Why does my doc care about my cholesterol?

         For the past 30 years doctors have been able to measure cholesterol levels and use that information to lower the risk of coronary artery disease. When a cholesterol plaque ruptures within your coronary artery a small clot forms over the plaque and a heart attack occurs. It is for this reason that I work so hard with patients to lower their cholesterol levels. Typically when we check cholesterol we check 5 components: Total Cholesterol, HDL (high density lipoprotein), LDL (low density lipoprotein), Triglycerides, and I like a Cholesterol/HDL ratio. There are a number of other particles that can be checked including Lp(a) and Apoprotein (b).

The LDL is what has traditionally been the biggest concern to doctors as it is the primary contributor to cholesterol plaque formation. Ideally, LDL values will be less than 130mg/dl in healthy people and we try to get them below 70mg/dl for patients with diabetes or known coronary artery disease.  We think of HDL as the scavenger or repair brigade, these particles repair damage to artery walls so that cholesterol plaques do not occur, the higher this number is the better, ideally over 50mg/dl in adults. The triglycerides transport fat in our bodies and are not an independent risk for coronary artery disease but they are indicators of Metabolic Syndrome (high triglycerides , low HDL, elevated blood sugar, and hypertension) which make diabetes and coronary artery disease more likely. The ratio of Cholesterol/HDL ratio provides us what proportion of total choles terol is the good cholesterol and we like to see this ratio less than 5.0 (i.e. Total Cholesterol 180mg/dl/HDL 50mg/dl=Ratio 3.6).  Other risk factor for coronary artery disease that we can modify are smoking and hypertension. 

A simple tool that you can use to calculate your risk for coronary artery disease is the Framingham Risk Calculator. The Framingham Risk Calculator was developed using data that was collected during the The Framingham Heart Study which analyzed approximately 5000 men and women from Framingham Massachusetts for over 50 years to determine risk factors for cardiovascular disease. Using the Framingham Risk Calculator we can determine whether or not a patient between 34-74 years old needs medical management of their risk factors for cardiovascular disease. Interestingly, we only can hypothesize about people older and younger than 34-74 years old, but  we can infer that having a good cholesterol profile, a healthy diet, an active life style, and blood pressure awareness prior to age 34 will lower your risk of having cardiovascular disease. I think we will look at other risk factors to help us predict who will develop cardiovascular disease including genetics, infections and associated systemic inflammation, and other small cholesterol particles. For now, I think the most important thing you can do beyond having your cholesterol measured is to stay active and eat a low fat, low cholesterol diet.