CD-ROM Today 1996 January

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$Unique_ID{BRK01754} $Pretitle{} $Title{Cholesterol Control: A Lifetime Plan, part I} $Subject{Cholesterol high blood pressure pressures heart disease diseases Cigarette smoking diet dietary dieting dieter dieters diets animals fats fat blocked arteries artery LIPOPROTEINS LIPOPROTEIN low-density high-density very LDL HDL VLDL SATURATED UNSATURATED MONOUNSATURATED POLYUNSATURATED OMEGA-3 HYDROGENATED Cigarettes smoke circulatory system intermediate-density IDL} $Volume{Y-0} $Log{ How Cholesterol Levels Affect the Arteries*0002701.scf HDL Transports Cholesterol Back to the Liver*0002702.scf Exercise Increses HDL*0002703.scf Exercise Lowers Triglycerides and Raises HDL*0003203.scf The Effects of Smoking*0007301.scf Glossary*0174201.tid} Copyright (c) 1991-92,1993 Tribune Media Services, Inc. Health Update by Dr. Allan Bruckheim Cholesterol Control: A Lifetime Plan, part I ------------------------------------------------------------------------------ CHOLESTEROL AWARENESS IN AMERICA High blood cholesterol is one of the three major risk factors for heart disease. Cigarette smoking and high blood pressure are the other two. Fortunately, all three risk factors can be modified--that is, you can change them, and lower your risk of developing heart disease. Most Americans are acutely aware of cholesterol. Newspapers and magazines run frequent articles on it, best-selling books tell how to control it, and grocery store shelves are lined with products boasting that they don't contain it. Cholesterol is such an important public health concern that more than 20 health groups, including the American Heart Association and the National Heart, Lung and Blood Institute have joined a campaign, called the National Cholesterol Education Program, to promote lower cholesterol levels. Unfortunately, the more we see and hear about cholesterol, the more complicated and confusing the message gets. What exactly is cholesterol? Why is some cholesterol "good" and some "bad"? What is the difference between "dietary" cholesterol and "blood" cholesterol? Does diet really affect cholesterol levels? Can exercise lower cholesterol levels? Can reducing cholesterol protect you from heart disease or premature death? This booklet is designed to end your confusion over cholesterol. It includes the latest, most reliable scientific information on this complex and important topic. You can do something to lower your cholesterol level--and lower your risk for heart disease. Here is the information you need to begin a lifetime plan to control cholesterol and keep your heart healthy. The cornerstone of cholesterol control is dietary modification. Other measures, and sometimes cholesterol-lowering medications, may also be appropriate. After reviewing your medical history and measuring the amount of cholesterol in your blood, your physician can recommend the approach that is best for you WHAT IS CHOLESTEROL? Cholesterol is a waxy, fat-like substance that is an important part of the normal system of blood fats found in humans and animals. Cholesterol is not bad by itself; in fact, it is essential to several vital body processes. It helps produce hormones, it contributes to development of the brain, and it aids the functioning of the nervous system. It is not necessary to consume cholesterol in your diet. The liver manufactures all that your body needs: it also processes the additional cholesterol that comes from the foods you eat. Cholesterol becomes a problem only when the body makes too much of it. The bloodstream carries cholesterol from the liver to other body cells. Excess cholesterol that the cells don't need can collect on the lining of the blood vessels. This can cause a condition called coronary atherosclerosis--that is, the buildup of fatty deposits, or plaque, in the arteries. These fatty deposits narrow the blood vessels, making the heart work harder to pump blood through. Blood clots (thrombosis) can also form around these fatty deposits. Atherosclerosis can cut off the supply of blood carrying oxygen and other vital nutrients to the heart and other organs. Poor circulation of blood to the legs can cause crampy pains that doctors call intermittent claudication. In an artery supplying the heart, clogging can disrupt the normal beating of the heart and Lead to a heart attack or chest pain (angina). If a blood vessel nourishing the brain becomes clogged, the decreased supply of oxygen and nutrients could lead to a stroke. LESS CHOLESTEROL MEANS LOWER RISK The bad news is that the higher your total blood cholesterol level, the greater your risk of heart disease. The good news is that you can reduce your risk of heart disease by lowering the amount of cholesterol in your blood. According to the American Heart Association, for every I percent that you lower blood cholesterol levels, you reduce your risk of heart attack by 2 percent--in other words, you are two times less likely to have a heart attack than if your levels remained