From the office of

Robert S. Grimshaw Jr MD FACP
Internal Medicine
3535 Hill Blvd Yorktown Hts NY
914 962-3180
NEWS
Recognized Provider “With Distinction” by the American Diabetes Association/National Committee for Quality Assurance 2/99-2/02

Cholesterol Information Revised 9/99

Geri Merante, RD, MPH, CDN

Let me begin by explaining all the parameters:

    Total cholesterol (TC): Originally this is all that was looked at and the goal was to keep it under 200, except people still had heart disease. So, the scientific community began to look at High Density Lipoprotein (HDL - the good cholesterol), and the ratio of total to good. A ratio of 4 or less is considered protective (25% or more of TC). But, people were still getting heart disease. So, they began to look at the Low Density Lipoprotein (LDL - the “bad” cholesterol) and came up with a breakdown: if there is no known heart disease and one or no risk factors it should not exceed 160. If there’s no known heart disease but two or more risk factors it should not exceed 130, and with known heart disease it should not exceed 100.

    The risk factors: smoking, diabetes, hypertension, HDL less than 35, and family history of early onset heart disease (a cardiac event in males before 55 and in females before 65), being a man over 45 or being a woman over 55.

    Because we could all live well and healthily into our 90*s by preventing arteriosclerotic heart disease, I say we fine tune every parameter to our benefit:

    LDL is made up of 2 types: the smaller molecular pattern B type which is readily oxidized and adheres to the artery walls and the larger molecular pattern A which is more easily swept from the bloodstream by the HDL (there are a bunch of other remnants fIoating as well which is why the HDL and LDL added together do not equal the TC). Sophisticated testing is available to determine if you are pattern A or B, but it*s generally not done unless you*ve had an event or unless you*ve got an aggressive internist. Anyway, most pattern B people are also triglyceride formers. Triglyceride levels should always be less than 200.

    Triglycerides generally represent excess fat and sugar calories that get converted to and stored as fat. In that conversion process they become triglyceride-rich particles which have a great affinity for adhering to the artery walls and speeding up the process of hardening them. Triglycerides are also an important ingredient in LDL particles which is why overweight people usually have high LDL’s and why weight loss usually results in decreasing LDL (unless routine daily exercise is part of the equation, bringing down the TC may result in bringing down both HDL and LDL and the ratio doesn*t improve, so the risk remains high).

    Two additional tests to discuss with your internist:

    A homocysteine level. Homocysteine is a by-product of protein metabolism which makes the wall of the arteries stickier, easing the adherence of oxidized LDL and speeding up the process of hardening of the arteries. You want your homocysteine level to be less than 9.

    A Doppler of your carotid arteries. This non invasive test looks at the interior of the carotid arteries of the neck--the ones that, if blocked, lead to a stroke. If there is any plague deposited in these arteries, there is a 70% likelihood that the coronary arteries have developed plaque also.