Types of Cholesterol

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Information on Types of Cholesterol

One form of cholesterol, commonly abbreviated as HDL because it is attached to high-density lipoproteins, is now attracting a lot of attention.  HDL-cholesterol is a complex of fat and protein found in everybody's blood, and within the past five years, accumulated evidence has shown that people with relatively high levels of HDL in their blood have fewer heart attacks than others.  Perhaps, then, HDL is protecting them from heart disease.  Cholesterol itself is the same, and that the differences between LDL and HDL reflect the proportions and types of lipids and proteins within them, not the type of cholesterol.


Lipoproteins exist for a reason.  Because fat and water do not mix, the body needs a system for carrying fats (including cholesterol, which has many good uses) through the watery medium of the bloodstream.  Proteins, in the main, serve this purpose for cholesterol; the two major classes are known as low-density and high-density lipoproteins (LDL and HDL).  Produced by the intestine and liver, these proteins are secreted into the bloodstream, where they become attached to cholesterol.  But there is an important difference between the two.  LDL, the blood cholesterol linked to heart disease, seems to serve as a delivery truck; it picks up cholesterol and deposits it in cells, including - under abnormal conditions - those of our blood vessels.  High LDL is associated with a high risk of heart attack, whereas high HDL cholesterol seems to have a protective effect.  HDL, on the other hand, is the garbage truck; it collects excess cholesterol - perhaps even removing it from cells - and (probably) carries the material back to the liver for elimination.  Fat cells may release glycerol, fatty acids, cholesterol, and phospho-lipids to the blood.  The liver makes HDL to transport cholesterol from the cells back to the liver for recycling or disposal.


According to this scenario, a person's susceptibility to heart disease depends on the relative balance of the delivery and removal systems.  Raise the proportion of HDL relative to LDL and potentially damaging excesses of cholesterol can be diminished.  The theory is suggestive, and many people take it seriously.


Measuring the ratio of total cholesterol (which is mostly LDL-cholesterol) to HDL-cholesterol is worth doing once early in life - around the age of two - to find individuals with a genetic disorder called "type 2 hyperlipidemia." which predisposes to early, severe coronary artery disease.  Such children should be started on a strict program to lower their blood-fat levels, and family members should likewise be checked to see whether they have the same disorder.


A second check is recommended sometime in early adulthood, in the twenties.  If the value is acceptable, he advises subsequent checks at ten-year intervals.  A high ratio, signaling the risk of heart disease, should lead to a program that attempts to lower it, and values should then be checked more frequently.  However, certain measures seem prudent, and it should come as no surprise that most ways of lowering the ratio are already standard recommendations for reducing the risk of heart disease.


Giving up smoking raises HDL, and it certainly reduces heart disease.  Vigorous exercise appears to have a powerful influence on HDL.  By comparison with their sedentary contemporaries, middle-aged runners have a favorable ratio.  What is not yet certain is whether a middle-aged person who abandons the armchair for a pair of running shoes will be rewarded by a rise in HDL or a longer life.


Recommended dietary measures also have a familiar ring.  Reduce the intake of calories and of all kinds of fat, especially animal fat and cholesterol.  Polyunsaturated fats can be substituted for other fats but should not be added to the diet as an extra.  Cold-water fish seem to raise the level of HDL, as do garlic, brewer's yeast, and lecithin - but then so do chlorinated pesticides, which are hardly recommended in the diet.  As yet, no evidence warrants a faddish use of any food or substance to alter HDL-cholesterol levels.  Periodic measurement of the ratio can serve as a guide to effectiveness of a diet-and-exercise program.


Consumption of alcohol clearly raises the level of HDL and seems also to protect against heart attacks.  Moderate drinkers (who consume no more than a couple of ounces of whisky a day or the equivalent) had a lower mortality rate than teetotalers in five out of six analyses conducted.  More than this amount, however, rapidly decreased life expectancy in direct proportion to the increasing intake.  The difficulty many people have in controlling their alcohol consumption makes it unwise to encourage drinking.


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