Rating Your Cholesterol-Related Risk: Running through the tests to count your cholesterol and check your arteries, Explaining why your cholesterol level is where it is, Adapting adult cholesterol goals for kids, Explaining how cholesterol’s effects change with age and Figuring your own personal chance for heart attack

Rating Your Cholesterol-Related Risk

In This Chapter

� Running through the tests to count your cholesterol and check your arteries

� Explaining why your cholesterol level is where it is

� Adapting adult cholesterol goals for kids

� Explaining how cholesterol’s effects change with age

� Figuring your own personal chance for heart attack

This chapter is totally straightforward. The information here has just one purpose: to provide answers to three basic questions and make it possible for you to evaluate your own cholesterol-related risk of heart disease (the whole range of heart problems) and heart attack (the 800-pound gorilla). As for those three basic questions, here they are:

•  Question #1: What’s the real definition of high cholesterol?
•  Question #2: Who’s likely to have high cholesterol?
•  Question #3: Are you at risk for high cholesterol?

My editors remind me that I should tell you to grab a pencil before you start reading this chapter because I include several tests for you to fill out at the end. Meanwhile, avanti! (That’s Italian for, “Let’s get to it!”)

Categorizing Cholesterol as a Risk Factor

Generally, medical risk factors fit into one of three basic categories:

� Risk factors you can’t control

� Risk factors you can control

� Risk factors whose effects you can lessen but not entirely eliminate

High cholesterol is an interesting risk factor because it fits into all three of these categories. Take a look at the evidence:

� Your genes determine how much cholesterol your body produces naturally, so high cholesterol may be a risk factor you can’t control.

� You can take one of several different cholesterol-lowering drugs designed to pull your cholesterol down to safe levels, so high cholesterol may be a risk factor you can control. (For more about cholesterol-lowering drugs, check out Chapter 12.)

� You can change your diet, lose weight, and exercise to increase your “good” cholesterol, high-density lipoproteins (HDLs), while lowering your “bad” cholesterol, low-density lipoproteins (LDLs), so high cholesterol (or at least high “bad” cholesterol) may be a risk factor whose effects you can soften.

My point? Although high cholesterol is an important risk factor for heart disease — and decreasing your longevity — you have a leading role to play in controlling the risk. What you eat, how you spend your leisure time, and how you work with your doctor have much to do with determining where your rank is on the cholesterol scale. Interesting proposition, eh?

Adding Up Your Basic Cholesterol Numbers

Before you decide what to do about your cholesterol, you need to know how much cholesterol you actually have. So get up, march over to your doctor’s office, and hold out your arm so your doctor can stick a hollow needle into the vein in the crook of your elbow and draw about 20 milliliters (ml) of bright, red blood. Then when you go home, the little glass tube holding your blood goes off to a medical laboratory where a technician counts the cholesterol particles. The results you get back look like this: 225 mg/dL. Translation: You have 225 milligrams of total cholesterol in every deciliter (1⁄10 liter) of blood.

But these numbers don’t paint the whole picture. The figures for your low- density lipoproteins (VLDLs, IDLs, LDLs) and high-density lipoproteins (HDLs) are still missing. Shaky on the details? You can read all about these little fellas in Chapter 2, which explains that lipoproteins are fat-and-protein particles that carry cholesterol into your arteries (LDLs) or out of your body (HDLs), which is why HDLs are “good” and some of the LDLs are “bad.”

The problem with simple finger-stick tests such as those found in cholesterol home-testing kits is that they only measure total cholesterol levels — no HDLs and no LDLs. An incomplete result (total cholesterol alone) can scare you to death if it shows you have high total cholesterol without letting you know that you — lucky girl! lucky boy! — also have high HDLs. The finger- stick test can also provide false reassurance if it shows a low total cholesterol level without letting you know that your LDLs are also very low.

Now that you know all this and have an accurate, complete doctor’s report in hand, what do the results say about you? How can you tell if the numbers are high, low, or in-between?

Defining Higher, Lower, Medium — and Just Right

The information you need to grade your cholesterol levels comes from the usual suspects — I mean the usual experts: the National Cholesterol Education Program (NCEP) at the National Heart, Lung, and Blood Institute (NHLBI), an arm of the National Institutes of Health (NIH).

In 2001, the NCEP issued a report called ATP III, short for The Third Report of the Expert Panel on the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. In this report, the NCEP said:

� A total cholesterol level higher than 240 mg/dL translates into a “high risk” for heart disease.

� A total cholesterol level between 200 and 239 mg/dL means there’s a “moderate risk” for heart disease.

� A total cholesterol level below 200 mg/dL is “desirable.”

Regardless of total cholesterol levels, the risk of heart attack is highest among men whose HDLs are lower than 37 mg/dL and women whose HDLs are lower than 47 mg/dL. Conversely, the risk of heart attack is lowest among men whose HDLs are higher than 53 mg/dL and women whose HDLs are higher than 60 mg/dL.

Table 3-1 shows the current descriptions of various levels of total cholesterol, LDL cholesterol, and HDL cholesterol.

But in July 2004, just when everyone thought they had the numbers down pat, the experts at the NCEP added a footnote: People at high risk should push their LDLs down below 100 mg/dL, a task that requires taking one or more of the cholesterol-busting drugs described in Chapter 12.

