Comparing Cholesterol’s Risks and Benefits: Locating the cholesterol in the human body, Proving that cholesterol has a good side, Confirming cholesterol’s risks, Identifying other harmful compounds in your blood and Mastering CPR.

Comparing Cholesterol’s Risks and Benefits

This chapter starts off by covering the ways in which your body uses cholesterol for everything from powering your brain to building your sex hormones. Then — fair is fair — you can find out why something so good can also be hazardous to your heart health.

Finally, because cholesterol isn’t the only bad guy to be found in your blood, I provide you with a short description of some of the other unhealthy criminals floating through your bloodstream.

After you’ve made your way through the heavy stuff, reward yourself with a bit of fun by taking the heart art quiz at the end of this chapter. The quiz asks you to match literary, musical, and other heart-related titles with their authors.

Shaking Hands with Cholesterol

Cholesterol is the Dr. Jekyll and Mr. Hyde of the nutrition world. This fat-like substance is both essential for your healthy body and potentially hazardous to your heart.

Double trouble

The split-personality title character in Robert Louis Stevenson’s novel, The Strange Case of Dr. Jekyll and Mr. Hyde (1886), embodies both good and evil — the two sides of human nature. (Pop quiz: Which personality is the good guy? Which one isn’t? See the end of this sidebar for the answers.)

This sort of duality isn’t uncommon in religion, philosophy, and literature. For example, the Aztec god Quetzalcoatl was both male and female. And Janus, the Roman god of doors, had two faces, one in the front of his head and one in back, because every door faces two ways — in and out. By the way, Janus is the namesake of January, the door to the New Year.

The Chinese symbol of two-sidedness is the yin and the yang. The yin symbolizes the female, and the yang stands for the male. The yin and yang also symbolize the coexistence of other opposing concepts, such as life and death, good and evil, black and white, and love and hate. What makes this even more interesting is the fact that the word yin, which sounds totally non-Western, is a variant on the Scottish word for one.

So, you can see that cholesterol has some company when it comes to having two sides to a story. And Jekyll is the good guy; Hyde isn’t.

Making the most of cholesterol’s Jekyll-like good characteristics while counteracting its Hyde-like bad impulses can be a delicate but not impossible balancing act. The task begins with understanding how and where cholesterol does its good work and how and where it can cause problems. Begin your mission, in the true scientific spirit, at the beginning.

Where cholesterol comes from

Yes, you get some cholesterol from food, but the curious fact is that most of the cholesterol in your blood and body tissues is produced right in your very own liver. Your liver uses the proteins, fats, and carbohydrates in food to manufacture and churn out about 1 gram (1,000 milligrams) of cholesterol a day.

How cholesterol travels around your body

Whether your cholesterol comes from food or your liver, it travels through your bloodstream in particles called lipoproteins, a name derived from lipos (the Greek word for “fat”) and protos (Greek for “first” or “most important”).

The fatty substances in lipoproteins include cholesterol and triglycerides, the most common fatty substance in the human body (more about triglycerides in the section “Focusing on Other Blood Baddies”). The proteins that com- bine with fats to produce lipoproteins are called apolipoproteins, often abbreviated as apo.

Lipoproteins develop through five distinct phases as they mature into the particles that carry cholesterol around your body:

•  Phase 1: Chylomicrons
•  Phase 2: Very low-density lipoproteins (VLDLs)
•  Phase 3: Intermediate-density lipoproteins (IDLs)
•  Phase 4: Low-density lipoproteins (LDLs)
•  Phase 5: High-density lipoproteins (HDLs)

How does a chylomicron become a VLDL, then an IDL, then an LDL, and finally, maybe, an HDL? The following roadmap marks the route.

Bringing up baby lipoproteins

A lipoprotein is born as a chylomicron, a particle that your intestinal cells assemble from the proteins and fats you eat. Chylomicrons are very, very low-density particles.

Why are some lipoproteins called low-density and others high-density?

