HDL, LDL, Triglycerides..... What are your numbers?
The Cholesterol Question
By Arthur Agatston, M.D., Prevention
The other day, I was explaining to a patient why we needed to devise a strategy to lower her cholesterol, when she waved me silent. "It's hard for me to place too much faith in that plan," she said. "A good friend of mine who always had exemplary cholesterol levels just had a heart attack."
I've had other patients tell me this as well. And in fact, it's true: Many people with relatively low cholesterol do have heart attacks every year, supporting the somewhat contrarian theory that cholesterol is not the main cause of heart disease. Instead, skeptics often point to iron or homocysteine, an amino acid that accumulates in the blood if you eat too much meat and dairy, as chief culprits. Although homocysteine and excess iron can contribute to heart disease, large-scale studies have failed to confirm that either one plays a primary role. Still, those findings have done little to quell the doubts of the naysayers who maintain that cholesterol does not cause coronary heart disease.
I have three words in response: Don't believe them.
Here's why: Virtually every heart attack starts with cholesterol. Each occurs because the waxy substance burrows into the heart vessel wall and eventually bursts, much like a pimple, leaving an ulceration of the artery lining that the body tries to heal by forming a blood clot. This clot blocks the artery, causing a heart attack. In very rare instances, a clot will migrate to the heart from somewhere else, but this is almost unheard of.
Still, how do we explain a heart attack in someone like my patient's friend, who, thanks to her low number, is presumably not forming plaque? Turns out, size and number of LDL particles matter. Think of LDL and HDL (the healthy one) as shuttle buses that carry cholesterol to and from your heart, respectively. If they're small (if one is, so is the other), that's bad. Tiny LDL particles can more easily slip into blood vessel walls than bigger ones. And let's say you have an LDL of 130, a desirable number: If your particles are small, there will be more of them to do their nasty work. Meanwhile, tiny HDL particles are poorly equipped to mop up excess cholesterol and transport it back to the liver for excretion, compared with larger, more absorbent ones. That's why you can have good, healthy cholesterol numbers but still be at high risk of a heart attack.
To quickly find out if your particles may be small, cross-check your triglycerides with your cholesterol numbers. If you have low triglycerides (less than 100) and your HDL is high (greater than 60), you likely have the favored large particles. But if you have high triglycerides and low HDL, your cholesterol is probably of the small-particle variety. Then you should ask your doctor for a lipoprotein subfraction test, which divides your cholesterol into subparticles based on their size and density.
Many people with diabetes or pre-diabetes fall into this group. As the disease approaches epidemic proportions in the United States, it's no wonder we're seeing more heart attacks in people with low cholesterol. It's also no wonder that, to explain the phenomenon, some people may be proposing alternative theories of heart disease.
Just don't believe them.
"If you have diabetes, low HDL, and high triglycerides, get a test that measures the size of your cholesterol particles."
Slash your risk!
Find out which foods can help you lower cholesterol at prevention.com/heartsmartfoods.
Arthur Agatston, M.D., a preventive cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine, conducted several groundbreaking studies on heart disease and wrote the international bestseller, The South Beach Diet. He maintains a cardiology practice and research foundation in Miami Beach, FL.
By Arthur Agatston, M.D., Prevention
The other day, I was explaining to a patient why we needed to devise a strategy to lower her cholesterol, when she waved me silent. "It's hard for me to place too much faith in that plan," she said. "A good friend of mine who always had exemplary cholesterol levels just had a heart attack."
I've had other patients tell me this as well. And in fact, it's true: Many people with relatively low cholesterol do have heart attacks every year, supporting the somewhat contrarian theory that cholesterol is not the main cause of heart disease. Instead, skeptics often point to iron or homocysteine, an amino acid that accumulates in the blood if you eat too much meat and dairy, as chief culprits. Although homocysteine and excess iron can contribute to heart disease, large-scale studies have failed to confirm that either one plays a primary role. Still, those findings have done little to quell the doubts of the naysayers who maintain that cholesterol does not cause coronary heart disease.
I have three words in response: Don't believe them.
Here's why: Virtually every heart attack starts with cholesterol. Each occurs because the waxy substance burrows into the heart vessel wall and eventually bursts, much like a pimple, leaving an ulceration of the artery lining that the body tries to heal by forming a blood clot. This clot blocks the artery, causing a heart attack. In very rare instances, a clot will migrate to the heart from somewhere else, but this is almost unheard of.
Still, how do we explain a heart attack in someone like my patient's friend, who, thanks to her low number, is presumably not forming plaque? Turns out, size and number of LDL particles matter. Think of LDL and HDL (the healthy one) as shuttle buses that carry cholesterol to and from your heart, respectively. If they're small (if one is, so is the other), that's bad. Tiny LDL particles can more easily slip into blood vessel walls than bigger ones. And let's say you have an LDL of 130, a desirable number: If your particles are small, there will be more of them to do their nasty work. Meanwhile, tiny HDL particles are poorly equipped to mop up excess cholesterol and transport it back to the liver for excretion, compared with larger, more absorbent ones. That's why you can have good, healthy cholesterol numbers but still be at high risk of a heart attack.
To quickly find out if your particles may be small, cross-check your triglycerides with your cholesterol numbers. If you have low triglycerides (less than 100) and your HDL is high (greater than 60), you likely have the favored large particles. But if you have high triglycerides and low HDL, your cholesterol is probably of the small-particle variety. Then you should ask your doctor for a lipoprotein subfraction test, which divides your cholesterol into subparticles based on their size and density.
Many people with diabetes or pre-diabetes fall into this group. As the disease approaches epidemic proportions in the United States, it's no wonder we're seeing more heart attacks in people with low cholesterol. It's also no wonder that, to explain the phenomenon, some people may be proposing alternative theories of heart disease.
Just don't believe them.
"If you have diabetes, low HDL, and high triglycerides, get a test that measures the size of your cholesterol particles."
Slash your risk!
Find out which foods can help you lower cholesterol at prevention.com/heartsmartfoods.
Arthur Agatston, M.D., a preventive cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine, conducted several groundbreaking studies on heart disease and wrote the international bestseller, The South Beach Diet. He maintains a cardiology practice and research foundation in Miami Beach, FL.
Provided by Prevention
posted by Auntie Tracye @ 8:54 PM
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