Are these recommendations final? Probably not. Experience shows that precise numbers for healthful cholesterol levels can change at any moment. What doesn’t change are the basics: Higher HDLs are good. Lower LDLs are good. Sooner or later, like Goldilocks and the Three Bears, someone will figure out exactly how low and how high is just right.

Blood simple

Blood circulates through a system of vessels called arteries and veins. Arteries carry blood away from the heart; veins carry blood back to the heart. The average human body has about 5 quarts of blood. Large people may have slightly more; small people may have slightly less. Every 60 seconds, about 1⁄5 quart of blood flows out of your heart through your coronary arteries. Sixty seconds after that, the blood zips through your entire circulatory system and heads back to your heart.

The life span of one red blood cell is about 120 days for a man and about 14 days less for a woman. Men have more red blood cells — about 4.5 to 6.2 million per cubic microliter of blood compared to 4 to 5.5 million for women. Because males have more red blood cells, they also have higher values of hemoglobin, the pigment in red blood cells that carries oxygen throughout the body. They also have higher levels of iron, an important element in hemoglobin.

White blood cells play a primary role in your immune system as avengers that zero in on invaders, such as bacteria, to chew them up and spit them out. The normal number of white blood cells is exactly the same for men and women — 4,100 to 10,900 per microliter of blood.

Blood is a vehicle for nutrients, medications, and other circulating particles such as — what a surprise — the lipoproteins that carry cholesterol. By the way, the blood for a cholesterol test always comes from a vein, not an artery. Blood from a vein is easier and safer to obtain, and it’s a representative sample of what’s in your body. And yes, clenching your fist does make your vein pop up so it’s easier to puncture.

Listing Other Risk Factors

According to the American Heart Association, as you read this chapter an estimated 105,200,000 Americans have total cholesterol levels higher than 200 mg/dL, putting them all into the borderline high category; 36.6 million of those have high total cholesterol levels above 240 mg/dL. Who are all these people? What puts them into these special high-risk categories?

Age and gender

Among people younger than 50, men are more likely to have high cholesterol. After age 50, women edge into the lead. Either way, a woman’s blood vessels are more elastic than a man’s blood vessels. As a result, women have a little more protection than men throughout their lives against a blood clot that may block their blood vessels and trigger a heart attack.

Pregnancy — strictly a female activity — lowers a woman’s levels of good HDLs, but a study of 1,051 women conducted by researchers at Kaiser Permanente in Oakland, California, showed that nursing the newborn for longer than three months is protective and reduces the decline of HDLs.

Counting kids’ cholesterol

The cholesterol levels shown in Table 3-1 earlier in this chapter are for grown-ups. (Translation: Adults are people between the ages of 20 and 74.) The recommendations for children are a different story. A child’s total cholesterol level rises slowly from age 2 to age 10 and then begins to rise and fall in a gender-related pattern. According to University of Texas (Houston) researcher Darwin R. Labarthe, a girl’s cholesterol level is likely to peak around age 9, a boy’s around age 16. Conversely, a girl’s cholesterol level goes down for a while around age 16; a boy’s cholesterol goes down for a while around age 17.

All adults should be tested at least once to establish a baseline cholesterol reading; if the level is higher than it should be, more frequent testing may be required. But as of this writing, the American Academy of Pediatrics (AAP) only recommends cholesterol testing for a relatively small number of children:

� Kids with a parent or grandparent who had a heart attack, suffered a stroke, or received a diagnosis of coronary artery disease before age 55

� Children whose parents have high cholesterol (above 240 mg/dL)

The recommendations of the American Heart Association (AHA) are similar to those of the AAP. The AHA suggests only testing children older than the age of 2 who have a family history of coronary artery disease — a parent or a grandparent with high cholesterol or a history of heart disease.

Table 3-2 shows the AHA-recommended cholesterol levels for children and adolescents between the ages of 2 and 19.

Lower isn’t always safer

You get your blood test back from your doctor and — wonder of wonders — your cholesterol has dropped! Time to celebrate? Not necessarily.

A steady, gradual decrease in cholesterol due to a cholesterol-control diet (see Chapter 4) or one of the new cholesterol-lowering medications (see Chapter 12) is great. But a sudden, unexplained decline in total cholesterol — hypocholesterolemia in doctor-speak — may be a pre-clinical sign (something that shows up before disease is evident) of malnutrition, an overactive thyroid, cirrhosis of the liver, certain forms of cancer, or genetic mutations. All of these factors can drop total cholesterol levels to the basement (<100 mg/dL).

And get this: According to a 2007 report on a 2,000-person study at the Aging Research Center at the Karolinska Institute in Stockholm, Sweden, a sudden unexplained drop in cholesterol levels at mid-life, around age 50, may be a risk factor for cognitive problems (translation: dementia) later on. Sometimes it seems you can’t win for losing!

Gilding the golden years

Pssst! Come over here. I have a secret to share with you. As people turn 70 and sail into their eighth decade, their cholesterol level becomes a less important predictor of death by heart disease.

What should you make of this?

� Perhaps people who die of cholesterol-induced coronary artery disease simply check out earlier in life. After all, cholesterol is often described as a risk factor for an early heart attack.

� Perhaps, as you age, your cholesterol level becomes less important than your overall health.

� Perhaps total cholesterol levels aren’t as important as LDL and HDL levels, which aren’t reflected in studies that show the decreasing importance of cholesterol levels as a predictor of death by heart disease as people age.