• The term density refers to a lipoprotein’s weight.
• Protein weighs more than fat.
• Lipoproteins containing proportionately less protein than fat are low- density lipoproteins, also known as LDLs. LDLs are the “bad” particles that carry cholesterol into your arteries.
• Lipoproteins containing proportionately more protein than fat are high- density lipoproteins, also known as HDLs. HDLs are the “good” particles that ferry cholesterol out of your body.

Now, back to chylomicrons. These lipoproteins start out with very little protein and a lot of light and fluffy fat and cholesterol. But as they flow through your bloodstream from your intestines on their way to your liver (your body’s lipoprotein factory), the chylomicrons release their fats, known as triglycerides, into your blood.

The stripped-down chylomicron, also known as a chylomicron remnant, still has its cholesterol and protein. Now, the remnant slides into your liver, and fat comes back into the picture.

Moving through the fat factory

As anyone who has ever read a nutrient chart knows, liver (as a food) is very high in fat and cholesterol. In fact, your liver is a veritable fat and cholesterol factory that collects fat fragments from your blood and uses them to make cholesterol and new fats that your body can use to build tissue and perform other physiological functions.

The next few sections explain exactly how lipoproteins are made.

Putting the fats in lipoproteins (and taking them out again) When the chylomicron hits the liver, it picks up fat particles and mutates into the largest kind of lipoprotein, a fluffy particle called a very low-density lipoprotein (VLDL).

Then your liver sends the VLDL out into the wide world — your body. As the VLDL travels far and wide, it drops globs of fat, picks up globs of cholesterol, and changes into a slightly smaller, heavier particle called an intermediate low-density lipoprotein (IDL), and then a slightly smaller, heavier low-density lipoprotein (LDL).

The last step in the transformation of the baby lipoprotein (the chylomicron) occurs when an LDL has dropped so much fat and cholesterol into body tissue that it’s mostly protein. Now, you’re looking at a high-density lipoprotein (HDL).

Naming the proteins in lipoproteins

The primary proteins in VLDLs, IDLs, and LDLs belong to a class of apolipoproteins called apoB. The primary proteins in HDLs belong to a class of apolipoproteins called apoA. Other less prominent apolipoproteins found in lipoproteins are apoC and apoE.

You may have heard about a blood test for apoA; this test is interesting because a high level of apoA indicates a high level of protective HDLs (the “good” particles that haul cholesterol out of your body).

Pinning a blue ribbon on good lipoproteins

HDLs truly deserve the name “good cholesterol.” These particles don’t carry cholesterol into your arteries for the simple reason that they’re so compact and dense that they can’t squeeze through the spaces in the walls of your arteries. As a result, HDLs — and their cholesterol — travel away from your arteries and out of your body with the rest of your, um, solid waste.

What a neat set of facts to park in the back of your brain for the next time you’re at a party and someone asks you to explain the differences between VLDLs, IDLs, LDLs, and HDLs. “Well,” you can say, “it’s all a question of density, which, as you know, means. . . .” Don’t you just love being the smartest kid in class?

The good news about HDLs

You can think of HDLs as scavenger molecules that remove cholesterol from the arteries. Having a lot of HDLs reduces your risk of heart attack regardless of your total cholesterol levels.

In fact, X-ray studies have shown that people who raise their HDLs by exer- cising, stopping smoking, or taking medication not only reduce the choles- terol in the arteries but also remove the plaque — thus opening the arteries.

Having read that paragraph carefully, you may assume that all LDLs are bad guys, right? Wrong.

With LDLs, size may make all the difference

For years, everyone — that is, all the experts evaluating your cholesterol — conversely believed that a person with a lot of light and mushy LDLs (which can squeeze through your artery walls) inevitably had a higher risk of heart attack. The fact that some people with high levels of LDLs sailed happily into old age without experiencing heart problems was dismissed as plain good luck.

