear your doctor talk about a cholesterol risk ratio. He’s referring to the ratio between either total cholesterol or LDL cholesterol and HDL cholesterol. This is an excellent index of heart disease risk. Let’s look at some examples.
If total cholesterol is 5.2 and HDL cholesterol is 1.3, the ratio is 4:1 or 4.0. A total of 6.5 with an HDL of 1 gives a ratio of 6.25. Ideally that ratio should be no more than 4.0 for women and 4.5 for men. The difference reflects women’s greater production of HDL as a rule.
If using the LDL to HDL ratio, the numbers should be no more than 3.0. As an example, if the LDL were 3.6 and the HDL 0.9, the ratio would be 4.0. In this case we’d like to see the LDL come down and the HDL go up. We’ll discuss just how to achieve those changes in this chapter.
Blood tests prescribed by doctors will usually include information about levels of triglycerides. These are another category of fats in the blood, although their involvement in heart disease remains in question. Some doctors feel that elevated triglyceride levels have nothing to do with heart disease. Others believe that levels should not exceed 6.5. Still others are more stringent, calling for triglyceride counts of no more than 3.9. The concern here is that triglycerides are the major components of VLDL, which in turn can lead to increased LDL in the blood. An international expert panel upgraded the risk of elevated triglyceride levels at a 1991 meeting in New York. Those with levels of 5.2 or more are now considered to be at increased risk, especially when other risk factors are present.
Dietary fat, especially saturated fat and cholesterol, raise levels of cholesterol in the blood. Triglycerides are influenced by simple sugars and alcohol. The ideal dietary prescription, as we’ll see in more detail, calls for reduced amounts of fat, cholesterol, refined sugars and alcohol. But you’ve heard that before! Now it’s a matter of putting it to practice as you make your recovery.
Cardio & Blood/ Cholesterol

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