Should you rush out to tell grandma and grandpa to toss out that salad and start gorging on high-fat, high-cholesterol foods? Not yet. But you can send them a postcard with this comment from the American Heart Association: “The issue of cholesterol levels in the elderly is still unclear.”

Ethnicity

The cholesterol stats on ethnic groups in the United States are, to put it mildly, incomplete. Many stats exist for non-Hispanic Blacks, non-Hispanic Whites, and Mexican Americans. Scattered statistics exist for Native Americans, but there are no numbers for other ethnic groupings. As a result, given the variety of human beings in the U.S., it’s hard to figure out exactly which ethnic groups are most at risk of high cholesterol.

Nonetheless, Table 3-3, Table 3-4, and Table 3-5 provide useful — though, repeat, incomplete — guides. The tables show the percentage of 99,900,000 Americans (48,400,000 men and 51,500,000 women) age 20 and older whose cholesterol, LDL, or HDL levels put them at increased risk of heart disease in 2003.

Yes, this study predates the American Heart Association estimate of 105,200,000 adults with cholesterol levels above 200 mg/dL cited above (see “Listing Other Risk Factors” earlier in this chapter). That’s life in statistics-land.

Evaluating Your Own Risk Factors File

Now that you know what’s high and what’s low in the wide world of choles- terol and who’s likely to have high cholesterol and who isn’t, you can turn your attention to the specifics for one person: you. This section helps you figure out your very own personal risk of having high cholesterol. Begin at the beginning: your family.

When the “A” list rates a “B”

According to Ronald M. Krauss of the University of California (Berkeley), not everyone is created equal when it comes to LDL (the “bad” cholesterol) production. First in 2001 and then in follow- up studies in 2004 and 2005, Krauss proposed that genes tend to divide people into two groups of LDL-makers.

Some people — the A list — make big, bouncy LDLs. Others — the B list — make smaller, denser LDLs. (Need to know more about density — as in low-density lipoproteins? See Chapter 2.)

The B people tend to get better results when they go on low-fat, carb-based diets to reduce over- all cholesterol levels, dropping levels of both the big LDLs and the little LDLs, which results in an overall reduction in LDL cholesterol. The A people lose a lot of big, non-threatening LDLs, but their overall level of small, dense LDLs (the bad guys) rises. The catch is that nobody has yet identified the gene that determines whether you are an A or a B. Stay tuned.

The family

Your family history says a lot about your future. Your genes are a family trait, so if your first-degree relatives — father, mother, brothers, and sisters — have high cholesterol, you may too. If your father or brother had a heart attack when he was younger than 55 or your mother or sister had a heart attack before she turned 65, you need to watch your other risk factors.

But, all things being relative, your relatives’ cholesterol levels may not mirror yours. In my family, my mother has high cholesterol, and so do I. My father had low cholesterol, and so does my sister who, I might point out, also got the good nails and curly hair. Life can be sooooooo unfair!

You, yourself, and you

Some medical conditions either affect your risk of having high cholesterol or intensify cholesterol’s bad effects. If you have one of these conditions, you probably already know about the risks. But it never hurts to be sure, so here’s the scoop.

High blood pressure (hypertension)

Blood pressure is the force exerted by your heart when it pushes blood out into your arteries. When your arteries are clear and clean, your heart has an easy job: The blood flows easily into the arteries, and your blood pressure is normal.

But if your arteries have been narrowed — perhaps by cholesterol plaque buildup on the inside walls — your heart must contract more strongly and push harder to get the blood out into the vessel. As a result, blood is pushed out of the heart at higher-than-normal pressure. The high-pressure stream of blood bouncing against arterial walls can worsen the damage caused by cholesterol and plaque. (The damage is called arteriosclerosis or “hardening of the arteries.”)

How can you tell if you have high blood pressure? Look at your blood pressure reading. You’ll see two numbers written like this: 130/90 or 130/90 mm/Hg. The first number, the systolic reading, is the pressure exerted by your heart when it contracts (beats) to pump out blood. The second number, the diastolic reading, is the force exerted by your heart between beats.

The letters mm/Hg stand for millimeters/mercury. (Hg is the chemical symbol for mercury.) These terms are part of the reading because your doctor measures blood pressure by how high (in millimeters) mercury rises on the little gauge attached to the blood pressure cuff wrapped around your arm. Reading the gauge is similar to reading the temperature on a thermometer as the mercury inside the thermometer’s glass tube rises or falls when warmed or cooled.

For years and years, doctors considered an adult’s blood pressure normal when the systolic reading was lower than 130 mm/Hg and the diastolic reading was lower than 90 mm/Hg (130/90), but the newest numbers from the experts at the National Institutes of Health now put normal at 120/80. And as with cholesterol, there are varying degrees of normal when it comes to describing blood pressure.

Table 3-6 shows the most recent categorization of blood-pressure levels from the National Institutes of Health, starting with optimal (translation: the best possible result), and running up (or down) through normal and high normal to the various stages of hypertension (higher than high, and potentially hazardous to your health).

If you already have high blood pressure, your doctor has no doubt told you about the basic strategies you can use to control it:

� Lose weight.

� Change your diet.

� Exercise.

� Take a pill.

