The truth about your blood cholesterol

By Dr Harold Gunatillake - Health Writer

“Do not be complacent when your physician tells you that your risk of getting a heart attack is low, when your lipid profile is within normal range. It is far from the truth”

You are told that blood taken from your vein in the elbow for lipid assay checks your total cholesterol level (normal range-4-5.5mmol/dL), Good cholesterol (HDL range-above 1mmol/dL) and bad cholesterol-below 2.0mmol/dL), and if you are within these ranges your doctor and you’ll be very pleased. You go home with the idea that your risk of getting a heart attack is minimised.

Be not be complacent, the truth is that normal ranges described above means nothing, because heart disease is caused by other components of lipids floating in your blood. Sixty percent of people getting heart attacks do have a normal range of serum cholesterol.

 Are you aware that cholesterol is a yellow colour waxy, sticky, malleable substance not soluble in water, but soluble only in fat or oil? So how does one account for cholesterol floating in your blood (water soluble) like no other business. Normally, fat getting into your blood will paralyse you as in stroke, because such fat globules block your minute arteries and cuts of the blood to the region. These foreign globules are called emboli. The incidence of fat embolism is high in women who have liposuction contouring surgery.

Your liver has the solution. Liver produces a water soluble protein and mixes with cholesterol also manufactured in your liver; the molecule is referred to as a ‘lipo-protein’

That is how cholesterol in your blood gets the terms ‘High density lipoprotein” for HDL good cholesterol, and ‘Low density lipoprotein for the bad cholesterol LDL.

It is much better to classify blood cholesterol as HDL and “non-HDL cholesterol” for better understanding. HDL is your good cholesterol: its density is high and hence does not settle down or adhere or creep into the inner lining of your arteries (mucus lining). It is a heavy fellow that binds the bad fellow (LDL) back to the liver for removal or recycling. HDL reduces inflammation in the body and high level is linked with a lower risk of heart disease. No wonder it’s called good cholesterol.

Your non-HDL cholesterol includes total cholesterol minus your HDL cholesterol. These include- LDL, VLDL (very low density lipoprotein) and lipo-protein (a). VLDL minute particles carry triglycerides to tissues, and eventually becomes LDL (bad fellow).

High triglyceride levels also contribute to the LDL level and causes cholesterol to build up inside the mucus lining of the arteries. So higher your LDL, VLDL and triglycerides in your blood, the higher your risk of heart disease.

Triglycerides also prevent HDL binding LDL and taking them back into the liver for disposal.

The sugar produced from carbs is stored in your fat cells and the liver for storage as triglycerides. Insulin secreted in the pancreas participates in the transfer. In addition, fats broken down into fatty acids are also stored in fat cells as triglycerides. Normal level of triglycerides in your blood should be below 150, and above 200 are high.

It is not practical for laboratories to measure VLDL cholesterol levels on each person, and is usually estimated as a percentage of your triglyceride value.

Even LDL level is not measured in most laboratories instead it is being calculated, such estimates may not be accurate as the blood triglycerides gets higher. In situations where the triglyceride level is very high as much as 400mg/dL the laboratories then measure the LDL levels in your blood.

To check your non-HDL cholesterol levels fasting for 12 hours is not required. As the triglyceride level is as important in estimating the risk of heart disease, fasting is necessary, as the blood levels depend on when and what you have eaten.

Now what is the story about lipoprotein(a). Last year Bob Harper, the celebrity fitness trainer from the TV show “The Biggest Loser” suffered a heart attack and nearly died.

His LDL level was in the normal range. VDRL was not calculated routinely as said earlier. His triglycerides were in the normal range. The culprit was called lipoprotein(a), also known as lp(a). High levels of these fat particles can give you a heart attack or stroke.

So, it is meaningless to ever imagine that because your LDL and total cholesterol are within the normal range be complacent about it.

Furthermore, diet and exercise have no impact or influence on Lp(a). Even statins don’t seem to lower your lp(a) levels.

Cardiologists don’t know about it. It is not even tested routinely, and about 20 percent of the population in most countries do have a higher level when tested. Lp(a) was discovered in 1963 by a Norwegian scientist,  Kare Berg, who noticed that it was especially common among people with coronary heart disease.

So, the downside of having excessive lipoprotein (a) is to accelerate the formation of plaque in the arteries and it promotes blood clots.

The threshold for high lp(a) begins around 30 milligrams per d/L of blood, those who are at risk jumps above 60.

So, these studies explain how you could get a heart attack with normal lipid profile, where HDL, LDL, VDRL and triglyceride levels are only investigated on your blood.

Lastly, remember that lipids levels in your arteries are assessed by taking blood from your vein. Put on your thinking cap.

About the author:

Dr Gunatillake-Health editor is a member of the Academy of Medicine, Singapore. Member of the Australian Association of Cosmetic Surgery. Fellow of the Royal College of Surgeons (UK), Corresponding Fellow of the American Academy of Cosmetic Surgery, Member of the International Societies of Cosmetic surgery, Fellow of the International College of Surgery (US), Australian diplomat for the International Society of Plastic, Aesthetic & Reconstructive Surgery, Board member of the International Society of Aesthetic Surgery, Member of the American Academy of Aesthetic & restorative Surgery, Life Member of the College of Surgeons, Sri Lanka, Batchelor of Medicine & Surgery (Cey):  Government scholar to UK for higher studies and training.

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