Cholesterol and Heart Attacks
By Beth Portolese
Each year when getting the results of my annual physical (something that didn’t become annual until my 40s) I smile when my doctor tells me that my cholesterol is around 160. I think to myself that I must be doing something right with my diet; or perhaps pizza has now become the new salmon. Recently I heard about a friend who had a heart attack, which was scary since he is not far from my age and, from what I understood, his cholesterol level was around the same range as mine. This made me wonder whether the supposed link between low cholesterol numbers and a low risk of heart disease was really true, or just an urban myth that made those of us with cholesterol readings below 200 feel better. I figured I should do a little research.
As most of us know, there are two parts of the cholesterol reading, the LDL and HDL (the good one) levels. According to what I’ve read, virtually every heart attack starts with cholesterol. Cholesterol is a waxy kind of substance that burrows into the heart vessel wall and eventually bursts leaving an ulceration of the artery lining that the body tries to heal by forming a blood clot. This blood clot blocks the artery and causes a heart attack. It would follow then that the people with less cholesterol would have less of a chance of this whole process happening and, therefore, less of a chance of a heart attack. Then what explains my friend having a heart attack? Apparently this is where the numbers and size of LDL and HDL particles come into play. Think of these two things as buses bringing cholesterol to and from your heart. LDL buses it in and HDL buses it out. If the numbers are both small then that is not a good thing. If the LDL is in small particles then it can more easily slip into blood vessel walls and the more of it there is (even in the so-called healthy number levels) the more of them there are to do this nasty work. If the HDL is in small particles it will be poorly equipped to mop up excess cholesterol and transport it out of your heart. If the HDL level is in bigger, more absorbent particles this transporting out is more likely to happen. This is why you might have good overall cholesterol numbers but still be at risk for a heart attack.
The question of course becomes how you know whether you have the big juicy HDL particles or the tiny ones. You can do this by cross checking your triglycerides with your cholesterol numbers. If you have low triglycerides (less than 100) and your HDL level is high (greater than 60) chances are you have these large particles. If you have high triglycerides and low HDL then your cholesterol is probably the small particles variety and you should ask your doctor what you can do to change or manage this.
Heart disease is a major epidemic in this country so the better you understand what causes it, the better off you will be. Other factors that can influence heart health are excess iron and homocysteine, an amino acid that accumulates in the blood if you eat too much meat and dairy. Neither one of these plays as important a role as cholesterol, though, which is why it is important to know as much as possible about it. Consult your doctor and get the right tests.