Judy Rupp / columnist

Merely an obscure scientific term a few decades ago, cholesterol quickly has become a household word with an image that’s almost universally “bad.” If you associate cholesterol with excess weight, fried foods and an increased risk of suffering a heart attack or stroke, you’re right. But that’s only one oversimplified part of a complex story.

Cholesterol is a naturally occurring wax-like substance needed by the body to build cell walls and make hormones. Without cholesterol, that work would never get done, but the body is capable of producing every bit of cholesterol that’s needed.

Most preventive and treatment strategies focus on lowering LDL and total cholesterol. Yet studies show increasing HDL — even with no corresponding decrease in LDL — may be at least as effective in reducing the risk of heart attack and stroke.

According to guideline of the National Cholesterol Education Project (NCEP), an HDL level above 60 mg/dL is desirable. For most individuals, an LDL under 130 is recommended, but persons diagnosed with heart disease or diabetes are advised to keep their LDL under 100 mg/dL.

One of the most important measures of cardiovascular health is the ratio of total cholesterol to HDL ratio. A total of 201 with an HDFL of 75, for example, yielded a ratio of 2.7 — considered very low risk, respite the moderately elevated total cholesterol. The NCEP recommends a ratio under 4.5

While a traditional low-fat diet will lower LDL and total cholesterol, it also may lower HDL, particularly if carbohydrates are substituted for the fats. More recent approaches advocate not just eliminating saturated fats but replacing them with fruits, vegetables, whole grains and monounsaturated fats. Found in olive and canola oil, almonds, walnuts and avocados, monounsaturated fats will maintain or increase HDL levels while providing beneficial antioxidants and nutrients.

Probably the two best ways to boost HDL are 1) weight loss and 2) regular exercise of at least moderate intensity. These should certainly be incorporated into any prevention or treatment program.

Other strategies to increase HDL include smoking cessation, avoidance of transfatty acids (found in many margarines and baked goods) and moderate use of alcohol. Studies have shown individuals who have one to two alcoholic drinks a day have HDL levels 12 percent higher on average than non-drinkers.

Among cholesterol-lowering medications statins bring about a 10 to 15 percent increase in HDL while reducing LDL by 30 to 50 percent. Niacin may be the best treatment for increasing HDL, and fibrates are the treatment of choice for high triglycerides.

In recent years, a new risk factor — inflammation — has emerged. People with even slightly elevated levels of c-reactive protein, a substance produced in reaction to inflammation or infection anywhere in the body, have an increased risk of heart attack or stroke, even if they have normal cholesterol levels.

In diagnosing, preventing and treating heart disease, doctors know they have much left to learn. For now and the foreseeable future, however, there’s no question cholesterol — in all its ramifications — will continue to play a major role.

Rupp is information and assistance case manager with the Northern Oklahoma Development Authority Area Agency on Aging.

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