Strangely enough, these steps sound just like the ways to control cholesterol. Think of them as a medical two-for-one coupon!

Diabetes

People with diabetes often have frighteningly high cholesterol levels. I’m not talking your piddling 240 mg/dL reading here. No, what I mean is a cholesterol level hovering around — hold your hat — 500 mg/dL.

People with diabetes also have high blood-levels of insulin, the hormone pro- duced by the pancreas and used to digest food. Yes, I know, you may have thought that people with diabetes have low levels of insulin. Actually, people with diabetes do produce less insulin than healthy people do, but they also have a problem using insulin to digest food, so the unused insulin continues to circulate in their blood until it is excreted from the body.

Type 2 diabetics are usually overweight adults. Being overweight leads to insulin resistance. Insulin resistance means that the cells in the body require a greater amount of insulin to push the glucose (sugar) into the cells so it can be used for energy. This is why they have higher levels of circulating insulin.

The best way to control diabetes? Lose weight, change your diet, exercise, and take your medicine. Good ways to control cholesterol? Lose weight (Chapter 7), change your diet (Chapter 4), and — sometimes — take your medicine (Chapter 12). Are you beginning to see a pattern here?

Previous heart attack

If you’ve already had a heart attack, you know your cholesterol numbers, and your doctor has probably already prescribed one of the cholesterol-lowering medications I talk about in Chapter 12. No need to dwell on this one.

Obesity

No, you don’t have to be rail thin. No, you don’t have to spend your life on

a diet. Your body was created to be at a good weight for your size and shape. This weight may not be the same for you as for your best friend or that model over there in the who-is-she-kidding slinky dress or the painted-on swim trunks. Just turn to Chapter 7, which explains exactly how excess pounds raise your cholesterol level and how staying in reasonable shape or losing as few as 3 to 5 pounds can lower your cholesterol.

Lifestyle

Are you a couch potato? Do you smoke? Shame on you! Don’t wait another minute — turn to Chapters 8 and 9. Read about the hazards of inactivity and smoking. You can decide to change these risk factors by the time you finish reading this sentence. So do it.

Heart Attack Risk Factors at a Glance

High LDLs and low HDLs are only two of the heart attack risk factors on the list compiled by the National Cholesterol Education Project, a group with more statistical information than you can shake a stick at. (I have no idea why anyone would want to shake a stick at these stats — or even what the saying means. Inquiring minds want to know!) Table 3-7 gives you a quick rundown on a whole bunch of risk factors. What a handy guide!

Cultural math: When 13 = 4

Westerners often turn shivery when they see the number 13. The number that spooks some Asians is 4. In Mandarin, Cantonese, and Japanese, the word for the number four sounds exactly like the word for death, a linguistic oddity that may have serious implications for some Asian-American heart attack victims.

A recent report in the British Medical Journal compared death statistics from 1973 to 1998 for more than 200,000 Asian Americans and 47 mil- lion White Americans living in the United States. The data shows that Chinese-American and Japanese-American heart attack victims who die of their heart disease are most likely to die on the fourth day of the month.

The highest number of fourth-day deaths occurred among hospitalized heart attack victims (versus people who had a heart attack at home or somewhere else). One possible conclusion is that the power of suggestion may play an important role in deciding whether a person survives a heart attack. Another possible conclusion is that being able to leave the hospital quickly after a heart attack increases the chances of survival.

By the way, there was no similar link between the 13th day of the month and the incidence of death among non-Asian heart attack patients, perhaps because the word thirteen doesn’t sound like death.

Checking for Plaque Buildup

A cholesterol blood test is definitely valuable because it tells you exactly where you stand, cholesterol-wise. But the test doesn’t tell you whether you already have plaque — the technical term for cholesterol deposits — in your arteries or whether the plaque deposits are serious enough to set a heart attack in motion. That’s a job for other tests specifically designed to determine the condition of your arteries. You can group these tests into two handy categories: blood tests and physical tests.

Blood tests

Blood tests are simple to do. Just stick out your arm and . . . well, if you’ve had your cholesterol tested, you know the drill.

Catching C-reactive proteins

C-reactive proteins (CRP) are substances released into your bloodstream when tissues, including the blood vessels leading to your heart, are damaged and inflamed. As a result, measuring levels of cardiac CRP in your blood can serve as a guide to the condition of your arteries and predict your risk of heart attack or stroke.

In 1998, a team of researchers from Brigham and Women’s Hospital and Harvard Medical School rated the risks linked to CRP levels in blood samples from nearly 40,000 healthy, post-menopausal female nurses participating in the legendary Nurses’ Health Study. The result? Women with the highest levels of CRP were five times more likely than women with very low levels to develop cardiovascular disease and seven times more likely to have a heart attack or stroke.

One year earlier, the Boston team noted similar results in an ongoing study of 22,000 healthy male doctors. These results led them to conclude that using “high-sensitivity” or “ultrasensitive” tests to measure cardiac CRP is a good way to “predict the risk of future heart attack and stroke events.” (Check out Chapter 8 for info on the connection between exercise and reducing CRP levels.)

Measuring MPO

White blood cells are the body’s natural defense against inflammation and infection. When the white blood cells sense trouble, they release myeloperoxidase (MPO), a protein that can knock the heck out of the bugs causing the inflammation and infection.

