Cholesterol and Heart Risk

How to Lower Your Cholesterol and Reduce Your Risk of Heart Attack and Stroke


HEART DISEASE is the number one killer of adult American males and females. This booklet clearly outlines the problems associated with the number one cause of the number one killer: high cholesterol. More importantly, it outlines simple steps to reduce your cholesterol levels and hence greatly improve your odds of never meeting this number one health enemy firsthand.

Cholesterol and Heart Risk is based upon the most recent and respected medical research available. Of course, its intention is to educate in the area of heart risk reduction, but it is not intended to be used as individual medical advice. A physician should be consulted to deal with specific medical problems.

 

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No part of this book may be reproduced in any form without express written consent from the author.


Table of Contents (Hyperlinked--click to go directly to section)

Introduction. 7

First, What is a Heart Attack?. 10

Components of Blood Lipids. 12

What Does LDL Cholesterol Do?. 13

What Does HDL Cholesterol Do?. 13

What Are Triglycerides and What Do They Do?. 14

Can I Change My Levels of Total Cholesterol, LDL, HDL and Triglycerides?  15

Are Ratios Important?. 17

The Truth About Total Cholesterol, LDL, HDL and Ratios. 18

How Important Are HDLs and the Cholesterol/HDL Ratio?. 21

Why The Conflicting Views?. 23

Steps To Reducing Your Risk. 25

Diet 25

What of Syndrome X, Carbohydrate Addiction and Insulin Resistance Syndrome?  25

Exercise. 26

Smoking. 26

Stress. 26

Cholesterol-Lowering Foods. 27

What About Cholesterol Medications?. 27

Cholesterol Medication for "Average" Cholesterol Levels?. 28

Other Risk Factors. 30

In a Nutshell 30

Recommended Reading List 30

Cholesterol Risk Chart 31

Introduction                                   

H

igh cholesterol is recognized as a major risk factor in the development of cardiovascular disease. In fact, many prominent cardiologists and researchers consider it to be the number one risk factor. You might expect that the number one risk factor of the number one killer of American adults would be readily understood by a majority of the populace. However, just the opposite is true. Most lay people, and in fact most physicians, have at best a very vague knowledge of the true risks associated with high cholesterol, or even what defines high cholesterol levels.

One does not have to look far to find confusing and contradictory information on this subject. Consider the two conflicting quotes that follow:

Quote 1: " Normal cholesterol is the level at which atherogenesis [the beginning of buildup of arterial plaque] does not occur, considering other risk factors. Animal and population studies suggest that this is about 160 mg/dl. In the famed Framingham Heart Study, those who had a cholesterol level lower than 160 mg/dl suffered no heart attacks no matter what their HDL, LDL or triglyceride levels were."

Quote 2: "Research shows that even those with desirable total cholesterol levels are at greater risk if their HDL levels are low."

Quote one clearly says that the most famous and comprehensive cholesterol study in the world, the Framingham Heart Study, showed that if one's cholesterol is below 160 mg/dl (milligrams per deciliter), the level of HDL ("good cholesterol") is not a factor at all. The next quote says that if your HDL level is low you are at risk no matter what your total cholesterol is—the exact opposite of the first quote. And the kicker is this—both quotes are not only from the same author, but they are found in the same book and only one page apart! Maureen Keane, The Red Yeast Rice Cholesterol Solution, Adams Media Corp., Holbrook , MA , 1999, pp. 159, 160.

Consider also these other confusing facts:

The National Cholesterol Education Panel (NCEP) Guidelines of 1993 and 2001 state that "desirable" total cholesterol levels are those under 200. This seems to be accepted by a large segment of the medical industry, if not a majority. However, please note the following statements:

"For maximum protection, total cholesterol levels should be under 150—much lower than 200, which the NCEP suggests as a safe limit. 'Thirty-five percent of people who have heart attacks actually have total cholesterol between 150 and 200,' Dr. Castelli explains. 'But people with total cholesterol levels under 150 just don't get heart disease.'"  Kris Napier, Susan Smith, Prevention magazine, April 1996, p. 107. An interview with Dr. William Castelli, longtime medical director of the Framingham Heart Study.

