means the process of becoming hardened, so the term indicates study looking at the lipid numbers of more than 136,000 people
soft deposits are first laid down in a place they shouldn’t be (like admitted to hospitals with coronary artery disease, more than
the artery walls) and then become hardened over time. The term 70% of those individuals had LDL cholesterol numbers in the
“arteriosclerosis,” which literally means “hardened arteries,” is “normal” range, and 50% had numbers considered in an “op-
often used interchangeably. timal” range.
Cholesterol crystals are often found at the center of the Much more important than total cholesterol, HDL and LDL
plaques that form in atherosclerosis. This has been taken to cholesterol are the various sub-particles. Cholesterol is carried
indicate that high blood cholesterol causes these plaques, in in the blood in a variety of different proteins. Each of these par-
turn causing narrowing of the arteries and eventually leading to ticles contains cholesterol, triglycerides and lipoproteins. HDL
complete blockage and heart disease. cholesterol ("good") has different lipoproteins than LDL choles-
The difficulty is that studies are not demonstrating that these terol ("bad"). Within each class, the particles differ in size and
changes are due to high cholesterol levels. The concentration of density. Simply measuring LDL tells nothing about the particle
cholesterol in the blood is not associated directly with heart size or number. The ability of cholesterol to penetrate the arte-
disease in people with family histories of high cholesterol. In rial lining is dependent on the amount of inflammation pres-
one study, in fact, those with the highest cholesterol levels had ent, type of lipoprotein carrying it, the particle size and num-
the lowest risk of heart disease. ber rather than on the level of cholesterol in the blood. Two of
Emerging evidence implicates chronic inflammation in the the most important sub-particles are: Apolipoprotein (apo) B, a
etiology of cardiovascular disease. According to the American component of LDL and apo A-1, a component of HDL. Several
Heart Association, “high-sensitivity C-reactive protein (hs-CRP) international studies have concluded "the apo B/A-1 ratio was
levels are an independent marker of cardiovascular disease risk.” the most important risk factor" and its "predictive power is supe-
And, elevated homocysteine levels were associated with in- rior to...any other lipid parameter or ratio".
creased risk for mortality in patients with coronary artery disease. The best assessment of your risk for future heart attack is to
measure the actual disease process, not just a surrogate marker.
Myth #4: Cholesterol levels are an accurate
In the past, this would have meant an invasive procedure like a
measure of heart disease
coronary catheterization that carries a not inconsequential risk.
More recently calcium scoring by high speed CT scan has been
Talking about your cholesterol count is now almost as com-
promoted but there are concerns about the amount of radiation
mon as discussing your golf score. In both, the convention is
exposure. What is one to do? There is another option: carotid
that the lower the number, the better you are. This assumption
intima-media thickness measurement using carotid ultrasound.
is again not demonstrated by the science. Data from the land-
The value of this technology has been recognized by the Ameri-
mark Framingham Heart Study revealed that the distribution of
can Heart Association, the American College of Cardiology and
cholesterol levels among individuals that had a heart attack and
the American Society of Echocardiographers for the early detec-
those that did not essentially mirrored each other. While choles-
tion of heart disease in asymptomatic individuals. A study out of
terol is involved to some degree in the development of arterial
the Mayo clinics found CIMT superior to calcium scoring, con-
plaque, it alone is not the problem.
cluding that “subclinical vascular disease can be detected by
Most heart attacks occur in people who have "normal"
CIMT in young to middle-aged patients with a low Framingham
cholesterol. Using cholesterol as the predictor of a future heart
Risk Score and a Coronary Artery Calcium Score of zero”.
attack is not even as good as flipping a coin. In a very large
26 NaturalNutmeg www.naturalnutmeg.com
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