Ask your friend at a cocktail party about his cholesterol level, and you’ll likely get an instantaneous answer – 164. Ask his wife next to him, and she might look down and quietly murmur the number because she’s embarrassed that her cholesterol is higher than her husband’s. Many of us have our cholesterol number committed to memory. We may have long forgotten a spouse’s birthday, Derek Jeter’s uniform number, or the amount of our home mortgage but easily can cite the last two years of cholesterol measurements with unfailing accuracy. Needless to say, the reason for this level of heightened awareness relates to our fear of cardiovascular (heart) disease, the major cause of death in the U.S. and Western countries.
We closely monitor our cholesterol levels in the hope of forestalling the disease. For those of us who have previously suffered a heart attack or been treated with coronary stents or bypass surgery, the need to manage cholesterol to prevent further disease is even more critical. High blood cholesterol levels help promote heart disease; reducing these levels with diet and medications can lower the likelihood of disease and cardiac “events” such as a heart attack.
We know much more about cholesterol than we did 50 or so years ago. Today, we understand that not all cholesterol is bad and the way cholesterol moves through the bloodstream is extremely important. Cholesterol doesn’t “fly solo” throughout our bodies; rather, cholesterol molecules are combined with proteins and other types of fats, and packaged into particles called lipoproteins. Low-density lipoproteins (LDL) are larger, loosely packed particles that appear to deposit their cholesterol into the wall of coronary arteries, forming potentially harmful plaques. LDL often is called “bad cholesterol” because high levels correlate with a higher risk of heart events; lowering LDL levels, particularly with statin drugs, lowers risk and improves heart health. On the other hand, the smaller, tightly packed high-density lipoproteins (HDL) appear to pull cholesterol out of plaques and may even undo some of the damaging blockage. This is why HDL is referred to as “good cholesterol.”
So a higher cholesterol level may not be cause for concern if much of that cholesterol is of the good HDL variety and a lower level can be a problem if most of the cholesterol is the unfavorable LDL variety. Your cardiologist can measure your various cholesterol levels and help you take action for healthier numbers and a healthier heart.