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Cholesterol

Cholesterol is a fat produced by the liver and is essential for life. It is used to form cell membranes and aids in manufacturing hormones, bile acids, and Vitamin D. Cholesterol is known mainly as HDL (high density lipoprotein), (the good kind), and LDL (low density lipoprotein), (the bad kind). HDL makes up about 20% and LDL about 70% of all cholesterol in the body. There are two other parts of cholesterol named VLDL and ILD. These two usually make up about 10% of all cholesterol.

HDL is called the "good cholesterol" because HDL prevents atherosclerosis by extracting cholesterol from the artery walls and disposing of them through the liver. Low levels of HDL are associated with an increased risk of heart disease. A low HDL level often results from a high blood triglyceride level. High triglyceride levels may be induced by high intakes of simple carbohydrates. Smoking also lowers HDL cholesterol levels. HDL-cholesterol level can be raised by exercising.

LDL cholesterol is called "bad" cholesterol, because elevated LDL cholesterol is associated with an increased risk of coronary heart disease. When too much LDL cholesterol circulates in the blood, it deposits cholesterol on the artery walls, causing the formation of a hard, thick substance called cholesterol plaque. Over time, cholesterol plaque causes thickening of the artery walls and narrowing of the arteries. This condition is known as atherosclerosis. Arteries that supply blood and oxygen to the heart muscles are called coronary arteries. When coronary arteries are narrowed by atherosclerosis, they are incapable of supplying enough blood and oxygen to the heart muscle during exertion. If a clot forms and blocks a narrowed artery, it can cause a heart attack or stroke. Carotid arteries in the neck can become narrowed and may lead to clots forming in the neck and floating downstream into the brain, causing a stroke or recurrent temporary strokes (also known as TIAs). Coronary heart disease is the most common cause of death in the United States, accounting for about 600,000 deaths annually. A desirable level of LDL is less than 130 mg/dL. A borderline-high risk level is from 131 to 159 mg/dL. High risk is 160 mg/dL and above.

A blood cholesterol test is used to diagnose high cholesterol. This test measures total cholesterol, LDL, HDL, and triglycerides. A desirable level of total cholesterol is less than 200 mg/dL. Borderline-high is 200 to 239 mg/dL. High cholesterol is 240 mg/dL or greater.

Most people are confused about their cholesterol levels. This is because too much emphasis is placed on the importance of the total cholesterol. A far more important predictor of cardiovascular risk is actually the ratio of good cholesterol (HDL) to total cholesterol.

There are two methods of stating cholesterol levels.
One method used is to divide the HDL by the total cholesterol (HDL/Total Cholesterol). Ideally this number should be above 24%. Levels below 10 are very dangerous and usually indicate an imminent cardiovascular problem. Ideally this level should be 30 or higher.
Another method used is to divide the total cholesterol by the HDL (Total Cholesterol/HDL). In this case, the numbers should be lower. A poor ratio would be any number greater than 4, with greater than 10 having serious problems. This number rarely drops below 2.

It's important to note that there are a small subset of individuals born with a genetic condition called familiar hypercholsterolemia (about one in 500 people) in which their cholesterols are typically around 350 or higher.

The tendency to build up high cholesterol levels are usually the result of a poor diet high in saturated fats and calories, combined with little or no exercise. In some cases, an elevated cholesterol level may be associated with an undiagnosed medical condition, such as hypothyroidism (low thyroid function), high blood pressure, alcohol abuse or diabetes.

Triglycerides are a different type of fat, which mostly come from fats in food. Calories that are eaten and not used immediately are converted into triglycerides and transported to fat cells for storage. Most of the body's stored fat is in the form of triglycerides. Although most triglycerides are stored in fat tissue, low levels are also found in the blood. They are carried in the blood as very low density lipoproteins (VLDL). A raised level of blood triglycerides together with high LDL can increase the risk of heart disease.

Medications.
These medicines may raise total cholesterol level:
• anabolic steroids
• certain types of medicine to lower blood pressure, such as clonidine and methyldopa
• some diuretics, (also called water pills)
• progestins

These medicines may reduce HDL, or good, cholesterol:
• anabolic steroids
• some beta-blockers
• some progestins.
Most cholesterol-lowering medicines can have bad effects on the liver.

To lower and maintain good cholesterol levels:
Exercise on a regular basis.
Eat a diet high in fiber (can take a fiber supplement). Include fruits, vegetables, nuts, seeds, cereals, legumes, and other plant-based foods.
Avoid simple carbohydrates, like sugar, white rice and flour.
Eliminate all hydrogenated oils. (trans fats)
Limit saturated fat consumption.
Avoid obesity.
Control mental stress.
Quit alcohol.
Quit smoking.

Other cardiovascular risk indicators.
C-Reactive protein (CRP), a sensitive marker of systemic inflammation, has emerged as a powerful predictor of cardiovascular diseases, particularly of coronary heart disease.

Homocysteine is a chemical found in our blood. It is a product of the metabolism of protein in our bodies. Multiple epidemiological studies have shown that people with higher levels of homocysteine in their blood have a higher chance of developing heart disease.


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