Cholesterol and Heart Disease - The Good, the Bad and the Ugly

"And if you have high cholesterol, you will feel the same as if you had low cholesterol because of no side effects, no symptoms of high cholesterol." Mark Spitz, winner of nine Olympic gold medals in swimming.

Heart disease remains a leading killer of men and women in the United States. Every year, 1,200,000 people suffer from coronary heart attacks, and about 40% of them die. An American dies in a coronary event approximately 65 seconds. Abnormal cholesterol, other than smoking, diabetes, high blood pressure, obesity and physical inactivity, remains one of the major risk factors for coronary heart disease.

"I'm driving too fast to worry about cholesterol." Comedian Steven Wright. But we should. Abnormal cholesterol levels can clog your arteries. There are hundreds of studies that confirm the harmful effects of abnormal cholesterol levels. The Framingham Heart study found that under the age of 50, total cholesterol levels were directly associated with 30-year overall mortality and cardiovascular death. For every 10 mg / d of cholesterol increase, there was a 5% overall increase in mortality and a 9% cardiovascular death. Abnormal cholesterol levels are also involved in stroke, limb amputation, erectile dysfunction, Alzheimer's disease and kidney failure.

Cholesterol isn't bad at all. Cholesterol keeps the cell membrane fluid, flexible and functional. Cholesterol helps in the production of bile, and thus helps in the digestion of fat. It is also essential for fat-soluble vitamin metabolism, including vitamins A, D, E and K. It is involved as a key precursor in the synthesis of vitamin D and many steroid hormones, including adrenal cortisol and aldosterone hormones, and sex hormones progesterone, estrogen, testosterone, and derivatives. Cholesterol is water insoluble, and is carried to the destination by lipoproteins. About 80% of cholesterol is produced by the liver through carbohydrate metabolism via the HMG-CoA reductase pathway. This is about 1000 mg a day. Diets in Western countries add about 200 - 300 mg for intestinal intake. Most dietary cholesterol comes from animal foods, including meat, chicken, fish, egg yolk, butter, cheese and whole milk. Fat trans fats are hydrogenated and are found in margarine and many processed and commercially processed foods in fried foods such as cookies, cakes, crackers, fries and donuts. It is also unhealthy and its use is associated with atherosclerosis. The source of plant foods (fruits, vegetables, nuts and grains) is free from cholesterol. Phytosterols found in certain plant products such as hemp and peanut can actually help lower serum cholesterol. However, cooking oils from plants, especially palm oil and coconut oil, high in saturated fat and heart are unhealthy. But there is another type of fat called essential fatty acids. These are unsaturated fats and include omega-3 and omega-6 fats. This aid is the cell membrane and is required for the production of certain hormones that are important for blood clotting, blood pressure control, and eye and brain function. Overall, they lower blood pressure and cholesterol, and reduce mortality from heart disease.

"Somewhere, above the rainbow, rising high, there was a land where they had never heard of cholesterol." Musician Allan Sherman. However, in the real world, we need to monitor its levels. Cholesterol levels should be measured after 9 to 12 hours fast. Levels of less than 200 mg / dl are appropriate. Levels of 200 to 239 mg / dl are borderline high and levels above 240 mg / dl are associated with a higher risk of coronary heart disease. However, lipoprotein analysis is more reliable because it has a better risk profile. Lipid profiles provide low levels of low density lipoprotein cholesterol (LDL), good high density lipoprotein (HDL) cholesterol and triglycerides. LDL levels should be less than 100 mg / dl. Levels of over 160 are high and are associated with an increased risk of heart disease. HDL provides protection against heart disease if it exceeds 60 mg / dl. Levels of less than 40 mg / dl are associated with increased heart disease. The triglyceride level should be less than 150 mg / dl. Higher levels, especially when associated with abnormal levels of LDL or HDL, increase the risk of heart disease.

Does it lower cholesterol? Scientific medical literature is filled with research data that confirms the beneficial effects of lowering cholesterol. A 1995 study called the Western Coronary Prevention Study (WOSCOPS) followed 6500 men with high cholesterol for 5 years. Some people are given cholesterol lowering the statin drug, provostatin, while others are given placebo. The drug lowers cholesterol levels by 20 percent and low LDL cholesterol levels by 26 percent. The risk of heart attack is reduced by 31 percent in those who receive statin medications. The need for short-term surgery or angioplasty was reduced by 37 percent. Overall death from all causes was reduced by 22 percent, and death from cardiovascular causes by 32 percent. In 1998, the results of the Texas Coronary Atherosclerosis Prevention Study (AFCAPS / TexCAPS) showed that lowering cholesterol with another statin drug, lovastatin, also reduced the risk of the first major coronary event by 37 percent when given to generally healthy men and women with average cholesterol levels. . Cholesterol levels in the treatment group decreased by 18 percent and LDL-cholesterol level by 25 percent, after one year of treatment. As in the WOSCOPS study, significant reductions in events were also observed: heart attacks reduced by 40 percent, unstable angina 32 percent, bypass surgery or angioplasty required 33 percent, and all cardiovascular events were 25 percent. Recent scientific data shows that higher doses of statins may be of greater benefit.

The most commonly used drug to lower high cholesterol or bad LDL cholesterol is statins. Statins lower cholesterol by blocking the enzyme HMG-CoA reductase, a rate-limiting enzyme in cholesterol synthesis. Inhibition of this enzyme in the liver results in increased LDL from the bloodstream and decreased blood cholesterol levels. The results are seen as early as one week. The maximum effect occurs after four to six weeks. There are more than ten commercially available statins in the United States. Other agents are also available to lower cholesterol and LDL levels and act primarily by preventing the absorption of cholesterol in the intestines. They are often used in combination with statins. While statins can raise good HDL cholesterol, the effect is small. HDL can be raised by the usual vitamin niacin. The class of drugs called fibrates not only helps to increase HDL but also helps to reduce triglycerides.

There are many ways to improve your lipid profile without medication. Reduce the amount of animal fat and saturated fat you eat. Regular exercise and weight loss can not only help lower LDL and triglyceride levels, but also improve HDL levels. Moderate alcohol consumption also increases HDL cholesterol. Consuming more fruits and vegetables and eating more lean fat also increases the lipid profile. Remember, our health always seems more valuable after we lose it. So let's hear motivational speaker Jim Rohn, who says, "Take care of your body, it's the only place you need to live."

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