CHOLESTEROL PRIMER

High 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 some physicians have at best a very vague knowledge of the true risks associated with high serum cholesterol, or even what defines high serum cholesterol levels.

Cholesterol is a waxy, fat-like substance that circulates freely in the blood.  Since cholesterol is such a problem with regard to heart attacks, is it to be considered our enemy?  Not at all.  In fact, cholesterol is absolutely necessary for many vital bodily functions.  You could not live without an ample supply of cholesterol in your bloodstream.

The problem begins where our cholesterol count elevates past the normal level to excessive.  This is the condition that leads to clogged arteries and heart attacks.  But what is this level?  There is not one simple answer, because there are several factors involved.  However, there are a few guidelines that can uncomplicate the cholesterol puzzle.

A few decades ago, when cholesterol research was in its beginning stages, the average cholesterol level of adults in the United States was in the 235 mg. (milligrams per deciliter) range.  Organizations such as the American Heart Association and the National Cholesterol Education Panel (NCEP) made the recommendation that to lower risk of heart disease, levels must be reduced to below 200.  This was a good start, as those with a level of 200 are at much lower risk than those at 235.  However, further research showed that even those at the 200 mark, while not at extremely high risk, were still at significantly high risk.  In fact, about 35% of those who have heart attacks have cholesterol levels between 160 and 200.

For some reason, even though research (and especially that of the famed Framingham Heart Study) shows that 200 is not a safe level, these organizations have never revised their official guidelines.  However, there are an abundance of cardiologists and heart specialists who are very prominent in the field who have been at the forefront of pointing out to the public this fact.

National guidelines tell us that 200 mg/dl is the highest healthy level of cholesterol in a person's blood.  This may not be 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.)  A cholesterol level of 150 mg/dl is a safer standard than the 200 mg/dl recommended by American experts. 

Many, such as Dr. Dean Ornish, Dr. John McDougall, Robert Kowalski, and the authors of The Stanford Life Plan For a Healthy Heart agree and all suggest a cholesterol level of 150-160 or lower. 

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.” 

If you want tremendous protection against heart disease, get your cholesterol level to the 150-160 range or lower and keep it in that range.  If you are unable to do this, get it as close as possible.  Don't worry about your total cholesterol becoming too low.  Unless there is some unusual disorder or serious illness, your body won't let that happen.

There are other factors to pay attention to besides total cholesterol.  HDL level and subsequent Cholesterol/HDL ratio is one of them.  How should this ratio be viewed?  As we read earlier, 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 and ratio level is important.  If your total cholesterol is 200, your HDL level and ratio is very important.  At 220 or higher it is 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 on our web page Cholesterol Risk Chart

Other factors are also involved, such as triglycerides.  The relationship of triglycerides to heart risk is also illustrated on Cholesterol Risk Chart.

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