Maybe not, says a group of researchers at Albert Einstein College of Medicine in New York City. In 2003, looking for clues to longevity, the team, which included members from the University of Maryland School of Medicine, Tufts University, Boston University School of Medicine, and Roche Molecular Systems, ran various tests, including cholesterol tests, on 213 senior citizens, plus 216 of their children and grandchildren. For comparison, they ran the same tests on a control group of non-blood relatives, such as the children’s husbands and wives.

The tests showed something really surprising: The long-lived oldsters were three times more likely than other people to have a mutation in a gene that regulates cholesteryl ester transfer protein (CETP), an enzyme that affects the size of lipoproteins. As a result, compared with other people, including those non-related husbands and wives, even the oldsters who had high levels of LDLs had relatively larger low-density lipoproteins. (Their HDLs were also relatively bigger.)

According to the Einstein team, led by Dr. Nir Barzilai, the level of LDLs doesn’t predict heart disease; it’s the size of the LDLs in the mix. In other words, having many small LDLs may raise the risk of heart attack even if your overall cholesterol level is low. Definitely more to come on this one.

Believe It or Not, You Need Cholesterol

Your healthy body needs cholesterol, but I haven’t told you the reasons why. Let me list them now:

• Cholesterol directs the development of some cells in the growing fetus.
• Cholesterol is part of the membrane that surrounds and protects each cell in your body.
• Cholesterol comprises a major portion of your brain, which is composed of mostly fatty tissue.
• Cholesterol contributes to the construction of synapses, structures through which nerve cells transmit messages.
• Cholesterol is a building block for hormones, including the male sex hormone testosterone and the vital adrenal hormone cortisone.
• Cholesterol is an ingredient in digestive juices, such as bile.
• Cholesterol is used as a building block for vitamin D, which is made when sunlight hits the fatty tissue just under your skin.
• And, oh yes, cholesterol is part of body fat.

Is that an impressive list or what? I think it’s impressive as all get out, so I’m going to take some time to explain exactly how cholesterol performs each of these incredibly important jobs.

Cholesterol helps your body develop

Cholesterol begins to influence your body even before you’re born. According to a 1996 report in the journal Science, cholesterol enhances an embryo’s healthy development by triggering the activity of the specific genes

that instruct embryonic cells to become specialized body structures — arms, legs, spine, and so on. Sadly, as Science reported, approximately one in every 9,000 babies is born with a birth defect linked to the fetus’s failure to make the cholesterol it needs.

In 2003, researchers at the U.S. National Human Genome Research Institute linked a pregnant woman’s cholesterol deficiency to a defect in the fetal brain called HPE (the failure of the brain to divide normally into two halves). Ninety-nine percent of embryos with HPE are spontaneously aborted; those born live experience severe mental retardation, are unable to walk or talk, and usually die within the first year of life.

To prevent these problems, pregnant women are often advised not to take cholesterol-lowering drugs.

Cholesterol holds your cells together

Think back to your first chemistry or physics class. Never took chemistry or physics? Well, then imagine being in class where one of the first things your teacher wants you to know is that there’s no such thing as a solid substance.

Things that look solid — this book, that lamp, you, and me — are actually gazillions of individual atoms, molecules, and cells whirling around in space, held together only by an exchange of electrical charges. If you can’t remember much chemistry or physics, check out the “Recognizing the difference between an atom, a molecule, and a body cell” sidebar in this chapter. Mark your place, read the sidebar, and then come right back.

Okay, as I was saying, some things that look solid aren’t solid. They’re simply groups of cells held together by electrical charges that keep the cells in place so that a piece of this page or a piece of your finger doesn’t go spinning off into space. Individual cells stay intact because they have a cell membrane, an outer skin that serves as neat and tidy packaging for the cell.

One requirement for healthy cell membranes is — drumroll please — cholesterol. A whopping 90 percent of all the cholesterol in your body is in your cell membranes. The cholesterol protects the integrity of the cell membrane, helping to keep it flexible and strong.

