By Craig M. Walker, M.D.
Medical Director,
Cardiocascular Institute of the South

Here's the problem with cholesterol: you're feeding cheeseburgers to a body that thinks you're a caveman living on roots, nuts and berries, with just the occasional mastodon steak thrown in. It still behaves as if obtaining cholesterol -- a vital nutrient -- is a much bigger problem than getting rid of it.

In our prosperous society with its fat and cholesterol-rich diet, the reverse is actually true, and it is a concern for everyone, not just for the middle-aged and elderly. Vietnam War era studies found that a significant number of physically fit American men in their late teens and early 20s had already developed advanced levels of atherosclerosis -- the buildup of waxy cholesterol plaque in arteries that ultimately leads to heart attacks.

We're more aware today of the risks posed by excessive cholesterol, a form of fat which comes entirely from animal products, and saturated fats, which have both animal and vegetable sources. Most people have even heard that there is a "good cholesterol" (HDL) and a "bad cholesterol" (LDL).

Unfortunately, that effort to provide a simple explanation of cholesterol measurement actually misrepresents it. HDL and LDL aren't cholesterol, and both are vital to our survival. They are lipoproteins, a low-density form (LDL), which transports cholesterol to the body's cells, and a high-density form (HDL), which carries away excess cholesterol the cells don't use. Chemically, they are detergents -- molecules which have one fat-soluble (lipo) end and one water-soluble (protein) end that allow them to hold fats in suspension in a water-based medium -- blood -- which, by itself, couldn't dissolve or transport them.

What we call cholesterol measurement actually measures the levels of these two transporting detergents, not the cholesterol itself. Theoretically, the higher the level of HDL, which carries away excess cholesterol, compared to LDL, which carries it to the cells, the less likely there will be excess cholesterol left around to start building up plaque accumulations in our arteries.

You can, with some effort, actually improve your own HDL-to-LDL ratio. Aerobic exercise -- jogging, walking or any other regimen which features lots of motion against little resistance -- can be one of the biggest factors in shifting your body's LDL /HDL ratio in your favor. Losing weight can also have a positive effect.

And, yes, there is evidence that alcohol, in moderation, can have some small beneficial effect in raising HDL levels. But the important word in this regard is moderation. If your alcohol consumption exceeds one or two drinks a day, you can raise your blood pressure and increase the levels of fatty triglycerides in your blood stream, thus undoing the benefit of more restrained consumption.

It has been learned recently that a third lipoprotein, called LP(a), figures in the type of high cholesterol that runs in some families with a high incidence of atherosclerotic cardiovascular disease and in some ethnic groups, including African-Americans. If you fall into one of these high-risk groups, it would be worthwhile for you to schedule a special test, called a vertical analytical profile, which can detect elevated LP(a) levels.. LP(a)-related high cholesterol can be controlled by physician-monitored administration of niacin, one of the B-complex vitamins.

If none of these remedies suffice to bring your cholesterol level into the "safe" zone, there are a number of medications your doctor can prescribe that are effective in controlling the condition.

I almost hesitate to mention that a sufficiently high level of HDL can even slightly reduce plaque accumulation in arteries, because so many patients make too much of the fact. HDL isn't some sort of biological Drano that can clear out badly clogged arteries. And you can't administer it like a drug. You have to make your own -- the hard way.

&copy 1995 Cardiocascular Institute of the South

For further information, call Jane Arnette, Cardiocascular Institute of the South/Houma, 1-800-425-2565, or Jim Keyser at 1-800-848-2715. E-mail questions or comments to: jakeyser@cardio.com.

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