high. But does lowering cholesterol actually reduce the risk of death from heart disease? This has been an area of considerable scientific controversy. For many years, there was no evidence that people who reduced their cholesterol levels lived any longer than those who didn't--even though they were less likely to have heart attacks. Because there was no clear scientific evidence that reducing cholesterol saved lives, some scientists and physicians were skeptical about whether people should make drastic changes in lifestyle and diet to control cholesterol. Now the evidence is in. A 10-year scientific study of more than 800 people proved that those with normal hearts whose blood cholesterol is brought down from abnormally high levels live longer than those whose cholesterol levels remain high. Furthermore, people who lowered their cholesterol levels were less likely to need surgery to unclog blocked arteries. Lowering cholesterol to reduce the buildup of atherosclerotic plaque in blood vessels also protected against heart attacks. The knowledge that lowering cholesterol levels can keep your heart healthier and help you live longer should give you all the incentive you need to watch your cholesterol levels. BLOOD CHOLESTEROL AND LIPOPROTEINS The kind of cholesterol in your blood is as important as the total amount. The different types of cholesterol are described in terms of the way they are transported through the bloodstream. Cholesterol is a fat, so it cannot mix with blood, which is water soluble. Therefore, cholesterol is carried through the bloodstream in protein "packets" called lipoproteins. These are of various sizes and weights (or densities). The two most common kinds of cholesterol are large low-density lipoproteins (LDL) and smaller, denser lipoproteins, called high-density lipoproteins (HDL). LDL and HDL account count for most of your blood cholesterol, but there are other kinds of blood fats as well, including very low-density lipoproteins (VLDL), intermediate-density lipoproteins (IDL), and triglycerides. Normally, most of the cholesterol circulating in your bloodstream is carried by LDL. LDL is often called "bad" cholesterol because it promotes heart disease. Extra LDL cholesterol that isn't used by the body in its normal functions tends to "stick" to the walls of the arteries. These deposits can develop into atherosclerosis. HDL cholesterol is considered "good" because it appears to carry cholesterol back to the liver for processing or removal from the body. HDL may help prevent the formation of fatty plaques in the arteries, and protect against heart disease. 'DIETARY' VS. 'BLOOD' CHOLESTEROL "Dietary" cholesterol refers to the cholesterol contained in foods you eat. Cholesterol is found naturally in all animal tissue, but it does not occur in any plants. Fatty meats, dairy products and eggs are the most common sources of dietary cholesterol. Cholesterol does not occur in fats made from vegetable sources, like cooking oil, although some vegetable oils contain other fats you should avoid. "Blood" cholesterol refers to the cholesterol circulating in your bloodstream. Your blood cholesterol level is affected by two things. The first is your genetic makeup (which determines how much cholesterol your body produces). The second is the amount of saturated fat and cholesterol in your diet. Generally, the body makes only about 80 percent of its cholesterol, and the rest comes from the food we eat. The liver processes dietary cholesterol and saturated fats into the lipoproteins that make up your blood cholesterol "profile". KNOW YOUR CHOLESTEROL NUMBERS High blood cholesterol doesn't cause any symptoms. The only way you can know if your levels are too high is to have a simple blood test done by your doctor or other qualified health professional. All adults over the age of 20 should have their blood cholesterol tested every five years. A sample of blood is taken from your finger or arm and tested to determine the blood cholesterol level. Four items get special attention. These are the total amount of cholesterol in your blood; the relative amounts of HDL (or "good" cholesterol) and LDL (or "bad" cholesterol); and total serum triglycerides, which are the most common type of fat in the body. TOTAL CHOLESTEROL: The National Heart, Lung and Blood Institute has classified total blood cholesterol levels into three groups: Desirable: 200 milligrams/deciliter or less Borderline high: 200-239 milligrams/deciliter High: Over 240 milligrams/deciliter The results of your first cholesterol test may be confirmed with a second one. Generally, the higher your total cholesterol number, the greater your risk for heart disease. If your total blood cholesterol level is high, or if you have additional risk factors for heart disease, you should have a lipoprotein analysis done. This will determine the LDL (low-density lipoproteins) level in your blood. LDL CHOLESTEROL: LDL is also classified into three groups: Desirable LDL: 200 milligrams/deciliter or less Borderline high LDL: 200-239 