But MPO may also irritate arteries and short-circuit natural body chemicals that keep “bad” cholesterol particles from glomming on to artery walls, thus contributing to the buildup of plaque inside your blood vessels. In July 2007, the Journal of the American College of Cardiology published data from a study of more than 1,000 healthy Brits showing that, over the years, those with the highest blood levels of MPO had the highest risk of coronary artery disease (CAD).

In other words, high blood levels of MPO may signal artery trouble ahead, even when other indicators, such as LDL levels, are fine. Naturally, the researchers want to see more studies before they stick an MPO test onto your yearly lab tests, but, as one of the researchers said, “MPO looks like a ‘keeper’ that will one day become part of clinical care.”

Many insurance companies, including Medicare, may not pay for CRP or MPO blood tests because they argue that if you have elevated levels, you need to make all the necessary lifestyle changes (lose weight, treat high blood pressure, stop smoking, eat a healthy diet, and so on). You should be doing this anyway! However, sometimes demonstrating to people that their risk of a heart attack in the next five years is great can stimulate them to become more serious about making lifestyle changes.

Physical tests

You don’t stick out your arm for these tests; you warm up the muscles on treadmills and other such devices.

Stress tests

For a simple stress test, your doctor sticks electrodes on various parts of your anatomy, mainly your upper torso, and reads the results as you march on a treadmill or push the pedals on a stationary bike . . . No, no, no — come back. Electrodes aren’t needles. They’re round, flat gizmos that are “pasted” on to you with sticky fluid. The electrodes transmit electrical impulses to a machine. The machine then translates the impulses into numerical measurements of the flow of blood through your cardiovascular system as you do the treadmill or bicycle thing.

Sometimes a simple stress test delivers false positives (suggesting you have heart disease when you don’t) or false negatives (suggesting you’re risk-free when you’re not). For more accurate results, your doctor relies on a thallium stress test or sestamibi stress test.

The thallium or sestamibi stress test begins with an injection containing radioactive thallium or sestamibi. After the shot, your doctor asks you to wait for about three hours while the radioactive substance circulates through your blood vessels. Then you get fitted with electrodes, climb on the tread- mill or bike, and your doctor monitors your blood flow via those electrodes. Next you lie on a table while a special low-dose X-ray machine tracks the radioactive substance as it flows through your heart and blood vessels. As you can imagine, trouble spots — a narrowing here and buildup there — are clearly visible.

By the way, if you have a medical condition, such as arthritis, that makes it difficult for you to walk on the treadmill or ride the bike, your doctor can use a special medication called persantium, rather than exercise, to speed up your heartbeat and blood flow.

ECBT

No, electron-beam-computed tomography (ECBT), sometimes called ultrafast CT, isn’t the machine that beams Captain Kirk up to the Enterprise. It’s an injection-free CAT scan that provides snapshots of your heart, lungs, and coronary arteries to uncover the presence of calcium deposits, a warning sign of plaque buildup in your arteries.

The ECBT is about seven times faster than a conventional CAT scan. The test, which takes about five minutes to run, is a super way to catch plaque problems very early or (think positively) to show that you’re plaque-free. Unfortunately, the test costs $300 to $500, and although doctors consider it basic medicine, some insurance plans haven’t yet adopted this view. Bummer.

Angiogram

Having an angiogram isn’t an everyday walk in the medical park. This proce- dure is reserved for people with chest pain or other signs of an imminent heart attack.

To perform the test, your cardiologist or radiologist (by this time, you’re way past the primary-care-physician stage) inserts a very small tube called a catheter into an artery, sends dye through the tube into your bloodstream, and watches an X-ray monitor to see how freely the dye flows. If the dye sud- denly slows or stops, blocked by a clot or narrowed area, your doctor may perform immediate angioplasty, the surgical procedure that removes the blockage and clears the blood vessel. In most cases, after clearing the vessel, the surgeon inserts a stent — a tiny spring — into the artery to hold it open, hopefully forever. The stent is designed to prevent restenosis, the technical term for blocking an artery after it has been cleared out. If the artery is blocked again, the treatment is a new angioplasty and a new stent.

In order to be able to do an angioplasty, the blockage must not be too far down the coronary artery or else the balloon won’t be able to fit in there. If you have multiple blocked arteries or an angioplasty can’t be performed, a cardiac surgeon can perform coronary bypass surgery whereby he takes arteries from one place in your body, such as the internal mammary arteries, and attaches them to your coronary circulation.

I certainly hope you never need an angiogram. But, if you do, the good news is that it can save your life and keep you alive for years and years to come, which gives you plenty of time to work on controlling your cholesterol.

Calculating Your Heart Attack Risk

Now you know all there is to know about the risk factors associated with high cholesterol and your risk of having high cholesterol. In this section, you can use all the info you’ve picked up to calculate your personal risk of having a heart attack in the next ten years.

The NCEP calculator

Luckily, you don’t have to be a calculus whiz to do the math. The National Cholesterol Education Project has created an interactive “Risk Assessment Tool for Estimating Your Ten-Year Risk of Having A Heart Attack.” You can find this tool at the following Web site: http://hp2010.nhlbihin.net/ atpiii/calculator.asp?usertype=pub.

