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Should You Be Worried About Your Cholesterol?

Find out if your cholesterol level is in the healthy range and if not, what you should do about it.

By
Rob Lamberts, MD,
June 29, 2010
Episode #002

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What Should Your Cholesterol Levels Be?

The idea that a cholesterol level should be under 200 dates back to before I was practicing medicine. Some smart scientists had noticed that people with high cholesterol had a higher risk of heart attack. More scientists got together and decided that, based on the evidence, 200 was a good cut-off point. To celebrate their decision, they went out to a dinner of bacon cheeseburgers and donuts.

OK, I’m not really sure about the celebration, but they did decide on 200 as the cutoff.

What are the Different Types of Cholesterol?

Some time later, some other scientists noticed that there are people with cholesterol over 200 who don’t have heart attacks, whereas others with levels under 200 do. Their research showed that there are several types of cholesterol of varying density. They named these types of cholesterol High Density Lipoproteins, or HDL, Low Density Lipoproteins, or LDL, and Very Low Density Lipoproteins,or VLDL.

What is the Difference Betwen HDL and. LDL?

Anyhow, it turns out that a high LDL is associated with higher risk of heart disease while a high HDL is associated with a lower risk. The VLDL, which is mainly triglycerides, has a much smaller effect than the HDL and LDL, so we’ll ignore it for now. LDL is commonly referred to as bad cholesterol, and HDL as good cholesterol. You have to wonder how long these politically-incorrect names will be used. LDL’s self-image must be shot by now with all the praised being heaped on HDL.

Back in the science lab, some other scientists began to notice that a few people with high LDL didn’t develop heart disease, and some with low LDL did. I say this only to point out that my explanation is a simplified one, and should not be taken as an exhaustive explanation. I also do it to point out how annoying some scientists can get if they have time on their hands.

When Should You Worry About Cholesterol?

So what about good old Ralph and his cholesterol over 200? Should he be worried? It’s hard to say. Total cholesterol is calculated by using a formula that includes HDL, LDL, and triglycerides. That makes the overall cholesterol number of limited use to me as a doctor. It’s kind of like if you asked someone for the score of a football game and they answered “42,” adding together the scores of both teams. Technically, they are right in their answer, but the information is probably not what you want. You want to know the score of the good team and how it compares to that of the bad team.

In the same way, the LDL and HDL numbers are far more important to Ralph than the total cholesterol. In fact, there is a calculation called the Framingham Risk Score which uses HDL and LDL levels, along with other risk factors, and calculates a person’s 10-year risk of having a heart attack. I’ll put a link to this formula in the show notes.

When you get down to it, people don’t die from high cholesterol, they die from heart attacks and strokes. If I knew a person with high cholesterol would stay healthy until they were 90, I wouldn’t bother treating them. That is what makes the Framingham Risk Score useful to me: it focuses on what really matters. It’s not a perfect formula, but it gives a decent idea of risk. My goal as a doctor is to get that 10-year risk as low as possible.

So what does this mean to you? Here are my quick and dirty tips about cholesterol:

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