Hi Sue,

I would greatly appreciate it if you could explain about the different types of cholesterol. I just received my cholesterol test results and I am confused. My total amount is 244 and the LDL is 153. But my HDL is 68 and the triglycerides are 117. How can my LDL and HDL both be high? I thought the HDL helped to lower the LDL. My doctor is talking about medications. I am only 23, am a vegetarian and already eat a low-fat diet. Is my cholesterol really that bad that I would need medication? I would really appreciate any insight.

Thank you.
Francine

Dear Francine,

You have asked a multifaceted question and I will try my best to answer as concisely as possible.

Cholesterol is a fat-like substance, although it is not fat. There are two main categories of cholesterol:

1. Blood cholesterol
2. Dietary (or food) cholesterol

You are asking about the first type. Blood cholesterol cannot mix with blood for transport, and so needs a vehicle in order to travel around the blood stream That vehicle is know as a lipoprotein. For cholesterol to circulate, it attaches to its lipoprotein vehicle. There are three types of lipoproteins:

1. High density lipoproteins, or HDL
2. Low density lipoproteins or LDL
3. Very low density lipoproteins or VLDL.

Your total blood cholesterol level is made up of those three measures.

High density lipoproteins are those that carry cholesterol from the body tissues, the arteries and vessels, to the liver for disposal. Since excess blood cholesterol is associated with heart disease, we call HDL the "good" cholesterol since it helps us to rid our body of it. High levels are associated with a decreased risk of heart disease.

Low density lipoproteins carry cholesterol from the liver to the tissues, and along the way, deposits some on the artery walls and vessels ... thus earning itself the distinction of "bad" cholesterol. High levels are LDL are associated with an increased risk of heart disease.

An increased level of total cholesterol means that more cholesterol is apt to collect on artery walls.

Because of their association with heart disease (either in increasing the risk as with high total cholesterol and high LDL, or lowering it with high HDL) the following desirable blood levels have been established:
Total cholesterol < 200 milligrams per dLiter LDL < 130 mg/dL HDL > 35 mg/dL

Not only are levels of LDL, HDL, and cholesterol important, but some doctors believe that the ratio of your total cholesterol to your HDL (TC/HDL)is the most predictive of heart disease risk. Low risk is associated with a ratio less than 4.5 for men and less than 4.0 for women.

In looking at your measures, it shows that you have a very high total cholesterol (244mg/dL), a borderline high LDL (153mg/dL) and a very high HDL (68mg/dL). Your ratio of TC/HDL is 244/68 = 3.6, which is associated with a low risk factor.

Triglycerides are the main form of fat in food, whether it is saturated, monounsaturated, or polyunsaturated. Triglycerides are also the form of fat that you make when you eat excess calories from any type of food (protein, carbohydrate or fat). It is debatable whether high triglyceride levels alone are predictive of heart disease. None the less, a desirable level of < 250mg/dL has been established. Your triglyceride levels are well within the desirable range.

High cholesterol levels, as well as LDL levels are most often associated with dietary and lifestyle factors, particularly diets high in saturated fats and a sedentary lifestyle. However, genetics is also an important factor in determining blood cholesterol levels. Some people, despite their best efforts to control cholesterol via diet and exercise, cannot successfully do so due to the genetic factor, and must resort to using a more powerful method in the form of drugs.

Although I am very unfamiliar with your complete history (e.g. family history of high cholesterol and heart disease, your activity level, your weight, other factors such as smoking, alcohol consumption and stress level, as well as a complete nutritional review of your diet) from your brief description, it appears that the genetic factor is worth looking into. Your blood levels of cholesterol and triglycerides are suggestive of type IIa hyperlipoproteinemia. It is a common form of hyperlipoproteinemia (increased concentrations of one or more of the lipoproteins in the blood) and can be genetic in origin. It is characterized by elevated cholesterol levels, normal or slightly elevated triglycerides, and increased LDL, all of which you have. You may wish to further consult with your doctor about this. Such cases are treated with dietary management by lowering dietary cholesterol as much as possible, limiting saturated fat intake, and increasing the intake of polyunsaturated fats. You and your doctor may try at first to control your cholesterol with diet alterations, but you may need to rely on drugs if the response is not great enough. Also, you may make great use of a professional dietitian. Consult your doctor for a reference, or find one at http://www.eatright.org and click on find a dietitian.

I hope this reply has been helpful and informative. Good luck in the management of your cholesterol, and thank you for writing.

Sincerely,
Sue Gilbert