"National guidelines tell us that 200 mg/dl is the highest healthy level of cholesterol in a person's blood. In my opinion, this is not good enough. A substantial number of heart attacks still occur when a person's cholesterol level is below 200 mg/dl. Experts making this recommendation are using an American standard. If we take a broader world view, we see that in places where traditional diets are still followed, such as China , cholesterol levels are much lower. Heart disease is almost non-existent in places where blood cholesterol is very low. If your cholesterol is around 160 mg/dl or less, your risk of heart disease is virtually zero. This is the conclusion of both the Chinese Diet Study and the Framingham Heart Study (both landmark studies in the field).  I believe that a cholesterol level of 150 mg/dl is a better standard than the 200 mg/dl recommended by American experts."  Dr. Terry Shintani, Hawaii Diet, Pocket Books, New York , New York , 1999, p. 68-9.

Now note these two conflicting statements regarding the importance of total cholesterol verses ratios:

"The best predictor of cardiac risk is the total cholesterol/HDL ratio." Mary P. McGowan, Heart Fitness For Life, Oxford University Press, New York , New York , 1997, p. 17

"You may hear your cardiologist refer to an 'HDL' ratio. I do not place much stock in this number for the simple reason that total cholesterol is much more diagnostic."  John A. McDougall, The McDougall Program For a Healthy Heart, Dutton, New York, New York, 1996, p. 150.

And finally, note these seemingly opposite statements concerning HDL levels:

"Higher is definitely better when it comes to this cholesterol number [HDL]."  Kris Napier, Susan Smith, Prevention Magazine, April 1996, p. 107

"Worldwide, the people with the lowest HDL levels have the lowest incidence of heart disease."  John A. McDougall, The McDougall Program For a Healthy Heart, Dutton, New York, New York, 1996, p. 42

Are you confused?  Don't feel alone. Again, a majority of the general public and even many medical doctors do not have the cholesterol puzzle solved. However, this is a very solvable, easy to understand puzzle, with just a few pieces that need to be put into place. This publication will accomplish that task for you.

First, What is a Heart Attack?

By first identifying what a common heart attack really is, you will have a better grasp of why cholesterol control is such a vital factor in staving off heart disease.

Initially, lets dispel a common misconception (at least among non-medical personnel) as to what a heart attack is. After someone dies of cardiac arrest it is common for an acquaintance to remark: "His heart just gave out."  That person is implying that the heart muscle was old and weak and it couldn't beat anymore. This is probably not what happened.

Rather, heart attacks are almost always caused by the following mechanism: In those whose cholesterol levels are too high, and especially where coupled with HDL levels that are too low, excess cholesterol begins to build up on artery walls in a hardened form known as plaque. This process is accelerated by such factors as high blood pressure, stress and diabetes. You won't know that you have this buildup occurring inside your arteries at first because it is painless and symptom-less.

However, as the buildup continues and begins to significantly narrow the arteries, symptoms may arise in the form of angina. This is a chest pain that follows exertion or stress, and occurs because the heart muscle is no longer able to receive sufficient oxygen due to the reduced blood flow entering the heart region. Usually rest or a reduction of stress will quickly alleviate the problem, as the heart's need for oxygen will return to normal, lower levels.

Whether angina is present or not, as the arteries narrow more and more the risk of a heart attack becomes greater and greater. Blood clots are relatively common occurrences, but we never notice them because they simply pass through our systems without incident. However, if the coronary arteries are severely narrowed, and especially when they become over 70% blocked, these tiny clots can get trapped in the arteries. When they do blood flow to the heart will stop, and the heart will literally starve for oxygen. If the situation is not corrected quickly by medical intervention, part of the heart will begin to die. This is a common heart attack. If this is substantial, likely the heart will become unable to beat, and death will soon follow.

Another similar danger, it has been reported, is that in those with plaque-narrowed arteries, a chunk of the plaque can break off and have the same effect as a blood clot, blocking the artery and preventing the heart from receiving its blood/oxygen supply.

So you can see how great a factor cholesterol is in heart disease. High cholesterol levels provide the materials that allow the process of the buildup of plaque. Hence, it is imperative that if you are concerned about never having a heart attack, you pay close attention to your cholesterol levels throughout your entire adult life.

There was a very interesting observation made along these lines regarding entertainer David Letterman, who at the beginning of the year 2000 underwent quintuple bypass heart surgery. Please note this in the excerpts from the wire article that follows:

NEW YORK, Jan 14 (Reuters) - CBS late night talk show host and comic David Letterman underwent successful heart bypass surgery on Friday and was expected to make a full recovery, his spokesman said.

