This is not a blog about a Clint Eastwood film. It's a blog about cholesterol. In particular, it's a blog about the terms 'good' and 'bad' cholesterol. It's time we stop using those terms*. They are misleading and only part of the picture. Let me explain.
We all know about the cholesterol hypothesis and the link that has been established between raised cholesterol and heart disease. The Framingham study is a large multi-generational population study that began in 1948. It helped reveal what we now know as the cardiac 'risk factors'. Well established risk factors for heart disease include high blood pressure, smoking & elevated cholesterol.
Initially the prime suspect was LDL cholesterol, often referred to as 'bad cholesterol'. However, over time it has become clearer that not everyone with established heart disease has high LDL cholesterol and not everyone with high LDL cholesterol gets heart disease. Furthermore it has been shown that LDL comes in different sizes from small and dense to large and fluffy. Some forms of LDL cholesterol are worse for our arteries than others. The particularly problematic LDL cholesterols include small dense LDLs and oxidised LDL's. So in short, LDL is not all 'bad'. Some types of LDL are 'bad'.
Let's move on to HDL. Known around town as 'good' cholesterol it is known to have beneficial roles such as moving cholesterol back to the liver and away from the arteries. That sounds good...and it is...but it is now well established that under some circumstances even HDL can become oxidised. Under certain conditions HDLs are not always 'good'.
So 'bad' isn't always bad and 'good' isn't always good. But we are left with these terms well entrenched in the modern cholesterol vernacular. Used by many Doctors and patients alike.**
The study of lipids and cardiac risk has advanced a lot in the past decade. We now know it's a lot more complex than just checking a fasting LDL & HDL cholesterol. A thorough cardiac risk assessment should consider tests for inflammation (hs-crp), insulin resistance (TG;HDL ratio, fasting insulin & glucose), and homocysteine. Other important markers may include Apolipoprotein B, Lipoprotein A and LDL subfractions.
The take home message; Cardiac disease is still the number one killer in most countries. Sadly it is often picked up too late when a lot of injury has already happened to the blood vessels. Like many chronic diseases, the best time to pick it up and address it is early. By utilising modern diagnostic tests and risk assessments tools we are better placed than ever to identify those at greatest risk and intervene with the appropriate measures to prevent heart disease. If you are concerned about your cardiac risk I would encourage you to go and see a doctor who specialises in this type of risk assessment. Remember, try not to ask "what's my good and bad cholesterol? "Try to ask "what is my cardiac risk?" It's a better question.
*this includes Doctors!
**I too was guilty, weren't we all?
Comentarios