If you were to diet so stringently or use so many cholesterol-lowering drugs that your cholesterol level fell to zero (an impossibility by the way), your cell membranes would be very dry and easily torn. The stuff inside the cells would leak out, and cells would die all over the place. That would sort of put an end to the whole darn shootin’ match. Every healthy body cell needs some cholesterol, and so does every healthy brain.

Recognizing the difference between an atom, a molecule, and a body cell

Atoms are the basic building blocks of elements — hydrogen, oxygen, carbon, and all their chemical cousins.

Each atom carries the name of the element it represents (such as hydrogen). In addition, each atom has a shorthand symbol — call it a nick- name — such as H for hydrogen. Sometimes, an atom’s shorthand name seems totally divorced from its full name. For example, lead atoms are called, well, lead atoms, but the symbol for a lead atom is Pb, from plumbum, the Latin word for lead. There are also elements and atoms named for human beings. For example, seaborgium is named for Nobel Laureate Glenn T. Seaborg; its shorthand symbol is Sg.

Individual atoms form bonds with other atoms to create clusters of atoms called molecules. To write the name of a molecule — its formula — you write the symbols of the different atoms that the molecule contains and the number of each type of atom right after the symbol. For example, if I write H2O, the formula for the water molecule, you know immediately that a water molecule has two hydrogen atoms and one oxygen atom.

A body cell, the smallest independent unit of a living creature, is a collection of molecules. And you, wonderful reader, are a collection of cells.

Cholesterol builds your gray matter

As French philosopher René Descartes so eloquently wrote in 1637, “I think, therefore I am.” The organ that enables you to think — and therefore, to be — is your brain, a marvelous structure composed primarily of water and fat.

The average human brain weighs about 3 pounds. Up to 78 percent of that weight is water. Some of the weight is protein (8 percent), some is carbohydrates (1 percent), and some is a grab bag of organic and inorganic com- pounds (3 percent). The rest (up to 12 percent) is fat, including — surprise, surprise — cholesterol.

Cholesterol on the brain? You bet. As I explain in the next section, without cholesterol, your brain cells can’t send the messages that power every other organ in your body and, most importantly, make it possible for you to think. To paraphrase Descartes, “Wow!”

Cholesterol revs up your nerve cells

The fact that you have cholesterol in your brain tissue isn’t a new discovery, but the knowledge of what the cholesterol actually does up there is new.

In November 2001, a group of French and German researchers at the Max- Delbruck Center for Molecular Medicine in Berlin reported something extraordinary, so extraordinary that the lead researcher told fellow scientists at a meeting of the Society for Neuroscience, “We were definitely shocked.”

Before getting to the shocking part, take a timeout for a short but important lesson in neurology. About 90 percent of the cells in your brain are non-nerve cells called glial cells. Glial cells aren’t the cells through which brain cells communicate, so they have always seemed sort of blah.

Now comes the shocking part. The guys at Max-Delbruck discovered that glial cells contain cholesterol, which enables them to secrete a molecule that encourages the formation of synapses, teensy junctions in the brain where messages are exchanged among nerve cells. The molecule secreted by the glial cell is called apolipoprotein E (apoE). When the Berlin researchers added plain cholesterol to nerve cells in a laboratory dish, the nerve cells began to form synapses like crazy.

So should you start stuffing yourself with cholesterol-rich foods to jump-start your brain? In a word, no. Your glial cells make all the cholesterol your brain requires. The point of this section is just to let you know what cholesterol is doing up there in your head.

Cholesterol is part of your hormones

What else can one wonder fat do? “What else?” you ask? How about, it helps make you sexy?

Chemically speaking, cholesterol is a sterol, a compound made of hydrogen and oxygen atoms arranged in a series of ring-like structures with chain-like attachments of atoms hanging off the sides. Your body uses cholesterol to synthesize other sterol compounds, such as the adrenal hormone cortisol, the fat-soluble nutrient vitamin D, and — yes, indeed — the male sex hormone, testosterone.