On the online form, type in the appropriate numbers, click the proper boxes, and hit the appropriate button (the one labeled “Calculate Your Ten-Year Risk”). What you get back may surprise you. For example, my total cholesterol is high, but my HDLs are also high. My blood pressure is normal, and I haven’t smoked in years, so the calculator puts my ten-year risk of heart attack at 5 percent (meaning 5 of every 100 persons with my particular numbers will experience a heart attack in the next ten years).

Try it. You, too, may be pleasantly surprised at the answer. On the other hand, if your number is higher than you want, move on to the next section, a calculator with a point system.

A second numbers game

The multi-part Risk Predictor Score Sheet created by the National Heart, Lung, and Blood Institute, a division of the National Institutes of Health (NHLBI/NIH, for short), calculates the ten-year risk of heart attack by assigning specific points for the following six specific risk factors:

� Age

� Total cholesterol

� HDL cholesterol

� Blood pressure

� Diabetes

� Smoking

Because men and women have different bodies and, thus, different levels of risk, there are two score sheets based on gender:

� Women: www.nhlbi.nih.gov/about/framingham/risktwom.pdf

� Men: www.aafp.org/fpm/20040100/coronarydiseaserisk_ men.pdf

You can simply grab a pencil and walk through the following steps, which are as simple as one, two, three, four . . . or, more accurately, Table 3-8 all the way up through Table 3-12.

Follow these steps:

1. Score yourself from the following five tables. Yup. This is where the pencil pushing starts.

2. Add up your scores from Table 3-7, Table 3-8, Table 3-9, Table 3-10, Table 3-11, and Table 3-12 to get your total score.

Your total score:

3. Check your total against Table 3-13, which estimates your risk for heart disease in the next ten years due to blocked arteries.

For example, a man with a total point score of 9 has a 20 percent risk of heart attack in the next ten years. With a point score of 14 — where the count for men stops — the odds of his having a heart attack in the next ten years zoom all the way up to 53 percent. For a woman, the equivalent risks are 8 percent and 19 percent.

Read More

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.

Read More

Mapping the Heart Land:Picturing your heart,Quantifying heart disease and tracking the stats on heart attacks and Setting a sensible strategy to cut your personal risk.

Mapping the Heart Land

Heart disease is America’s number one health killer; it’s ahead of every type of cancer combined and every infectious and degenerative disease. Heart attack is the most common form of heart disease, and one significant risk factor for heart attack is high cholesterol or, more specifically, a high level of certain kinds of low-density lipoproteins (LDLs) — the “bad” fat and protein particles that ferry cholesterol into your arteries.

If you already know all this introductory stuff, feel free to skip Chapter 1 and head right into Chapter 2 where I describe cholesterol’s dual nature (yes, cholesterol has two sides).

But, then again, this chapter does lay out a statistical picture of heart disease and heart attack and explain the role cholesterol plays in placing you at risk. In fact, come to think of it, this chapter is a darn good intro to Controlling Cholesterol For Dummies, 2nd Edition.

No surprise there!

Ladies and Gentlemen, Meet Your Heart

Your heart is a pretty spectacular organ — a four-chambered, hollow muscle right smack in the middle of your chest. The heart’s job is to pump the blood that carries life-giving oxygen and other nutrients to every body tissue. To show how this works, the clever For Dummies artists have drawn a cross section of your heart in Figure 1-1 tracing the path of blood flowing in and out and in and out and in . . . you get the idea.

Every second of every minute of every hour of every day, blood flows out from your heart to carry oxygen and other nutrients to every tissue and organ in your body, and then comes back to your heart to pick up more oxygen and nutrients. In other words, blood circulates, which is why your heart and the vessels through which blood travels are called the circulatory system.

The best way to explain this process is to begin at the beginning, the point at which blood flows back from your body, into your heart:

1. The blood enters your heart from the superior vena cava, a large vein that opens into the right atrium, the first chamber of your heart.

Yes, the vena cava and the right atrium are on the left side of the picture above. In this picture, you’re looking at the front of the heart as it sits in the chest of the person to whom it belongs. If he were to turn around so that you were looking at him from the back, the vena cava and the right atrium would be in the correct position, on the right side of his body. Got it? Good. Onward.

Naming the blood vessels

Blood vessels are grouped according to the job they perform in your body, which means they’re grouped in terms of whether they carry blood to your heart or away from your heart. This list explains how the groupings work:

� Veins: Blood vessels that carry blood toward your heart. The word vein comes from vena, the Latin word for hollow.

� Venules: Small veins.

� Capillaries: Teensy, little veins that connect arteries to veins right under the skin. When blood flows into your capillaries, the red liquid under the skin gives you a rosy glow — a blush.

� Arteries: Blood vessels that carry blood away from your heart. The word artery comes from arteria, the Latin word for windpipe.

� Arterioles: Very small arteries.

I have no idea why the person who named the blood vessels picked a word that means hollow for veins and a word that means windpipe for arteries. If it were up to me, I would’ve used a word that means “bring to” for veins, and a word that means “go away from” for arteries.

In fact, the words afferent (from the Latin ad = toward and ferro = carry) and efferent (ferro plus the Latin ex = away) are used to describe, respectively, nerves that carry impulses to or away from the central nervous system. Maybe whoever named the blood vessels picked veins and arteries because afferent and efferent were already taken. Works for me.

2. From the right atrium, blood spills down through a one-way “trapdoor” called the tricuspid valve and into the right ventricle.