Letterman, 52, who has a family history of heart disease, went into the hospital for an angiogram to look for blockages in his veins or arteries, and was operated on shortly after when the test mandated surgery.

The surgery was performed by Dr. O. Wayne Isom, chairman of Cardiothoracic Surgery at New York-Weill Cornell Centre, at New York Presbyterian Hospital .

``Dave has the heart muscle of a 20-year-old,'' Isom said after the operation.

Again, as shown in Mr. Letterman's case, it is usually not the strength of the heart muscle that determines heart disease, but rather the buildup of arterial plaque caused by dangerous cholesterol levels.

Components of Blood Lipids

Blood lipids consist of several components, the most important of which regarding heart disease are LDL cholesterol, usually referred to as "bad" or "Lethal" cholesterol; HDL cholesterol, usually referred to as "good" or "Healthy" cholesterol; and triglycerides. Your total cholesterol level is made up primarily of your LDL and HDL cholesterol subtotals. Cholesterol in its makeup is a waxy fat-like substance, while triglycerides are a true blood fat.

What Does LDL Cholesterol Do?

Is LDL cholesterol really lethal and bad?  Actually, LDL cholesterol is absolutely necessary for many vital functions of life. You could not function nor live without LDL in your blood. Where LDL becomes hazardous is when the level in your bloodstream becomes excessive. If you were to eat little or no dietary cholesterol and a low amount of saturated fats, your LDL would normally remain at a healthy level for your body to carry out its normal functions. But when, usually through dietary indiscretions, your LDL becomes higher than ideal, excess LDL is deposited as plaque in the arteries. This buildup is responsible for the accumulating risk of coronary artery disease. And the higher the level of LDL and hence greater excess in the bloodstream, the more quickly and severely this process will occur.

What Does HDL Cholesterol Do?

So then is HDL cholesterol really "good"?  Yes. HDL cholesterol works by protecting the body from the dangerous effects of excessive LDL. There are various theories as to how this occurs, but the most common thought is that HDL ushers LDL away from the artery walls and prevents the LDLs from forming plaque on those walls.

An amazing aspect of HDL cholesterol is that it rises and lowers in response to the body's need for it. For example, take a person who practices nutritionally sound dietary habits and perhaps has an LDL level 100 and an HDL of 45. If that person began to eat a less healthful diet and the LDL level rose, normally the HDL level would also rise as a protective response. The new profile might be LDL 130, HDL 50.

Is the rise in protective HDL enough to completely counterbalance the risk of increased LDL cholesterol?  No. It helps somewhat, but total risk still rises. It is safer to keep the LDL level as low as possible. (By the way, your LDL level can't get too low—with the exception of severe illness, your body won't let it.)

What Are Triglycerides and What Do They Do?

Triglyerides, though not technically a cholesterol, are a fat that occurs naturally in the blood. A healthy level is usually considered in the 50-150 range. When triglycerides become high, the blood is thickened and circulation can be reduced. Thus, while triglycerides levels have not been studied to the extent that total cholesterol, LDL and HDL have, excessive triglycerides in the blood is considered a heart risk factor. Risk is usually considered double when triglycerides are at the 400-600 level. Other medical problems may also occur when triglyceride levels become too high. A most common cause of elevated triglyceride levels is a diet that is high in fats and simple sugars.

Can I Change My Levels of Total Cholesterol, LDL, HDL and Triglycerides?

Very definitely. In fact, if your levels are not in the healthful range, you are encouraged to take steps to bring them within those ranges. You'll be pleased to know that positive changes will occur very quickly. Improvements show up on blood tests in just two or three days for cholesterol and within hours or even minutes for triglycerides. (This property of triglycerides is the main reason you fast for 12-14 hours before a lipid blood drawing is taken.)

Three of the four factors—total cholesterol, LDL cholesterol and triglycerides—can be changed dramatically. HDL levels can be altered somewhat, but not nearly to the extent of the others.

