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RISK FACTORS FOR CORONARY HEART DISEASE: CHOLESTEROL
There are many excellent resources for patients and families to find out about cholesterol, and its importance in heart disease. We provide only a very brief summary here. Cholesterol is a natural substance found in the blood and body tissues, which is necessary for the body’s normal functioning. Most of the cholesterol in the blood is manufactured by the liver, and does not come directly from the diet. However, a diet high in fats, particularly so-called saturated fats (found in animal products, whole milk or butter, and certain plant oils) leads to a higher cholesterol level in the blood since more is manufactured by the liver. Since cholesterol is a form of fat, and since it doesn’t mix with the water in the blood, much as oil and vinegar do not readily mix in a salad dressing, cholesterol is transported or ferried around in the blood in transport modules called lipoproteins. Cholesterol packaged in low-density lipoproteins is so-called bad cholesterol, since it is this type of transport module that carries the cholesterol to blood vessel walls, where it may settle, ultimately causing and contributing to hardening of the arteries. To simplify, cholesterol packaged in high-density lipoproteins is more likely to be carried away from blood vessel walls, and thus this carrier transport can ferry cholesterol away from blood vessels where it does the most damage. High-density lipoproteins are thus “good cholesterol.”
There is now very clear scientific evidence that the higher the blood cholesterol, the greater the risk of developing coronary heart disease. The level of blood cholesterol in a given person is largely genetically determined, but can be slightly to moderately altered by diet. However, even with the most stringent diet, blood cholesterol can usually not be lowered by much more than about 20 percent.
Recent scientific studies have shown that patients with high cholesterol, or even so-called normal cholesterol (that is, at the average for Western society), can reduce their risk of heart attack or death by taking cholesterol-lowering drugs known as statins. Although it seems less artificial to modify the diet in order to lower cholesterol, there should be no shame or guilt attached to taking a drug to lower cholesterol, especially when such drugs are undoubtedly effective and rarely cause side effects. It should be remembered that taking cholesterol-lowering drugs is not a license to eat high-fat foods; rather, such drugs should be part of a treatment program that includes a sensible low-fat diet and exercise.
How does cholesterol wreak havoc in the arteries?
Although we are not entirely certain how it happens, cholesterol is probably deposited inside the cells lining the artery walls, called endothelial cells, where they can go through a chemical process known as oxidation and become irritants that stimulate the blood vessel walls to essentially form a scar. This scarring includes deposits of extra muscle cells, scar cells (fibrous tissue) and calcium. Although “hardening of the arteries” eventually leads to precisely what the term implies?rock-hard and stonelike blockages of the arteries?initially this process involves soft, fatty deposits inside blood vessel walls that are prone to tear or rupture, leading to clot formation and a rapid increase in the severity of blockage. This is probably why cholesterol lowering, especially the marked cholesterol lowering that can be achieved with drugs, can lead to very rapid diminishing of the risk of heart attack or death, although the deposits themselves may have been building up for years or decades. The important conclusion from recent research studies is that it is never too late to lower your cholesterol, and that the benefits can be seen quite quickly once treatment is started. All patients with a history of coronary heart disease should have their cholesterol measured, and treated to lower the cholesterol level in the blood if it is too high. The more risk factors a patient has, the more important it becomes to achieve and maintain an ideal cholesterol level.
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