milligrams/deciliter High LDL: Over 240 milligrams/deciliter If your cholesterol numbers are borderline, your doctor will probably suggest that you start on a cholesterol-lowering diet and have your cholesterol retested in a year. He or she may also recommend other lifestyle changes. For example, exercising, quitting smoking, and limiting alcohol and coffee consumption can help reduce blood cholesterol levels and lower the risk of heart disease. If the LDL ratio is unusually high, your doctor may prescribe cholesterol-lowering drugs to bring your blood lipids down to normal levels. Your doctor also may recommend an aggressive approach if you have other risk factors for coronary artery disease. ADDITIONAL RISK FACTORS When high blood cholesterol and certain other circumstances (such as smoking or high blood pressure) are combined, the risk of coronary heart disease is even greater. For example, if your cholesterol level is in the "high" category and you also have high blood pressure, your risk for coronary heart disease is six times higher than that of someone without those conditions. If you also smoke, your risk increases more than 20 times! Besides high cholesterol, high blood pressure and cigarette smoking, other risk factors for coronary heart disease include a family history of coronary heart disease before the age of 55, diabetes, vascular disease, obesity and being male. Whether your cholesterol level is borderline or high, you should make some changes in your diet to lower your level. You should also modify any additional risk factors. Of course, you can't change all of these risk factors--for example, your sex, or your family's medical history. If you have risk factors that you cannot modify, that's all the more reason to work harder at changing the ones you can--like quitting smoking, losing weight or lowering your blood pressure. Your doctor may also prescribe additional treatments and regular cholesterol monitoring. CAUSES OF HIGH BLOOD CHOLESTEROL Several different factors can raise the level of cholesterol in your blood. While you can't alter things like your genetic heritage, your age, or your sex, other factors can be controlled. Most people can lower their cholesterol levels with diet alone. DIET: Among the factors you can control, diet has the largest effect on your blood cholesterol levels. Diets that are high in cholesterol, saturated fats and excess calories are linked to high blood cholesterol levels. Saturated fat raises your blood cholesterol level more than anything else you eat. HEREDITY: The genes you inherited from your parents also play a role in determining your blood cholesterol level and can control your ability to lower your level by diet. A small number of people have an inherited tendency to have a low cholesterol level; others have a genetic predisposition to high levels. If you have a generic disorder that contributes to high blood cholesterol (hypercholesterolemia), then your parents, children, brothers and sisters should also have their cholesterol checked. Dietary modification is important even if generic factors contribute to your high cholesterol levels. AGE AND SEX: Cholesterol levels tend to rise with age. In the United States, men's cholesterol levels generally rise from about age 20 to age 50, when they start to decline slightly. In women, levels also start rising at age 20, but they generally remain lower than men's until the time of menopause. After menopause, women's levels often increase to levels higher than those of most men. Pregnancy and certain oral contraceptives also can increase blood cholesterol levels in some women. WEIGHT: People who are overweight tend to have high total cholesterol levels. They also tend to have low levels of the "good" protective HDL cholesterol. A low-fat, low-cholesterol diet can help lower their total cholesterol levels, and weight loss can improve the ratio of HDL cholesterol in the blot. PHYSICAL ACTIVITY: Regular exercise can help you control your weight and lower your blood pressure--both important additional risk factors for coronary heart disease. In addition, aerobic exercise can increase your "good" HDL cholesterol level. SMOKING: Besides being an important additional risk factor for coronary heart disease, smoking may also contribute to high cholesterol levels. There is evidence that smoking suppresses HDL levels; if you quit, the level of this protective form of cholesterol increases. STRESS: High cholesterol levels have been linked to stress, but it is not clear if stress itself raises cholesterol levels. One theory is that tension may somehow stimulate the release of stored fat into the bloodstream. Another explanation is that during periods of stress, people tend to eat more foods that are high in saturated fat and cholesterol. MEDICATION: Certain kinds of medications can raise your cholesterol levels. Be sure to let your doctor know of any medications you are taking, so he or she can determine if they might be a factor. ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.