How much can total cholesterol be changed?  Dr. Harvey Simon of the Harvard Medical School reports on the results of Dr. Dean Ornish's Lifestyle Heart Trial: "The diet-treated patients dropped their cholesterol levels dramatically, with average values falling from 213 to 157." Harvey Simon, Conquering Heart Disease, Little, Brown and Company, Boston , 1994 p. 101. Dr. Ornish himself, a world-renowned leader in the field of prevention and reversal of heart disease, notes one spectacular case: "Joseph Forgione had the misfortune of having a cholesterol level as high as 558. Within six months [of being on Dr. Ornish's reversal diet] his cholesterol had decreased to 107." Dean Ornish, Dr. Dean Ornish's Program for Reversing Heart Disease, Ivy Books, New York, 1990, p. 247.

The above improvements, it should be noted, came about through significant dietary changes. Dr. Ornish's program is very low in fat and cholesterol and is completely lacto-vegetarian. Typically, though, changes of 30 or 40 mg/dl are not uncommon through a moderate reduction in saturated fat and cholesterol intake. (And such changes are very medically significant. A lowering of cholesterol from 200 to 160 moves one from substantial risk to practically no risk at all.)

HDL levels are more genetically determined. While average HDL levels for adult men are about 45 and adult women about 55, some have levels as high as 100 or more and others as low as 30 or less. With some effort you might be able to healthfully raise your HDL somewhat, but essentially the level you were born with is the general level you will always have. Note that I mention "healthfully" raising your HDL level. I say this because it is possible to raise your HDLs in an unhealthful manner. You could do this by raising your overall cholesterol level through unhealthy eating. While the HDLs would rise, this would bring about an even greater increase in total cholesterol, LDL levels and hence overall risk. You can even raise your HDL, it is reported, by ingesting the pesticide DDT, though this would be, shall we say, very inadvisable. So healthfully raising HDL is referring to doing so by methods that will not likewise increase the level of total and LDL cholesterol or otherwise harm your health.

Triglyceride levels can soar from a normal of 50-150 to well over 1,000. Some patients have had levels exceeding 5,000. It is reported that such patients have visibly fatty and sludged blood—that a layer of fat will rise to the top of a blood vial as the blood is being drawn. Proper dietary measures can greatly reduce elevated levels of triglycerides. Especially important in doing so is the avoidance of excessive fats and simple sugars, such as found in sucrose, honey, maple syrup, fruit, and similar sweet foods.

Are Ratios Important?

When cholesterol first became a well-known heart risk factor in the 1960s, all we heard about was the level of total cholesterol. Then in the 1980s another aspect of cholesterol began to get as much or even more press, that of the ratio of total cholesterol to HDL. Such adult ratios average about 4.2 (210 total/50 HDL = 4.2). It is said that ratios much lower than this are very protective and ratios higher than this put one at increasing risk. There are also other ratios that are sometimes considered, such as LDL/HDL. But most physicians are speaking of total cholesterol/HDL when they mention risk ratio.

Most doctors will tell you that both the total level of cholesterol and the cholesterol/HDL ratio are about equally important. Some favor total cholesterol as more important, while most today seem to think they are of similar importance or that ratio is even more important. It may be somehow sophisticated, or modernly "in the know," to favor ratios. There is, though, more to the equation.

A problem occurs, for instance, where one risk factor is either good or bad (such as total cholesterol) and the other (ratio) is the opposite. An example of this is where total cholesterol is low (150), but the ratio is high (5.0, due to an HDL level of 30). On the other hand total cholesterol may be high (300), but the ratio may be low (3.75, due to an HDL level of 80). In these cases, what is a doctor to tell a patient?  "Your cholesterol is low but your ratio is high" or "your cholesterol is high but your ratio is low" just won't suffice. The patient wants to know the bottom line: "Am I at high risk or not?"

What would you say from the two examples above?  In reality, one is very healthy and the other is very dangerous. Can you guess which?  By learning the principles in the next section you will become something of an expert at evaluating heart risk from cholesterol levels, including having a good understanding of your own lipid profile.

The Truth About Total Cholesterol, LDL, HDL and Ratios

The experts today have a very common voice regarding cholesterol and heart risk, and they are saying and even shouting the same thing. See if you can find the common threads in the following quotations:

"No one in the Framingham Heart Study has had a heart attack whose blood cholesterol level has remained consistently under 150. In countries where heart disease is very rare, blood cholesterol levels remain at about this level. Thus, a normal cholesterol level is around 150 or less." Dean Ornish, Dr. Dean Ornish's Program for Reversing Heart Disease, Ivy Books, New York, 1990, p. 286.

