by Francisco Contreras, M.D.
 
Q. With heart disease as rampant as it is, just how concerned should I be if I have a high cholesterol level?
M.C., Coronado, California

A. When people get together and the subject of health comes up, it's very common to hear someone ask, "What's your cholesterol level?" If the answer is 195, people think it's good. However, if the answer is, say, 220, then the reaction is typically sympathetic.

Most people think anything under 200 is good and anything over that is bad. But a level of 195 may not be good, and 220 may not be all that bad.

 

There is good cholesterol and there is bad cholesterol. High-Density Lipoproteins (HDL) is the "good" cholesterol and Low-Density Lipoproteins (LDL) is the "bad" cholesterol. The important thing is the ratio between them.

HDL actually helps prevent cardiovascular disease because it helps remove LDL from blood cells, which means that less LDL can enter into the blood vessel walls. HDL can reverse the buildup in the arteries and act as a blood-thinning agent. This is very important to good heart health.

LDL, on the other hand, is very unhealthy for you if the level in your blood is high. It can cause the inside layers of your arteries to inflame, and fatty plaques and platelets can begin to build up. The blood can start to thicken, a process that can lead to heart complications.

Here is the most important fact to know about cholesterol levels: It is not the individual levels of HDL and LDL or their combined levels that make a big difference. It is the ratio of HDL to LDL that will determine your risk for heart disease.

Your total cholesterol divided by your HDL should be less than 4, and your LDL divided by the HDL should be less than 3.

If your ratios work out to be less than 4 and less than 3 respectively, you are at a low risk to develop heart disease. If your ratios are higher, your risk of heart disease is much higher, regardless of what the individual levels of cholesterol are. That is why a person with a total cholesterol greater than 200 may not be at risk, and a person with a lower cholesterol level may be at great risk.

I recommend that you have your cholesterol levels checked by a doctor and then work out your ratios. If you see that they are higher than what they should be, you should ask your doctor and a nutritionist to help you lower them, preferably through diet and exercise instead of prescription drugs. May you be blessed with a healthy heart.


Francisco Contreras, M.D., director of Oasis of Hope Hospital in Mexico, oversees the treatment of 600 cancer patients annually.

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