3. When the right ventricle contracts (squeezes together), the blood is sent out of your heart through the pulmonary artery and into your lungs where it picks up a plentiful supply of oxygen.

4. The newly oxygenated blood flows back into your heart through the

pulmonary vein into the left atrium.

5. Then the blood spills down through a second one-way trapdoor called the mitral valve and into the left ventricle.

6. When the left ventricle contracts, blood is pushed up through the large artery called the aorta and out into your body.

In real life, as opposed to a drawing, the right atrium and the left atrium receive blood simultaneously from the vena cava and the pulmonary vein respectively. The right and the left atria (plural for atrium) contract simultaneously to send blood down through the tricuspid valve and the mitral valve respectively. And the right and left ventricles contract simultaneously to push blood up into the pulmonary artery and the aorta respectively. All this without missing a beat. Hey, I told you this was a spectacular organ!

Talking heart disease

The phrase cardiovascular disease (CVD) means “all medical conditions affecting the heart and blood vessels.” CVD includes heart attack, high blood pressure, stroke, rheumatic heart disease, congenital defects, and congestive heart failure.

Coronary artery disease (CAD) or coronary heart disease (CHD) means “conditions affecting the heart and its major blood vessels” — heart attack and angina pectoris (chest pain due to narrowed blood vessels).

Myocardial infarction (myo = muscle, cardio = heart, infarction = blockage) is the formal name for a heart attack. The name pretty much describes what happens, but you can read all the truly excruciating details in Chapter 2.

Attack of the Killer Heart Disease

Heart disease is the leading killer of Americans, and heart attacks are the most common form of heart disease. But you don’t have to take my word for it. Many U.S. government agencies, including the Centers for Disease Control and Prevention and the National Center for Health Statistics, have piled up

a ton of stats and translated all the numbers into dozens of charts to show exactly how lethal heart disease can be.

Heart disease versus everything else

First things first. Table 1-1 lists the ten leading causes of death in the United States for 2004. See what’s in first place? Check it out. Note: Stroke, a form of cardiovascular disease known medically as cerebrovascular disease, is counted as a separate category.

Heart disease versus heart attack

The United States isn’t alone in its battle with cardiovascular disease (CVD) and coronary heart disease (CHD) — heart attack. According to the World Health Organization (WHO), CVD and CHD are the Numero Uno nasties around the globe. Grouping the rich countries, poor countries, and countries in-between, WHO statisticians discovered one common thread: Heart disease kills more people every year than any other illness or medical condition.

Table 1-2 lays out the WHO statistics for causes of death in 2002 and the predicted figures for 2005. Some points of interest in these figures are as follows:

� Yes, as you read this, 2005 is already several years in the past, and 2002 is practically ancient history. But as every math major knows, in the statistics game, several years must pass before you can gather all the numbers you need to draw a firm conclusion. Hence the lag time.

� Yes, the percentage of the world’s population that succumbs to the various forms of cancer is lower than the percentage in the United States. Why? Because in many poor countries, so many infants die at birth or expire young of preventable illnesses that there are fewer people who grow old enough to develop and eventually die of illnesses of older age, such as cancer or Alzheimer’s disease.

Getting to the Point of This Book

Congratulations! By plunking down some of your hard-earned cash for a copy of Controlling Cholesterol For Dummies, 2nd Edition, (or borrowing it from a smart friend), you’ve made a commitment to, well, try to control your cholesterol before it controls you.

And, by slogging your way through a discussion of how your heart works and a slew of charts with figures proving what I bet you already knew — heart disease and heart attack send a great many folks to their ultimate reward — you’ve shown just how serious you are about getting a handle on those nasty cholesterol numbers. As a reward, now, by gosh, you’ve reached the heart of the matter: cholesterol.

Why counting cholesterol numbers counts

In the past half century, literally hundreds of well-run scientific studies, run by thousands of different researchers in dozens of different countries, have shown beyond a shadow of a doubt that having high cholesterol — specifically, high levels of LDLs, particularly the smaller ones described in Chapter 2 — is a strong warning that Mr. Heart Disease and Ms. Heart Attack are lying in wait somewhere in the future. Luckily, a similar long list of studies shows that what you eat and how you live your life to stay fit and relatively trim can help reduce your risk

How to control your cholesterol risks

What you eat and drink plays an important role in controlling your cholesterol, as I explain in Part II of this book. So does maintaining a healthful weight, engaging in a realistic exercise program, and avoiding tobacco (in all its ugly forms) — three subjects covered in Part III. And if these basic first steps don’t do the job, cholesterol-lowering medications, discussed in Part IV, offer yet another option.

Each of these methods for lowering your cholesterol — diet, weight control, exercise, and medicines — has its own chapter (or two or three) in this book. As a health-conscious consumer, you get to pick and choose among them — like a gourmet at a gorgeous buffet table. A low-fat, low-cholesterol buffet table, of course. After which you can relax with the grab bag of factoids and funny stuff in Part V — the well-known For Dummies Part of Tens.

Go for it. Your heart will thank you.

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Why Cholesterol, triglycerides and glycaemia tests are important ?

Cholesterol and triglycerides, that is. the fats of our bodies, and glycaemia, i.e. the main blood sugar level, must be held under supervision.

