Understanding Cholesterol

Cholesterol is a type of fat (lipid) produced in small quantities by the liver and contained in many of the foods we commonly eat including fried foods, butter, cheese products, and red meats. Cholesterol does not dissolve in our blood stream and it attaches to the insides of the arteries supplying blood to the muscle of the heart, the brain and the extremities. These deposits of cholesterol initiate a physiological process leading to narrowing of the arteries. Doctors call this process arteriosclerosis.

Arteriosclerosis may develop in any artery in our body, but doctors become most concerned when arteriosclerosis injures the arteries supplying blood to our heart muscle (coronary arteries), the arteries supplying blood to our brain (carotid arteries) or the arteries supplying blood to our feet and legs (peripheral arteries).

Sometimes clots may suddenly occlude arteries already narrowed and damaged by arteriosclerosis. When a clot suddenly occludes an artery supplying blood to the muscle of the heart, patients experience a heart attack. Similarly the sudden cessation of blood flow to the brain results in a stroke.

Arteries damaged by arteriosclerosis may also narrow slowly. In the case of the coronary arteries (heart) this gradual narrowing will cause intermittent chest pain known as angina. In the case of peripheral arteries supplying blood to the legs and feet, this gradual narrowing will cause pain with walking called claudication.

Monitoring and lowering levels of cholesterol in the blood will decrease your risk of a heart attack, stroke or claudication. In order to better achieve this goal, doctors divide cholesterol into two major categories: low density lipoproteins and high-density lipoproteins (HDL). Low-density lipoproteins (LDL) describe the microscopic packages of cholesterol wrapped in proteins traveling from the liver and gastrointestinal system to the susceptible arteries. High-density lipoproteins describe the microscopic packages of cholesterol wrapped in proteins carrying the cholesterol away from the susceptible arteries. The goal of cholesterol treatment is to decrease the quantity of LDL and increase the levels of HDL; thereby minimizing the amount of cholesterol being deposited in the arteries and maximizing the amount of cholesterol being removed from damaged arteries.

No matter what your medical circumstances, your HDL (high density lipoproteins) should be greater than 40 mg/dl and your LDL (low density lipoproteins) should be less than 160 mg/dl. If you smoke, suffer from diabetes or come from a family with a tendency towards heart disease, the cardiologist will try to lower your LDL below 130 mg/dl and if you recently suffered a heart attack most experts recommend keeping your LDL below 100 mg/dl.

If necessary our cardiologists will initiate treatment with dietary recommendations and an exercise program. If the LDL level remains elevated after these measures, most cardiologists will begin medication. Modern medicine offers a large variety of potential cholesterol lowering medications including Lipitor, Zocor, Pravachol, niacin and others. Which medication the cardiologist selects depends on your blood test results, coexisting medical illnesses and other unique circumstances.