Cholesterol and Heart Disease

Everyone living in any developed country must have heard about cholesterol. The message has been pushed that high cholesterol levels spell out inevitable heart disease, and that we should all switch to eating habits that lower them.

Yet how many people know what cholesterol is, and why it should be so apparently dangerous? My guess is very few. Fewer still have been given the unbiased facts about it, and most do not know how to go about lowering their cholesterol levels.

First, it is important to understand that it is normal to have cholesterol in the bloodstream. It is a fatty substance used by the body to maintain the integrity of several important organs, such as the liver and brain, and is a 'building brick' in the construction of complex fat-based substances such as cortisone and sex hormones.

So we cannot do without cholesterol completely. We do, however, need to keep its levels in the blood within certain limits. When they are too high, the excess cholesterol appears to be deposited, along with other fats (called lipids) in the walls of the blood vessels, as plaques of atheroma. Atheroma leads to heart attacks. So there is a good case for lowering cholesterol levels in people in whom they are too high. The problem, until recently, centred upon the definition of high. However, that has now been settled by such important authorities as the US National Heart Lung and Blood Institute, the Study Group of the European Atherosclero­sis Society, and the World Health Organization MONICA Project (MONitoring trends In Cardiovascular disease).

Cholesterol levels are measures - from a simple blood test - in millimoles per liter of serum (mmol/1). The experts agree that they are becoming moderately high when they are above 5.2 mmol/1, and need definite attention above 6.5 mmol/1. A person is defined as 'hyperlipidemic' (with a serious high blood fat level disorder needing medical treatment) if he or she has a cholesterol level above 7.8 mmol/1. The aim for everybody is to keep the cholesterol level between around 4 and 5 mmol/1.

All this advice sounds definite and accurate enough on the surface, but there are practical problems. For a start, if these figures were adhered to, then more than half the population of the United States, and many other developed countries, would need some form of treatment to lower their cholesterol levels.

All this advice sounds definite and accurate enough on the surface, but there are practical problems. For a start, if these figures were adhered to, then more than half the population of the United Kingdom, and many other developed countries, would need some form of treatment to lower their cholesterol levels.

How do we know if our cholesterol levels are too high? It is not easy. Like high blood pressure, there are no symptoms - until perhaps that fatal heart attack. Some, but not all, hyperlipidemic patients develop fatty lumps in the skin around the eyes. The only way to be sure is to have the blood test. Everyone over 40 should have one: this is especially important for close relatives of people who have had heart attacks in their early and middle adult life.

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