Higher cholesterol OK if the right kind

Published by Contra Costa Times

Posted on Fri, Feb. 24, 2006

By Dr. Stephen Daniels, Columnist

"WHAT'S MY cholesterol, doc?" It's a common question and important to know. But some cholesterol is good for your health and some is bad. Having too much bad cholesterol can be even more dangerous if combined with other illnesses such as diabetes.

"Bad" cholesterol is called LDL (low density lipoprotein) and "good" cholesterol is HDL (high density lipoprotein). To remember which is which, you want to keep LDL low, and HDL high. Most of us have a lot more bad (LDL) than good (HDL) cholesterol, which is why we often hear that "lowering cholesterol" is a good thing.

Most research suggests that having less LDL and more HDL in your blood helps prevent clogged arteries. And clogged arteries can lead to heart attacks and strokes.

High LDL (too much bad cholesterol) and low HDL (too little good cholesterol) can be caused by many things: poor diet, obesity, lack of physical activity, tobacco smoking, genetics, gender and age.

Foods that increase LDL (remember, you want to keep LDL low) are mostly from animal products such as meat, fats and milk. Lack of physical activity and tobacco smoke tend to lower HDL cholesterol. If your father suffered from clogged arteries before age 55, or your mother before age 65, your family may have a genetic predisposition toward high LDL (bad) cholesterol.

Women tend to have less LDL cholesterol than men until they are about age 65, then both genders are similar.

Talk to your doctor about when and how often you should check your cholesterol. If you have risk factors that cause high LDL and low HDL, as mentioned above, you should probably start getting checked about every five years at age 20.

Most people's LDL cholesterol levels range between 100 and 200 (mg/dl).An LDL of 129 or less is considered adequate for most healthy people, though recent studies suggest that lower is better. Many experts now think that even lower LDL levels are better, below 100 for those with diabetes, even below 70 for those with evidence of severely clogged arteries.

On the other hand, in some cases levels higher than 129 may be safe. HDL levels usually range between 40 and 50 (mg/dl). Lower than 40 is considered unhealthy and levels higher than 50 may be beneficial. Some research suggests that high HDL levels can reduce already clogged arteries and gradually wash off the plaque that can lead to heart attacks and strokes. Lots of physical exercise raises HDL levels. Some doctors use the ratio of total cholesterol to HDL to help determine a person's risk for clogged arteries. An ideal ratio is 3.5:1 or less.

For example, if the total cholesterol is 200 and the HDL is 50, then the ratio is 4:1. If the total cholesterol is 240 and the HDL is 40, then the ratio is 6:1. Ideally, if the total cholesterol is 250, then the HDL will be at least 69. Or, if the total cholesterol is 200, then the HDL will be at least 57. In any case, higher HDL and lower LDL reduces the risk of clogged arteries.

When you next visit your doctor, you might ask "What's my LDL, doc?" instead of "What's my cholesterol?" I'll discuss cholesterol treatment in a future column.