Saturday, October 8, 2011

Cholesterol and CVD Risk in a Nutshell

This is a brief summary of my current understanding about how to interpret cholesterol values as they appear on the blood chemistry panels that's done during regular medical check ups. (I deliberately don't list specific ranges, as this is about the essentials of what I think is a correct perspective.)

  • Elevated total cholesterol in the absence of inflammation (and associated oxidative stress) is unlikely to contribute to heart disease. (Though an extreme elevation or depression in cholesterol may indicate other problems in your body.)

  • Elevated cholesterol (especially high LDL relative to HDL) in the presence of inflammation is likely a risk factor. This is because this scenario involves LDL cholesterol carriers becoming oxidized and stuck inside the lining of blood vessels causing artherosclerosis as well as processes leading up to acutely threatening events such as infarctions.

  • The likelihood of cholesterol becoming target of harmful oxidation is higher in people who have blood sugar dysregulation (suggested by elevated triglycerides) such as the obese or (pre)-diabetic, because these malfunctions contribute to the formation of "small dense" highly oxidizable LDL as well as inflammation.

In other words, the more inflamed and/or diabetic your are (risk increases dramatically if you eat a typical Western diet) the more an elevation in cholesterol is likely to be a concern in regard to heart disease. In this situation, statin drugs may lower your risk somewhat, but possibly with side effects that will ultimately kill you from causes other than heart disease.

In people who do not fit the above disease- or dietary profile, cholesterol is likely of no particular concern unless it is heavily elevated or depressed. (Extremes in both directions may indicate chronic infection, genetic weaknesses related to cholesterol metabolism, or thyroid dysfunction.)

The apparently most relevant marker that suggests heart disease risk as it relates to inflammation is hsCRP ("High Sensitivity C Reactive Protein"). hsCRP tends to be well below 1.0 mg/L in healthy individuals with no acute infections.

This is not medical advice, and, as a health consultant, I don't diagnose or treat disease, but if your doctor isn't equipped with the knowledge to even discuss these points, he or she has no business trying to "treat" your cholesterol values as such.

(*Technically, what's listed on blood panels isn't actually cholesterol, but cholesterol carrier proteins, but, oh well, once we have declared war on a natural substance, who needs such distinctions...)

Thanks to Chris Masterjohn for contributing through lectures and writings to my understanding. (Any errors are mine and this is not an attempt at paraphrasing Chris.)

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