Figure 2-1 shows the structure of the cholesterol molecule, and Figure 2-2 shows the structure of the molecule for testosterone. See how similar they are? Didn’t expect that, did you?

Cholesterol powers up your digestive system

The gallbladder is a small organ that sits atop your small intestine. In pictures of the digestive system, the gallbladder is often colored green because it secretes a greenish liquid called bile or bile acids, digestive compounds based on — you got it — cholesterol.

On their own, fats — including the fats in food — don’t mix with water. Fat molecules and water molecules lack the chemical hooks-and-eyes (the proper electrical charges) needed to form bonds between their molecules. As a result, when you swallow fat-rich foods, the fat floats on top of the watery food and liquid mixture in your stomach, which means that fat-busting digestive enzymes in the mix below can’t reach it. But as fatty food moves through your digestive tract into your small intestine, an intestinal hormone called cholestokinin beeps your gallbladder, signaling it to release bile.

Bile is an emulsifier, a substance that makes it possible for fat to mix with water so you can digest and absorb dietary fats and fat-soluble nutrients such as vitamins A, D, E, and K.

Without cholesterol, you wouldn’t be able to make bile or bile acids. Without bile and bile acids, you wouldn’t be able to absorb fats. Without fats, you wouldn’t be able to manufacture fatty tissue, which cushions your organs, keeps your body warm, and serves as a base for various body chemicals. And that state of affairs isn’t compatible with a healthy, comfortable life. So thank your lucky stars that you have the cholesterol you need to make the bile and bile acids that process fat.

Breaking the Bad News

By now, you may be convinced that everything you’ve ever read about cholesterol is wrong, wrong, wrong. In fact, you may be muttering to yourself, “Hey, where can I get some more of this great stuff?” Well, hold your horses, cowboy. I hate to be the one to break this to you, but cholesterol can be a villain as well as a hero.

Yes, cholesterol protects your cells, maintains your brainpower, helps make hormones and vitamins, and on, and on, and on. But under certain circumstances, it can block your arteries and trigger — Oh no! — a heart attack. It’s all in the lipoproteins. This section focuses on cholesterol’s not-so-good effects on your body.

Cholesterol may endanger your heart

LDLs are the most common fat-and-protein particles in your body. Like their parents, the VLDLs and their cousins the IDLs, LDLs are soft enough to squeeze between the cells of your blood vessel walls, dragging cholesterol into your coronary arteries (the blood vessels leading away from your heart).

Once inside an artery, cholesterol particles may get caught on the infinite number of chinks in the artery wall. Stuck in place, the cholesterol now snags other particles floating by, eventually creating deposits called plaque. In time, the plaque on the artery wall may grow thick enough to block the flow of blood through the blood vessel, or a piece of plaque may break off, triggering the formation of a blood clot that can also block the artery. Either way, the sequence is called a heart attack.

As a general rule, heart docs assume that the more cholesterol you have floating through your bloodstream — especially the “bad” LDL cholesterol — the higher your risk for plaque build-up in your arteries and the higher your risk of a heart attack. In other words, to lower your risk of heart attack, you must lower your cholesterol, particularly those “bad” LDLs.

But this simple equation may not be the solution for every human body.

In December 2007, the results from a clinical trial of the new drug ezetimibe (Zetia) showed that taking the medicine, either alone or in combination with the statin drug simvastatin (Zocor), definitely lowered “bad” cholesterol, but also hastened the buildup of arterial plaque for some of the people in the trial.

In other words, simply lowering their LDLs did not protect these people from a heart attack. Something else, such as an individual tendency to pile up arterial plaque, also seemed to be at work. (Conversely, people with high cholesterol but clear arteries may have the opposite attribute — an inherent ability to resist plaque — that explains the puzzle of why some people with high cholesterol do not have heart attacks.)

You can read more about the ezetimibe trial in Chapter 12, which lays out the facts on various cholesterol-buster meds. Right here, the take-away point is that when you’re talking medicine, never assume that one size — or one theory — fits all.

