Why is high cholesterol important?

High cholesterol is important because it is a known cause of atherosclerosis, or plaquing and ‘hardening’ of the arteries. When plaque is deposited in the arteries, the artery becomes damaged, stiff, and narrow. A narrow artery can limit blood flow to the heart and cause a heart attack. Additionally, in a narrow, diseased artery, a clot can form acutely, leading to a heart attack or stroke.

What is LDL?
LDL, Low Density Lipoprotein, is the ‘bad’ cholesterol and is a known major risk factor for developing cardiovascular disease. When the LDL level rises, dangerous fatty acids are is deposited in the arteries, causing a blockage, reducing blood flow through the arteries. Once this blockage is severe enough, the heart cannot receive enough blood, which can cause a heart attack or stroke. Large studies have shown a direct correlation to high LDL levels and cardiovascular disease. Recent studies have also been able to show that patients have the lowest cardiovasduclar risk with very low LDL levels. For these reasons, recent guidelines have become more strict, especially for patients with cardiovascular risk factors.

What is HDL?
HDL, High Density Lipoprotein, is the ‘good’ cholesterol. HDL carries LDL, the bad cholesterol, away from the arteries and back to the liver where it is processed and eliminated. Therefore, the more HDL present, the more protection we have against developing an arterial lipid plaque. Studies have shown that low HDL is an independent risk factor for developing cardiovascular disease. Therefore, HDL is an important part of the cholesterol cycle in the development of cardiovascular disease.

What are Triglycerides?
Triglycerides are a form of fat that our body uses to store energy. When we eat, excess calories are stored as triglycerides, and our body mobilizes this form of energy in between meals. However, too many triglycerides are not healthy and can contribute to cardiovascular disease as well as other medical problems such as diabetes and fatty deposition in the liver and pancreas. Elevated triglycerides are often caused by dietary indiscretion, excessive intake of sugars and carbohydrates, excess body weight, inactivity (lack of exercise), alcohol intake, and smoking.

How do I interpret my cholesterol lab results?
Interpreting your cholesterol results can be confusing for several reasons. First of all, it is no longer acceptable to evaluate one’s cholesterol status by simply looking at the ‘total’ cholesterol. The total cholesterol reflects the summation of the good and bad cholesterol and one-fifth of the triglycerides. Therefore, if the total cholesterol number is “high,” it might be reflecting a high LDL(undesirable), a high Triglyceride(undesirable), or a high HDL(very desirable).

The goal of the LDL depends on whether you have risk factors for cardiovascular disease. For a patient who does not have any risk factors, the LDL should be lower than 130. For a patient who has two risk factors or who has hypertension, then the LDL should be less than 100. For patients with known diabetes, coronary disease, or history of stroke, the LDL needs to be less than 70.

The goal of the HDL for men is above 40 and for women is above 50.

The goal for Triglycerides is less than 150.

How can I improve my cholesterol?
After identifying that over 100 million Americans have elevated cholesterol, the National Cholesterol Education Program Adult Treatment Plan developed the TLC plan, known as the Therapeutic Lifestyle Changes Plan. This plan presents diet and exercise recommendations for the treatment of elevated cholesterol. Specific recommendations of the TLC guidelines are as follows:

How do the different kinds of fats affect cholesterol?

  • Saturated Fats: these are the most potent of all fats in raising cholesterol and cardiovascular risk
  • Trans Fats: a very strong risk, equal to saturated fats, at raising cholesterol and cardiovascular risk. Food examples include partially hydrogenated oil, stick margarine, shortening, fried foods, desserts. These foods are solid at room temperature.
  • Polyunsaturated Fats: consuming polyunsaturated fats instead of saturated fats will reduce LDL cholesterol (a benefit) but can also lower HDL cholesterol (not a benefit). Therefore, it is recommended to limit consumption of polyunsaturated fats to no more than ten percent of total calories per day.
  • Monounsaturated Fats: this is the most desirable source of dietary fat. A diet emphasizing monounsaturated fats will reduce ‘bad’ LDL cholesterol but will not reduce ‘good’ HDL(unlike Polyunsaturated Fats).​