The Cholesterol, triglycerides and glucose are essential for our entire body: triglycerides and glucose are important suppliers of energy, while cholesterol makes up cell membranes, is used to synthesize the hormones of growth, production and reproduction, and also functions to form the bile acids that provide digestive ingestion of fat. The amount of triglycerides, cholesterol and glucose must be examined, in order to stop them to cause harm to ourselves.

In terms of cholesterol , we should differentiate between the so-called "good" cholesterol (HDL type), which performs an essential role in the safety of arteries, and the VLDL or LDL cholesterol, the bad one, which can cause thickening of arteries and, as a result, loss of flexibility and tone, if it is existing in our bodies in excessive than regular levels. This indicates that an excessive build up of cholesterol in our body (over 200 mg per 100 ml of blood) may maximize the risk of heart attack and stroke. In order to prevent these issues, it is recommended to carry out specific tests to measure the concentration of cholesterol in the blood, especially if you are at risk. The cholesterol test allows us to determine the total level of cholesterol and the level of good and bad cholesterol. Measuring cholesterol is not essential to diagnose a disease, but to avoid cardiovascular illnesses, namely coronary, cerebral stroke and myocardial infarction. On the other hand, it is not adequate enough to know the level of blood cholesterol to understand something more about the risk of experiencing from one of these diseases: to be able to evaluate the cardiovascular danger you need to have an analysis of blood glucose, blood pressure, age, lifestyle and degree of triglycerides in the blood.

The analysis that determines the concentration of triglycerides in the blood, together with the cholesterol test, is extremely essential and helpful. Triglycerides, as well as cholesterol, are generated in part by the body and are in part presented though food. In the case of triglycerides, the highest fraction is presents via food: triglycerides are then built up in the adipose tissue and in part in blood. Checking the existence of blood triglycerides is important to assess the cardiovascular risk of a person, especially in the case of people suffering from heart diseases.

to the fats of your body, you should maintain also the amount of sugar under control, which is the glucose, which is an essential source of energy for the body. The level of blood sugar depends on the equilibrium between the sugar deriving from food or from body reserves and the sugar that is used by various tissues. If this balance is altered, there may be some severe problems such as hypoglycemia and hyperglycemia. The blood glucose test is consequently useful to distinguish that there are no such problems and is also essential for the diagnosis of diabetes.

To perform cholesterol, triglycerides and glycaemia tests a blood sample is sufficient, but for glycaemia additionally a urine test is required.

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foods that lower cholesterol

Examine a bunch of your own pals and you may discover at least one or two persons who are on medication drugs to lower cholesterol. The most frequently suggested medications for cutting down cholesterol levels are the statins drugs. Statins initially emerged from a organic origin but now are artificially altered. The statin drugs lower cholesterol by decreasing the manufacturing of cholesterol by the liver. Statins prevent the enzyme in the liver that triggers the liver to manufacture cholesterol.

The statin drugs do have negative effects such as liver deterioration, muscle discomfort, abdominals troubles and dermis rashes. I have had a number of colleagues who have taken the drugs experience of muscle pains. There are organic replacements to the statin drugs and some physicians are currently recommending these. One of most famous of these is red yeast rice.

Red yeast rice

Red yeast rice has been utilized by the Chinese for ages. Red yeast rice is a result of the yeast that is cultivated on rice. The so known as "secret substance" in red yeast rice is known as monacolins. Monoacolin K has identical configuration as the cholesterol decreasing drug lovastatin.

A number of researches have been conducted to determine the efficiency of red yeast rice to lower cholesterol. Results have been encouraging. One research by the UCLA School of Medicine involved 83 persons with high cholesterol levels. Patients who taken red yeast rice over a 12-week interval found considerable lower levels of overall cholesterol, bad LDL cholesterol, and triglycerides (fats in the blood) as opposed to those taking placebo (no drug or supplement). Good HDL cholesterol levels did not change in both study groups. Although the UCLA study did not show an raise of good cholesterol another 8-week study of 446 people with high cholesterol found those who took red yeast rice had a considerable decrease in cholesterol levels compared to those who took placebo. In this study HDL (the good cholesterol) is raised by 20% in the group that took red yeast rice.

Let's check out some of the most effective natural cholesterol reducers you may wish to take into account before plunging into the suspicious universe of prescription medication.

1. Fish oil And Omega-3

The following is one of the most affordable and most efficient ways to decrease cholesterol without chemicals. You can get fish oil in your body by dining fish, or merely by using a supplement. Supplements are the inexpensive route, and for the enormous cholesterol lowering benefits a good fish oil supplement will provide you, it is simply a great choice.

Remember, fish oil is not just great for cholesterol, but also for overall dermis, heart and brain physical condition.

2. Get Running

Decreasing cholesterol in a natural way doesn't get much more basic than physical activity. Exercise increases good cholesterol (HDL), while also lowering bad (LDL) cholesterol. Work out a simple exercise schedule for yourself and make sure you adhere to it.

3. Dissolvable Fiber

Dissolvable fiber comes highly advised by The American Heart Foundation as a organic cholesterol reducer. Oats is the most prosperous source of soluble fiber, although you can also find good portions in peas, citrus fruits, oat bran, beans and barley.

4. Natural Supplements

We already discussed fish oil supplements. Although, if all the earlier mentioned are still unable to deliver your cholesterol down to suitable levels, you may check out using a natural cholesterol supplement. These are products that make it easy for you to ingest proven cholesterol busters as a simple supplement.

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