Cholesterol can clog your brain

This is a very short section because everything you need to know about how cholesterol may be hazardous to your brain can be summed up in one word — ditto.

That’s ditto to what you’ve just read about cholesterol and your coronary arteries. Having high levels of cholesterol may also increase the risk of plaque in a cranial artery. Plaque can block the flow of blood traveling through a cranial artery to your brain, triggering a stroke.

Prevention is another ditto. The preventative steps that you can take in relation to your coronary arteries and your heart can also benefit your cranial arteries and your brain.

Cholesterol can build boulders in your gallbladder

Cholesterol is a building block for the bile you need to digest fats. This side of cholesterol behaves like the good Dr. Jekyll. But every yin has its yang, and the bad Mr. Hyde is gallstones.

A gallstone is a rock-like lump that forms when the normal percentages of fat in bile change so that the fat (in this case cholesterol) clumps in a lump in your gallbladder or in the duct leading from the gallbladder to your intestines. Approximately 80 to 95 percent of all gallstones are made primarily of cholesterol. (The rest are made primarily of calcium.)

According to the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), as many as 42 million Americans have gallstones. Many of the risk factors for cholesterol gallstones are the same as those for heart disease, such as the following:

• Diabetes
• High-cholesterol diet
• Obesity
• Smoking

But here’s an odd fact: Yes, being overweight raises your risk of gallstones, but so does going on a diet and losing weight very rapidly.

When your body is deprived of its normal quota of calories and fat, your liver is likely to increase its natural production of cholesterol (see the “Where cholesterol comes from” section back toward the beginning of this chapter). Sometimes you can’t win for losing, which includes the symptoms, signs, and consequences of gallstones: pain, nausea, belching, vomiting, fever, chills, and, maybe, surgery to remove your gallbladder.

If your doctor recommends yanking out the offending organ, not to worry. Or at least not too much. True, all surgery has potential risks, but modern gallbladder surgery is performed laparoscopically (translation: through very small incisions that heal quickly).

Once the gallbladder is out, you probably won’t notice much change in your ability to eat what you want. Your gallbladder is just a storage bin where bile produced by the liver is parked until your body yells, “Yo! Send down some bile.” After surgery, your liver still produces bile, which still makes its way into the intestine to help you digest fats.

While some people do develop gastric rumbles, okay, diarrhea, after eating a large, very fatty meal, most patients do just fine so long as they stick with food/meals containing moderate amounts of fat. What’s moderate varies from person to person. If you exceed your own personal limit, trust me, you will know.

Tick. Tock.

According to Yasuko Rikihisa, professor of veteri- nary biosciences at Ohio State University, people with high cholesterol may be more susceptible to human granulocytotropic anaplasmosis (HGA), a disease transmitted by Ixodes scapularis (deer tick), the little buggers that spread Lyme disease.

HGA attacks granulocytes, cells the immune system uses to knock out infectious agents such as bacteria. In Rikihisa’s lab, mice with high cholesterol were less able than mice with normal cholesterol levels to fight off HGA.

Should you worry about those mice? Maybe. The United States experiences up to 1,000 cases of HGA a year, but the symptoms of HGA are so similar to those caused by flu that many cases may go undetected. Once diagnosed, HGA can be treated with antibiotics; left untreated, HGA, like flu, may be fatal for those who are very young, very old, or have a weakened immune system. In other words, watch your cholesterol and never ignore a tick bite. But you knew that already, right?

Focusing on Other Blood Baddies

Although cholesterol gets most of the buzz, it isn’t the only substance in your blood that increases your risk of heart disease. Two other problematic com- pounds discussed in this section are homocysteine and triglycerides. The first is an amino acid; the second is a thoroughly useful fat.

Hunting homocysteine

Amino acids are the building blocks of protein. Most amino acids are friendly to your body, but homocysteine is a potentially hostile amino acid released when you digest protein foods. Researchers have conducted about a dozen important homocysteine studies in recent years, and most of the studies have demonstrated a clear link between high homocysteine levels (called hyperhomocysteinemia) and an increased risk of heart attack. The reasons for this connection are still a mystery. The current theory is that homocysteine may chew up cells in the lining of your blood vessels, trigger blood clots, or produce debris that blocks the arteries.