"Below 150 mg/dl—Little or no risk. This is what I consider a safe cholesterol level, and it's what I am shooting for in my patients."  John McDougall, The McDougall Program for a Healthy Heart, Dutton, Boston , 1996, p. 147.

"The incidence of heart disease begins to appear at 160 and slowly increases to 180. After 180 there is a dramatic surge in heart disease, and after 200 it soars. The handwriting is on the wall and on the pages of the medical journals. Get those cholesterol levels way down, much lower than 200."  Robert Kowalski, 8 Steps to a Healthy Heart, Warner Books, New York , 1992, p. 285.

"Normal cholesterol is the level at which atherogenesis does not occur, considering other risk factors. Animal and population studies suggest that this is about 160 mg/dl. In the famed Framingham Heart Study, those who had a cholesterol level lower than 160 mg/dl suffered no heart attacks no matter what their HDL, LDL or triglyceride levels were."  Maureen Keane, The Red Yeast Rice Cholesterol Solution, Adams Media Corp., Holbrook , MA , 1999, pp. 159.

"The recommended level is under 200 mg, but as we have said, studies have shown that heart attacks almost never occur when the cholesterol level drops to the 160 mg. range." Helen Cassidy Page, John Speer Schroeder, M.D., Tara Coghlin Dickson, M.S., R.D. The Stanford Life Plan For a Healthy Heart, Chronicle Books, S.F. CA. 1996, p. 41.

“There are few guarantees in life, but having a blood cholesterol level of less than 150 is probably the closest you can get to a guarantee that you will not be troubled with heart disease. One of the more interesting findings from the Framingham Heart Study is that no one in the history of the study has ever had a heart attack whose blood cholesterol was less than 150. If you can get your cholesterol under 150 you don’t even have to concern yourself with the further breakdown of ‘good’ and ‘bad’ cholesterol analysis.”  Kitty Gurkin Rosati, Heal Your Heart, Duke University Rice Diet Program, John Wiley & Sons, NY , NY , 1997, p. 16

"The most important risk factor for heart disease is total cholesterol. The importance of total cholesterol in determining risk of coronary heart disease is demonstrated by the fact that in the Framingham Heart Study, heart attacks virtually disappeared when cholesterol levels dropped below 150 mg/dl. At this low cholesterol level, heart disease risk disappeared, regardless of other risk factors, including obesity, diabetes, smoking and low HDL levels."  Dr. Terry Shintani, Hawaii Diet, Pocket Books, New York , New York , 1999, p. 67.

"Cholesterol readings are like golf scores. The lower the better."  Helen Cassidy Page, John Speer Schroeder, M.D., Tara Coghlin Dickson, M.S., R.D. The Stanford Life Plan For a Healthy Heart, Chronicle Books, S.F. CA. 1996, p. 61.

Do you see the two common threads?  They are that with regard to cholesterol, total cholesterol is the most important heart risk factor. Furthermore, the numbers 150 and 160 were repeatedly identified as a safe threshold, beneath which people simply do not get heart disease.

So the way to lower heart risk with regard to cholesterol is very straightforward and clear: Get your total cholesterol level under 150-160 mg/dl and keep it there. This almost guarantees that you will never be plagued with heart disease. If you can't attain this level, get it and keep it as close as possible.

How Important Are HDLs and the Cholesterol/HDL Ratio?

As we have seen, there is contradictory thinking in the medical profession as to the importance of HDL levels and the HDL/cholesterol ratio. The medically correct view, though, is quite simple and easily grasped.

First, let's revisit two apparently contradictory statements concerning the importance of HDL levels:

"Higher is definitely better when it comes to this [HDL] cholesterol number." Kris Napier, Susan Smith, Prevention Magazine, April 1996, p. 107

"Worldwide, the people with the lowest HDL levels have the lowest incidence of heart disease."  John McDougall, The McDougall Program for a Healthy Heart, Dutton, Boston , 1996, p. 42.

Which of these two is correct? In a sense both are. The Prevention quote is correct in that HDL cholesterol really is "good" cholesterol. By its design it keeps plaque from forming on the artery walls, thus preventing plaque buildup, the process that leads to heart disease.

The quote by Dr. McDougall, however, provides a more complete look at the situation regarding HDL levels. Although HDL is good, high levels could be a sign that something is wrong, and that is why the body is manufacturing such a high level. This could be compared to white blood cells, which are also good in that they protect the body from infection. When the level gets high, though, this is not a sign of superior health, but rather that something is wrong in the body, such as a severe infection.

