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Cholesterol is a waxy, fat like substance that is necessary for life. Your liver makes enough cholesterol to meet the body’s needs.

There are two kinds of cholesterol, a so-called “good” and a so-called “bad” kind. The good kind, “high-density lipoprotein (HDL)” helps remove the so-called bad kind, “low-density lipoprotein (LDL),” and bring it back to the liver. The LDL cholesterol transports cholesterol to the body cells. It is like an oil truck that delivers the 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 embolism, etc. When the arteries around the heart become clogged, the blood supply is restricted to the heart and causes angina pectoris.

Eating saturated fat foods will cause your liver to make more cholesterol, and especially make the “so called” bad (LDL) kind. 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) is 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 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 oils, cocoa butter that is 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.” Un-refined beans, grains, vegetables, seeds, and nuts contain mostly unsaturated fats. The unflavored 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.


The higher the “number” over 4.0, the greater the risk of developing cardiovascular disease.


The government’s cholesterol guidelines may not tell all

Until now, you could feel secure with a serum cholesterol level under 200 mg/dl—officially “low risk” for heart disease

But whoops! Now investigators at the ongoing Framingham Heart Study in Massachusetts report that 15% of their patients who died of heart attacks had levels below the supposedly magic 200 level.

LDL vs. HDL levels

What’s going on here? It turns out those heart attack patients also had low levels (less than 40 mg/dl on average) of high-density lipoproteins (HDL’s), which help rid the body of serum cholesterol.

So though their total cholesterol (under 200) seemed reassuring, it actually contained too few good HDL’s and too many low-density lipoproteins (the bad LDL’s that form plaque on artery walls).

A Johns Hopkins study shows similar results: A surprisingly large number of patients with coronary artery disease had total cholesterol levels under the 20 mg/dl declared desirable by the government’s National Cholesterol Education Program (NCEP).

That means many Americans who think they’re at low risk actually may be heart attack candidates. The Hopkins doctors are even urging the government to revise its guidelines.

Framingham chief Dr. William Castelli calls on doctors to go beyond the guidelines and do a screening with a total cholesterol test plus an HDL check.

Dr. DeWitt Goodman, chairman of the NCEP’s guidelines panel, acknowledges HDL’s importance as a risk factor, but says revisions aren’t necessary—at least not until more scientific studies are forth-coming.

A Complete Lipid Profile

Meanwhile, the only way to know your risk for sure is to ask for a complete lipid profile. That will reveal what proportion of your total blood cholesterol is made up of HDL’s and what part is the heart-clogging LDL type. The doctor may also check your tri-glycerides, other blood fats linked to heart disease.

Desirable level: at least 45 mg/dl for HDL’s; under 130 for LDL’s; and under 150 for triglycerides, says Dr. Castelli.

Total Cholesterol to HDL

Those are a lot of numbers to keep straight—even now, during National Cholesterol Awareness Month. So to simplify matters, suggests Dr. William B. Kannel of the Framingham study, just know the ratio of your total cholesterol to HDL—for example, 200 over 45 gives you a four-to-one ratio (4.4 to be precise). Anything over that points to a heart disease risk, adds Castelli.

What To Do

If your HDL ratio isn’t so great—can you bring it up? Sure. Start with a diet low in saturated animal fat, then control weight, exercise, quit smoking and drink only moderately.

Though as yet there’s no definitive scientific evidence that increasing HDL levels will reduce your heart disease risk, Harvard’s Dr. Meir Stampfer says it might be worthwhile. His studies suggest that people in groups with very low HDL levels have five times the heart attack risk of those with very high HDL’s.

—Larry Husten
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