The American Heart Association (AHA) hasn’t yet labeled hyperhomocys- teinemia a major risk factor for cardiovascular disease. But the AHA does re- commend that people who have at least one other known risk factor for heart disease, such as high blood pressure, high cholesterol, smoking, obesity, or a family history of heart disease, attempt to lower their homocysteine level.

How do you lower homocysteine? No problem. The good news is that consuming adequate amounts of the B vitamins — folic acid (also known as folacin or folates), vitamin B6 (also known as pyridoxal, pyridoxine, and pyri- doxamine), and vitamin B12 — efficiently lowers the amount of homocysteine in your blood.

If you’re at high risk, check with your doctor to see how you can include foods high in B vitamins in your diet. Table 2-1 lists the homocysteine fighters and some of the foods you can find them in. It hasn’t been shown, however, that lowering homocysteine levels in the blood reduces the incidence of heart disease.

Tracking triglycerides

Ninety-five percent of the fats in foods are triglycerides, compounds that contain one molecule of glycerin and three (tri) molecules of fatty acids. Triglycerides are also the most common fats in your body. You use them to

• Build adipose (fatty tissue)
• Build cholesterol
• Fuel your energy

Chapter 5 has a complete definition of the different kinds of fats and fatty acids in your food. For the moment, just take my word for the fact that triglycerides are made of one unit of glycerol and three fatty acids.

Glycerol is a small, water-soluble carbohydrate that carries fats through blood; fatty acids are chains of carbon atoms with hydrogen atoms attached.

You get some triglycerides from food. You also manufacture them in your liver using carbohydrates, alcohol, and some of the cholesterol in food. Either way, high levels of triglycerides are a risk factor for heart disease because, like cholesterol, triglycerides — which travel in lipoproteins — can rough up the lining of your arteries, which enables floating particles to get stuck and begin to build plaque that can clog the artery, leading to a heart attack.

How high is high? Check out Chapter 3 where you can also find a whole bunch of tests designed to rate your risk of heart disease.

Clearly, you want to keep your triglycerides in the normal range, which means watching what you eat. But here’s an interesting fact: A diet that’s very low in fat and very high in carbohydrate foods, such as veggies, fruits, and grains — the quintessential “good heart” diet — may actually raise your triglycerides rather than lower them.

To lower your triglycerides, the AHA recommends eating a reasonable amount of polyunsaturated fats. No kidding. Read all about fats in Chapter 5. So much reading, so little time.

Warning! Heart Attack in Progress!

You say, “Heart attack.” Your doctor says, “Myocardial infarction.” Either way, heart attacks occur when the blood supply to your heart muscle is suddenly reduced or completely shut off. This reduction in blood supply is most commonly caused by a piece of plaque that breaks off from an artery wall, triggering the formation of a blood clot. That is why a coronary artery filled with a lesser amount of soft plaque (which can break off easily) is more dangerous than an artery filled with hard plaque.

The damage caused by a heart attack is due directly to how long the artery is blocked and how long your heart muscle and your brain don’t get the oxygen they need. Clearly, the faster a heart attack victim gets medical attention, the better his or her chances of surviving with minimal damage.

Knowing the symptoms

To get help, you need to recognize the classic symptoms of a heart attack:

• Pressure or pain in the center of your chest that lasts longer than a few minutes. Some people describe the pain as feeling like an elephant is sitting on their chests.
• Pain that starts in your chest and spreads out to your shoulders, up your neck, to your jaw, or down your arms.
• Pain in your chest plus

• Feelings of lightheadedness

• Nausea or heavy sweating

• Shortness of breath

• All of these symptoms, all at once

This list sounds definitive, but it isn’t. Diagnosing a heart attack is tricky business because any one of the symptoms listed above — on its own, without any pain — may also be a heart attack alert.