This is not to say that a high level of HDLs is a definite sign of trouble. Some people have very high levels of HDLs but also have healthy levels of total cholesterol, LDLs and triglycerides. This is ideal. But studies of the heart-healthiest peoples in the world reveal that they usually have low HDL levels. For example, the Tarahumara Indians are known for their incredible physical endurance, often playing a kickball game lasting 24 hours or more where they run 100-200 miles non stop. These people have virtually no heart disease and are seldomly troubled with other illnesses. Yet, studies have found that their average HDL level is 32 mg/dl, considered "at risk" by most sources. However, their average total cholesterol level is 125. These levels are attributed to their largely vegetarian diet, low-stress lifestyle and high level of physical endurance. So this is what Dr. McDougall is referring to when he says that the healthiest people in the world have low HDL levels. (You can see the problem the Tarahumara would encounter in the doctor's office using the traditional risk standards. They would be told that their total cholesterol of 125 puts them at low risk, that their cholesterol/HDL ratio of 3.91 puts them at average risk and their HDL level of 32 puts them at high risk. Which is it?  The temptation might be to take the middle road and say they are at average risk overall. The Cholesterol Risk Chart on page 31  clearly shows the typical Tarahumara is properly classified at very low risk.)

Keeping these factors in mind, it is apparent how HDL levels and the ratio of cholesterol/HDL should be viewed. When the total cholesterol is low, such as in the 150-160 range or less, HDL levels and ratios are essentially insignificant. At such low levels the LDL will also be low, and high or even "average" levels of HDL are not necessary to prevent the buildup of plaque. As the total cholesterol begins to rise, HDL levels and ratios take on more and more importance. So if your total cholesterol is 180, your HDL level and ratio are important. If your total cholesterol is 200, your HDL level and ratio are very important. At 220 or higher they are of extreme importance. Simply put, as the level of total cholesterol begins to exceed 150-160, the HDL level and cholesterol/HDL ratio begins to be a risk factor and gradually increases in importance as the cholesterol count goes higher. You will see this graded increase in the Cholesterol Risk Chart on page 31 .

Why The Conflicting Views?

Why would there be such conflicting views regarding cholesterol and heart risk?  Really, the answer is quite simple. Actually, there are not many schools of thought in this field, but as the above quotations showed, there are two, which represent more or less old school and new school thinking.

Old school thinking, which has been around for thirty or forty years, took a very simplified approach to cholesterol levels. When cholesterol research first began average adult cholesterol levels in the United States were in the 230-240 mg/dl range, so a "reasonable" goal seemed to be to shoot for 200. This convenient number thus became the standard in the as-of-then vaguely understood field of cholesterol and heart risk. (Keep in mind, this was a time when the beef and dairy industries were heavily pushing the view that the more meat we ate and the more milk we drank the healthier we would be. This was also before the explosion of the health food and exercise industries—It was then thought that people would never be willing to make major dietary or lifestyle changes, so that researchers better make the goal only slightly lower than the average reading. Question: How many varieties of sneakers could you buy in 1965?  [Note to younger ones: Sneakers were what we wore before Nike, Reebok and the rest produced "athletic shoes."] In those days, it was pretty much Converse All-Stars, US Keds or PF Flyers; white or black, low or hightop. The exercise and health food movements were in their infant stages and not taken seriously.)  The problem, as we learned earlier, is that 200 is simply not a safe level of total cholesterol. Not even close. Later when studies revealed a little more about the various components of cholesterol, and to find a better standard than a cholesterol level of 200, a new standard of about 4.0 for total cholesterol/HDL ratio was accepted. This too, as we have learned, is not a complete answer.

The new school of thought is reflected in the above quotes from William Castelli, Dean Ornish, Robert Kowalski, John McDougall, Harvard Medical School , Stanford University , and Duke University researchers; Terry Shintani and others. It is based on the full scope of research from the Framingham Heart Study, the Helsinki Heart Study and other similar studies, as well as empirical evidence of the comparison of heart disease data from peoples whose diets are high in cholesterol and saturated fats verses those whose diets are low in these factors, such as traditional Chinese, Japanese, Hunza and Tarahumara diets.

