Keep Cholesterol in Check

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Think of atherosclerosis as sludge in the arteries. Because it can lead to heart attacks and strokes, this condition is the leading cause of death in Americans older than 45. For most people, atherosclerosis begins slowly and sneakily in childhood and progresses year by year. The process seems to begin with an injury to an artery’s lining. Factors that can harm this delicate lining include high blood pressure, tobacco byproducts and an amino acid called homocysteine, which is generated by the breakdown of protein.

Cholesterol and other fats become trapped at the damaged site. When these fats accumulate, they become oxidized. (Oxidation is the same process that has butter go rancid and iron turn to rust.) These rancid blood fats are taken up by smooth muscle cells just beneath an artery’s inner lining. An assortment of cells migrate toward the site, hang about and generally cause trouble. This microscopic mob scene represents a plaque.

The problem with arterial plaques is that they impede blood flow. They also can break free and lodge in sometimes fatally inconvenient places, such as the arteries that would otherwise deliver blood to your brain or heart. When this happens, you end up with a stroke or a heart attack.

The Good and the Bad

Cholesterol itself is not evil. Our livers manufacture cholesterol — whether or not we eat any — because our bodies need it to maintain healthy cells and to make hormones. Most of us, aside from strict vegetarians, eat a good deal of the stuff by way of meat, poultry, fish, eggs and dairy products.

Cholesterol is shuttled within the body by lipoproteins (carriers made of fat plus protein). LDL cholesterol (also known as “bad” cholesterol) transports cholesterol to the tissues. This is the type of cholesterol you want to lower. HDL cholesterol (“good” cholesterol) transports cholesterol to the liver, where it is metabolized and excreted into the intestinal tract.

About 102 million American adults have total cholesterol levels that are borderline high (200 to 239 mg/dL), and 41 million have levels that are definitely high (more than 240 mg/dL). Some people are genetically unlucky — their bodies simply make too much cholesterol. For the majority of us, though, high cholesterol stems from lifestyle factors.

Heart-healthy Tips

A wealth of research shows that lowering blood cholesterol reduces the risk of heart attack. The solution lies in cleaning up Homer Simpson-type habits. Pioneering research by Dean Ornish, M.D., author of Dean Ornish’s Program for Reversing Heart Disease (Ivy, 1996), demonstrates that comprehensive lifestyle changes not only can prevent heart disease but actually reverse atherosclerosis. Such changes include good eating habits, exercise and stress reduction. People with borderline high cholesterol may want to add herbs and vitamins to that regimen. People who have documented high cholesterol may want to take a prescription medication to get things under control.

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