Sometimes, simple lightheadedness (what an awkward word) or nausea is the body’s way of saying, “Listen up! We’re in trouble here!” This is especially true for women who, as a group, are likely to experience much less severe heart attack symptoms than men do. The lesson? Better safe than sorry.

Chest pain or a feeling of “tightness” (sometimes described as a rubber band tightening around your chest) or pressure (sometimes described as “an elephant sitting on your chest”) that comes on with exertion such as walking up a slight hill, especially in cold weather, or climbing an ordinary flight of stairs that hadn’t caused problems in the past is a suspicious symptom. You should see your doctor or go to the emergency room immediately lest your symptoms signal an imminent heart attack.

As soon as you suspect that someone is having a heart attack, the American Heart Association recommends taking (or giving) one 325-milligram aspirin. The aspirin is a blood thinner. According to the AHA, taking the aspirin at the onset of symptoms lowers the risk of dying by 23 percent. Would you believe that only 20 to 40 percent of all heart attack victims follow this simple recommendation that the AHA insists could save 10,000 lives a year?

Never, ever ignore signs of a problem. Don’t panic, but do move quickly. Dial 911 or your local emergency medical service (EMS) to summon an ambulance staffed by EMS technicians who are trained to treat heart attack victims.

The ambulance is likely to get to you faster than you can get to the hospital, especially if you’re the one having the heart attack and would have to drive yourself.

Yes, yes, yes. If the hospital is right across the street, you should just go. But will you go? Will your friend? Maybe not. According to the AHA, denial is common. Many heart attack victims refuse to believe that they’re having a heart attack. That attitude can be a killer, robbing you (or your friend) of precious time.

Never ignore signs of a heart attack. If you’re with someone who’s having symptoms, don’t take no for an answer. Your friend may protest now, but she’ll thank you later when she’s still alive.

Becoming a coronary lifeguard

One type of heart attack is due to a cholesterol-related blockage of an artery. A second type of heart attack is cardiac arrest, a sudden interruption in the heartbeat that effectively stops the circulation of blood and oxygen through- out the body, leading fairly quickly to the phenomenon called sudden death.

The American Heart Association estimates that more than half the people who experience cardiac arrest outside a hospital setting can be saved if someone in the immediate vicinity knows how to perform cardiopulmonary resuscitation, commonly called CPR.

CPR uses physical compression of the patient’s chest along with breathing into his mouth to restart the heart while providing desperately needed oxygen. If you don’t already know CPR, get familiar with it. The life you save won’t be your own — even if you’re so flexible that you can wrap your legs behind your ears, you can’t do CPR on yourself — but your skill may someday save someone near and dear to you.

The following sections cover three ways to discover how to perform CPR.

Join a CPR class

The absolutely best way to master CPR is to take classes from a live instruc- tor in a room with live people. You practice on an inflatable dummy and not the person standing next to you, but being in class gives you the opportunity to ask questions that can help perfect your technique.

To find classes in your area, do an Internet search for the American Heart Association. After you reach the home page, slide your mouse down the left side of the page and click “Local info.” Then click the name of your state to get the phone number for your local AHA chapter.

Study CPR at home

You can study CPR with the American Heart Association’s CPR Anytime kit. Check out www.cpranytime.org online and order CPR Anytime Today! You can choose between adult and child models, and the $29.95 kit includes a CPR Anytime Skills Practice DVD, a CPR for Family and Friends resource booklet, and — among other things — your very own personal inflatable manikin (medical dummy).

Read about CPR

In a pinch, until you can get to a class or order a DVD, one excellent online site for CPR techniques is Learn CPR. The URL address is www.depts. Washington.edu/learncpr. This site, supported by the University of Washington School of Medicine, is a real treasure with pictures and diagrams and FAQs and facts and links and quizzes and CPR history.

The site is a great place to start, but eventually you need to polish your technique with a live instructor.