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Cholesterol is a waxy, fatty substance that is present in blood. Cholesterol is necessary for life. It aids in digestion and acts as a precursor for Vitamin D and certain hormones. It is needed in minute amounts. The body manufactures all of the cholesterol it requires.
Excess cholesterol is absorbed into the arterial walls, in the heart and elsewhere in the body, causing the buildup of layers of plaque that can ultimately lead to blockages. Heart attacks, strokes, and other serious problems often result.
Not all cholesterol is the same. Low-density lipoprotein (LDL-cholesterol) is considered "bad" since it causes plaque to build up in the arteries. High-density lipoprotein (HDL-cholesterol) is referred to as "good" cholesterol since it does the opposite, carrying plaque away from the arterial wall to the liver and out of the body.
Epidemiological investigations and clinical studies have established that an elevated serum LDL-cholesterol is a major contributing factor of coronary heart disease. Furthermore, individuals who have very high total cholesterol levels (>240mg/dL) are generally twice as likely to experience a heart attack or a stroke than individuals with a moderate cholesterol level (<200mg/dL) [American Heart Association, 2003].
More important than simply lowering total cholesterol, maintaining an optimal balance among LDL, HDL, and triglycerides is key to cardiovascular health. A low-fat diet, exercise, and regular consumption of dietary supplements formulated with scientifically proven, high quality ingredients such as vitamin E, niacin, and pantethine can help you achieve a healthy blood lipid profile.
Blood in Balance
The Basic Facts About Blood Lipids
The lipids (or fats) present in human blood include:
- low density lipoprotein (LDL) cholesterol
- high density lipoprotein (HDL) cholesterol
- triglycerides (TG)
These various blood lipid components must be balanced in order for your circulatory system to function correctly. Levels of HDL cholesterol should be high, while levels of the other blood lipids, including LDL cholesterol, should be low.
Although the NCEP guidelines for total cholesterol remain the same, recent medical findings have resulted in new recommendations for:
- a lower level of LDL cholesterol
a higher level of HDL cholesterol
- reduction of elevated triglycerides as a independent risk factor
Therefore, it is important to determine the levels of these blood lipids individually, in addition to your total cholesterol. These levels can be measured with a simple blood test. This test is called a "blood lipid panel" or "complete lipoprotein profile". Because food affects the levels of lipids in your blood, it is necessary to fast for 9-12 hours before the test. For convenience, the test is usually scheduled in the morning, after fasting overnight.
About Cholesterol and Heart Health
New Cholesterol Guidelines Released by U.S. National Institutes of Health
Updated guidelines for the prevention and management of high cholesterol were released in May 2001 by the National Institutes of Health (a division of the U.S. Department of Health & Human Services) as part of the National Cholesterol Education Program (NCEP). Updates are made when warranted by recent advances in science. The new guidelines are the first major update to the program in nearly a decade.
Total cholesterol is the measurement of all cholesterol present in your blood, including HDL, LDL, triglycerides, and all other carriers.
- Some test results will include a "cholesterol ratio". This number is total cholesterol divided by HDL cholesterol. For example, a total cholesterol level of 200 mg/dL divided by an HDL cholesterol level of 50 mg/dL would result in a ratio of 4:1. While this ratio offers a more complete picture than the total cholesterol number alone, absolute numbers for each of the blood lipids will be most helpful to your physician in determining heart health and an appropriate course of treatment.
- A person with a "high" total cholesterol level has more than twice the risk of heart disease compared to someone whose total cholesterol is "desirable".
| Total Cholesterol Level Guidelines |
| Less than 200 mg/dL |
Desirable |
| 200 to 239 mg/dL |
Borderline-high |
| 240 mg/dL and above |
High |
* millimoles per litre
High density lipoprotein (HDL) is often termed the "good" cholesterol. It acts like a scavenger in the body, gathering plaque and carrying it to the liver to be eliminated. Its role in preventing plaque deposits creates its reputation as a protector of your heart.
| HDL-Cholesterol Level Guidelines |
| Less than 40 mg/dL |
Low |
| 40 to 59 mg/dL |
Near Optimal |
| 60 mg/dL and above |
Optimal |
Low density lipoprotein (LDL) is the culprit in the blood lipid equation. High LDL levels can contribute to plaque formation. The more LDL in your blood, the greater your risk for plaque buildup, which can eventually block the arteries. This is why LDL is commonly referred to as being "bad" cholesterol.
| LDL-Cholesterol Level Guidelines |
| Less than 100 mg/dL |
Optimal |
| 100 to 129 mg/dL |
Near Optimal |
| 130 to 159 mg/dL |
Borderline High |
| 160 to 189 mg/dL |
High |
| 190 mg/dL and above |
Very High |
Triglycerides (TG) are the form in which fat is stored in the body for use as energy. High levels of triglycerides in the blood indicate a risk for heart disease. Excessive triglycerides often accumulate around major organs, including the heart, kidneys and liver. In addition to the impact on the body's vascular system, accumulated triglyceride deposits can impair the function of the liver. This is often referred to as "fatty liver syndrome". Maintenance of the liver, the body's waste purification system, is essential for normal cholesterol processing.
| Triglyceride Level Guidelines |
| Less than 150 mg/dL |
Normal |
| 150 to 199 mg/dL |
Borderline high |
| 200 to 499 mg/dL |
High |
| 500 mg/dL or above |
Very High |
| Comparison of Previous and New NCEP Guidelines |
| Blood Lipid Level |
Previous Guidelines |
New Guidelines |
| LDL-cholesterol |
| optimal |
< 130 mg/dL |
< 100 mg/dL |
| above optimal |
n/a |
100 - 129 mg/dL |
| borderline high |
130-159 mg/dL |
130-159 mg/dL |
| high |
160 mg/dL |
160 - 189 mg/dL |
| very high |
n/a |
> 190 mg/dL |
| HDL-cholesterol |
| minimum |
> 35 mg/dL |
> 40 mg/dL |
**From the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Cholesterol Education Program (NCEP)
National Heart, Lung, and Blood Institute (NHLBI)
National Institutes of Health (NIH)
The new guidelines reflect:
- more aggressive cholesterol-lowering treatment
- better identification of those at high risk for a heart attack
- identification of a "metabolic syndrome" of risk factors linked to insulin resistance, which dramatically increase risk
- use of a complete lipoprotein profile as the first test for high cholesterol
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