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CHOLESTEROL 101

By Steven Hallstrom, M.D.

       Do you ever get confused as to what the HDL, LDL, and tnglycerides mean? It can be confusing. What is the most important parameter that predicts coronary artery disease according to most cardiologists? I will attempt to explain what each of these terms mean.

 
       The good cholesterol is known as the HDL, or high density lipoprotein. Think of this as the "Happy cholesterol; remembering the “H” in the HDL name. The bad cholesterol is the LDL, or low density lipoprotein. A slick mnemonic is to remember that the “L” in LDL could be remembered as the "Lousy" cholesterol.
 
       The risk factors for coronary artery disease include the patient's age (male > 45 years and female > 55 years), low HDL cholesterol, hypertension (BP > 140/90 mm Hg or on anti-hypertensive treatment), smoking history, diabetes, and premature coronary artery disease (coronary artery disease in male first degree relative < 55 years; in female first degree relative < 65 years).
 
       The recent third report of the National Cholesterol Education Program (NCEP)1 raises the risk of persons with diabetes without coronary artery disease to the same risk level of those that already have coronary artery disease.
 
       The goals of treatment have been recently modified from the third report of the NCEP2 in 2004. The very highest risk group includes patients with coronary artery disease, diabetes mellitus type 2, metabolic syndrome, or a history of a stroke (cerebrovascular disease). The new goal is to get the LDL cholesterol to less than 70 in this highest risk group. The clear message is that the lower the LDL, the better the prognosis, according to expert cardiologists.
 
1 Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of a High Blood Cholesterol in Adults (Adult Treatment Panel III) May, 2001
 
2 Circulation 2004; 110-227

 

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