Simply put, if your doctor tells you that your cholesterol should be under 200 to be considered safe he or she is probably not very knowledgeable in this field. They are just repeating the outdated rule they were taught at medical school 10, 20 or maybe 40 years ago. This was long before modern research proved this inaccurate, hazardous and unacceptable. The newer school of thought is more up to date, more thoroughly researched, more honest and more in harmony with scientific studies; and hence, if applied, will save many, many lives.

Steps To Reducing Your Risk

Diet

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What of Syndrome X, Carbohydrate Addiction and Insulin Resistance Syndrome?

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Exercise

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Smoking

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Stress

If our lives are filled with stress our cholesterol levels rise. This has been demonstrated in studies involving college students and tax preparers, for instance. The students had their cholesterol checked right before important exams and then again afterward. The average cholesterol was higher before the exams and lower post exam, when the pressure was off. Similar was the case with tax preparers regarding the April 15 deadline. Cholesterol levels peaked just before the 15th and dropped after the deadline passed.

The lesson: Don't spend much time in emergency situations. Our bodies can withstand the occasional stress of real emergencies, but many people live in emergency mode with the constant pressure of deadlines or other urgencies. For some this is due to the nature of jobs that may require too much of us, but for others it is self-imposed through such destructive habits as procrastination, taking on too many responsibilities, or chronic negative emotions as guilt. Learn to live without constant pressure and without constant guilt. Learn to say no when necessary. Life as we know it is already too short, and these traits make it even shorter, as well as less satisfying along the way.

Experts recommend that we take time for ourselves every day. A walk in the park, listening to our favorite music, reading a good book, talking with a trusted friend—these are all known stress busters. For the long term, don't skimp on vacations. Give yourself a treat from time to time. It's been observed that we are all, in a sense, grown up children. Do you remember how you responded to treats as a child?  You'll probably enjoy them as much today, and you may need them just as much or more.

Cholesterol-Lowering Foods

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What About Cholesterol Medications?

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Cholesterol Medication for "Average" Cholesterol Levels?

Why would anyone want to even consider medication for "average" cholesterol levels?  Actually, this may be a very sound practice; one that has the potential to save many lives. The key is those parentheses around the word "average."  Average cholesterol levels in lands such as the United States are not healthy cholesterol levels. Millions of people with "average" cholesterol levels die each year of heart attacks. You and I don't want to be one of them.

Similar practices commonly occur in other fields of medicine. One of the most notable is optometry. It is actually "average" (there are those quotations again) to have worse than 20-20 vision. And yet no one doubts that poor eyesight is not healthy. It detracts from the quality of life and can be dangerous. So even though such vision is "average" or typical, virtually all those with this problem take corrective action by wearing eyeglasses or contact lenses. This is much the same reasoning for taking cholesterol medication even at "average" levels. Being at high risk of heart attack or stroke is no less dangerous than poor eyesight, and those with "average" levels are at high risk, so it is the course of wisdom to correct this if at all possible. The question is not whether or not your cholesterol is "average."  The question is whether you are at risk of heart disease and if medication will reduce your risk and perhaps save your life. The label "average" won't keep you alive, but reduced cholesterol levels will.

Incidentally, the idea of cholesterol medication for those not normally considered at high risk is not unique to this booklet. The New York Times published an article entitled Drug That Reduces Average Cholesterol Level Reduces Risk of Heart Attack, by science writer Gina Kolata, in its May 27, 1998 issue. The articles begins: "A new study provides the first evidence that people with average cholesterol levels can substantially reduce their risk of heart attack by taking a drug that drives their cholesterol levels even lower. The study, financed by Merck & Company, involved 6,605 middle-aged-to-elderly men and women, half of whom took Merck's powerful and expensive cholesterol-lowering drug, lovastatin [pharmaceutical name for Mevacor]; the rest took a dummy pill. After five years, those who had taken lovastatin had had 37 percent fewer heart attacks and other serious signs of heart disease than those who had taken the placebo. Medical experts said that the study had been well conducted and that its results were solid. Dr. Claude Lenfant, director of the National Heart, Lung and Blood Institute, described it as 'a great study.'"  The article goes on further to describe the benefits of statin medications for "average" or "normal" cholesterol levels.

