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Cardio-vascular Health

Blood Cholesterol, Coronary Heart Disease

Confused About Your Cholesterol Numbers?

By Dr. W. Gifford Jones

"Doctor, is my blood cholesterol normal?" I'm asked this question repeatedly by patients. It's understandable that they're concerned about blood cholesterol. After all, you'd have to be living on another planet not to believe that blood cholesterol was the leading indicator of coronary heart disease (CHD). But is there a specific number that allows doctors to answer "Yes" or "No to this question?

In 1988 The National Cholesterol Education Panel attempted to make the response simple. It chose a blood cholesterol level of 5.2 mmol/L. as normal in Canada. This corresponds to 250 milligrams in the U.S.

Simplicity is often a good thing. Today, the big mistake in medicine is making things so complicated you have to be a nuclear physicist to understand the ramifications.

But when you apply the" KISS" principle "keep it simple stupid" to the cholesterol problem, it causes a lot of headaches. It can make you feel good to have a normal blood cholesterol. And worried like hell if you happen to be on the wrong side of the number.

Zeroing in on a single arbitrary number is very misleading. For instance, it's a fact that 35 percent of people who develop CHD have normal blood cholesterol levels. Others with a high blood cholesterol live a long life and die from non©cardiac causes.

Most authorities now agree that blood cholesterol is by itself a poor predictor of coronary heart disease. "Know your number" is now past history.

So what is a good predictor of future heart attack? To answer this question you have to accept that CHD is a very complex disease. And until we have more facts you need the wisdom of Solomon to know which is important among all the variables.

A lot of things don't add up. For instance, North Americans are advised to increase their intake of veggies to decrease the risk of CHD.

But how much veggies help prevent atherosclerosis? If you agree that we are distantly related to gorillas, you may wonder. Gorillas are vegetarians and yet have a high incidence of atherosclerosis! That makes me think twice about never ordering another steak.

We're also urged to eat less fat. But most people wrongly perceive this dictum as condemning dairy products, a potentially harmful suggestion.

Robert Heaney, a nutrition expert, says, "milk is designed by nature to support tissue growth and adds far more than calcium to the diet." In fact, studies show that those who have a poor dietary intake of calcium usually also have a poor diet. So in the rush to fight CHD think twice before giving up dairy products.

But getting back to numbers, what are considered the important ones? It's generally agreed that the number to watch is the high HDL (high density lipoprotein). This should be high as it helps rid the blood of excess cholesterol.

The number to keep low is the LDL (low density lipoprotein) which is believed to be a prime instigator of atherosclerosis. A high triglyceride level is also undesirable.

The balance of these numbers is also important. For example, having a high blood cholesterol and a high LDL can be neutralized in part by having a high HDL. And if you divide blood cholesterol by HDL and end up with a low number, all the better.

Studies show that if you're over 70 years of age there's less reason to be as concerned about elevated blood cholesterol. Moreover, some epidemiological studies indicate that there's an increased risk of dying from non©cardiac reasons if you have a low blood cholesterol!

Why all this discrepancy? Because whether or not you drop from a coronary attack depends on many factors. Heredity is possibly the best protection against CHD. It determines how much cholesterol your liver makes every day which is about 1,000 milligrams.

But just because your ancestors all lived long lives, doesn't mean you can toss caution to the wind. A lack of exercise, obesity, diabetes and smoking can still lead to CHD. Autopsies show that current North American lifestyle leaves much to be desired.

For instance, the Korean war showed that 20 year old American soldiers who died in combat often showed evidence of CHD.

Heart attack in the young can be related to narrowed atherosclerotic coronary arteries. But in the elderly sudden death is often due to blood suddenly forming a clot. That's why a baby Aspirin (81 milligrams) every day is often recommended by doctors to prevent fatal clots from forming. And they may also prescribe a drug such as Pravachol to lower blood cholesterol.

Who dies from CHD is still a little like gambling in Monte Carlo. The numbers are only one part of the game.


W. Gifford-Jones M.D Most recent columns

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: docgiff.com.
Dr. Walker can be reached at info@docgiff.com















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