Therefore, if your total cholesterol levels are not near the safe 150-160 level, and especially if they are approaching or exceeding 200 and coupled with low HDLs, high triglycerides, or other risk factors, it would be beneficial to work to bring your lipid profile to a safe level by means of lifestyle changes. If you are unable or unwilling to do so, you might reduce your risk greatly by taking statin or other cholesterol medication. Of course you will need to consult a qualified physician before doing so. As this is not standard medical procedure at this time, you may want to share this information with your doctor.

Other Risk Factors

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In a Nutshell

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Recommended Reading List

This section is not available in the online version.  However, you may read the entire booklet by ordering  the published version.  See directions at the end of this online booklet.

   

May you have much success in keeping your risk factors minimally low. Good Health to You!

 

Cholesterol Risk Chart

Your true cholesterol risk! HDL figures are in the left column. Cholesterol figures are in the top row. Match the row and column.

 

<151

151-160

161-170

171-180

181-190

191-200

201-210

211-220

<21

n/a

n/a

n/a

n/a

n/a

Very High

Very High

Very High

21-30

Very Low

Very Low

Low

Average

High

High

High

Very High

31-35

Very Low

Very Low

Very Low

Low

Average

Average

High

High

36-40

Very Low

Very Low

Very Low

Low

Low

Average

Average

High

41-45

Very Low

Very Low

Very Low

Very Low

Low

Average

Average

Average

46-50

Very Low

Very Low

Very Low

Very Low

Low

Low

Average

Average

51-55

Very Low

Very Low

Very Low

Very Low

Very Low

Low

Low

Average

56-60

Very Low

Very Low

Very Low

Very Low

Very Low

Low

Low

Low

61-65

Very Low

Very Low

Very Low

Very Low

Very Low

Very Low

Low

Low

66-70

Very Low

Very Low

Very Low

Very Low

Very Low

Very Low

Low

Low

71-75

Very Low

Very Low

Very Low

Very Low

Very Low

Very Low

Very Low

Low

76-80

Very Low

Very Low

Very Low

Very Low

Very Low

Very Low

Very Low

Very Low

81-90

Very Low

Very Low

Very Low

Very Low

Very Low

Very Low

Very Low

Very Low

91-100

Very Low

Very Low

Very Low

Very Low

Very Low

Very Low

Very Low

Very Low

101-110

Very Low

Very Low

Very Low

Very Low

Very Low

Very Low

Very Low

Very Low

>110

Very Low

Very Low

Very Low

Very Low

Very Low

Very Low

Very Low

Very Low

 

 

221-230

231-240

241-250

251-270

271-290

290-310

>310

<21

Very High

Very High

Very High

Very High

Very High

Very High

Very High

21-30

Very High

Very High

Very High

Very High

Very High

Very High

Very High

31-35

High

Very High

Very High

Very High

Very High

Very High

Very High

36-40

High

High

High

Very High

Very High

Very High

Very High

41-45

High

High

High

Very High

Very High

Very High

Very High

46-50

Average

High

High

High

Very High

Very High

Very High

51-55

Average

Average

High

High

Very High

Very High

Very High

56-60

Average

Average

Average

High

High

Very High

Very High

61-65

Low

Average

Average

High

High

Very High

Very High

66-70

Low

Low

Average

Average

High

Very High

Very High

71-75

Low

Low

Low

Average

High

High

Very High

76-80

Very Low

Low

Low

Average

High

High

Very High

81-90

Very Low

Very Low

Low

Low

Average

High

Very High

91-100

Very Low

Very Low

Very Low

Low

Low

Average

n/a

101-110

Very Low

Very Low

Very Low

Very Low

Low

Low

n/a

>110

Very Low

Very Low

Very Low

Very Low

Very Low

Low

n/a

Copyright 2001, Heart Risk Evaluations, All Rights Reserved

To factor in triglycerides, for 251-350 mg. move 1 column to the right, level 351-500 move 2 columns, 501-700 -3 columns, 701-1000 -4 columns, over 1000 -5 columns

For a personalized printout of your lipid profile, please go to the web at www.heartriskonline.com/cholesterolevaluation.htm


For published copies of Cholesterol and Heart Risk:  

Send $4.95 per copy plus $1.00 shipping and handling for the first copy and $.35 for each additional copy to:

Peter Townsley

Heart Risk Evaluations

207 Townsend Place

Atlanta, GA 30327

 

770-635-3584

CholesterolBooklet@HeartRiskOnline.com