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A thorough evaluation of your heart attack risk requires much more than cholesterol level checks. Early detection of heart disease risk is critical if you want to prevent a heart attack.
Three main types of lipoproteins exist: - HDL - high-density lipoprotein
- LDL - low-density lipoprotein
- VLDL - very low density lipoprotein
All three types of lipoproteins come in different sizes. HDL carries the so-called "good" cholesterol. We now know that HDL can be grouped into large and small sizes. Large HDL removes cholesterol from the arteries while small HDL does not participate in this activity. As such it could be important to know if you have large HDL, acting to protect your heart, or small HDL, not adding any protection. When measuring HDL cholesterol there is no way to know the size of HDL.
LDL carries the so-called "bad" cholesterol. Unlike HDL with one good size and one bad size, all LDL is bad. LDL comes in three sizes and the smallest size is thought to be the most dangerous type. Small LDLs penetrate the artery wall easier than large LDLs and they are also more easily trapped in the artery wall where their cholesterol can be released to cause plaque build-up.
VLDLs mainly carry particles called triglycerides. The VLDLs are the group most influenced by when you last ate. Large VLDL particles are the most dangerous. A combination of high numbers of both large VLDL particles and small HDL particles may place an individual at substantial increased risk for heart disease.
Causes & Development
Elevated cholesterol levels have been seen in patients with atherosclerosis, diabetes, hypothyroidism and pregnancy.
Complications
Although an elevated total cholesterol (hypercholesterolemia) is associated with an increased heart attack risk, newer tests are more predictive. A simple and inexpensive blood test for high senstivity C-reactive protein (hs-CRP) has proved to be more accurate than cholesterol screening in predicting a person's risk for a heart attack according to researchers at the Brigham and Women's Hospital in Boston. [NEJM, 3/23/2000]
Here are some statistics about total cholesterol:- Among middle-aged men, 9-12% of those men with cholesterol at 240mg/dL or greater will develop symptomatic Congestive Heart Disease (CHD) over the next 7-9 years. Amongst men who do develop CHD, the majority also have one or more other risk factors that predispose them to developing CHD.
- Mortality is greatest in men over the age of 45 and specifically in those who smoke or have elevated blood pressure along with elevated total cholesterol.
- Highest mortality occurs in men who have total cholesterols greater than 300mg/dL.
- Women generally have about one-half the CHD risk as men for the same cholesterol levels.
- One study found that, for both men and women, CHD risk correlated greatly with level of elevation of LDL-Cholesterol and reduction of HDL-Cholesterol.
- HDL-Cholesterol is generally a better predictor of CHD. When elevated there is a lower risk of CHD, when low there is a higher risk of CHD.
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Conditions that suggest High Total Cholesterol:
Risk factors for High Total Cholesterol:
High Total Cholesterol suggests the following may be present:
High Total Cholesterol can lead to: | | | | | Aging |  Alzheimer's Disease | It is thought that the connection between high cholesterol and Alzheimer's disease exists in a protein called beta-amyloid, a sticky substance that builds up in the brains of Alzheimer's patients leading to nerve cell damage and loss of cognitive function. Accumulation of the protein is believed to be related to higher cholesterol levels. |
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Recommendations and treatments for High Total Cholesterol: | | | | | Amino Acid / Protein |  L-Taurine
 Cysteine / N-Acetyl-Cysteine (NAC) |
Botanical |
Garlic| | Several studies have shown a mild lowering effect on total cholesterol and LDL cholesterol. Garlic oil does not produce this cholesterol-lowering benefit like raw, cooked or powdered garlic does. Large doses are required (6,000 to 8,000mg per day) to produce this effect, which causes gastrointestinal discomfort for some people. Furthermore, this benefit does not become evident until after 3 months of continuous use. |
Artichoke Extract| | Choleretics typically lower cholesterol levels because they increase the excretion of cholesterol and decrease the synthesis of cholesterol in the liver. Consistent with its choleretic effect, cynara extract from artichoke leaf has been shown to lower blood cholesterol (13%) and triglyceride levels (5%) in both human and animal studies. |
Grape Seed Extract (Pycnogenol)| | One month of treatment with Pycnogenol (360mg per day) reduced total and LDL-cholesterol levels, but had no effect on HDL-cholesterol levels, in a study of 40 patients with diagnosed chronic venous insufficiency. [Phytother Res 2002;16(2): pp.1-5] |
Green Tea |
Diet |
 Plant-Based Nutrition| | Cholesterol levels are much lower in vegetarians.[1-4] Vegetarian diets reduce serum cholesterol levels to a much greater degree than is achieved with the National Cholesterol Education Program Step Two diet.[5-8] In one study published in The Lancet [7] total cholesterol in those following a vegetarian diet for 12 months decreased by 24.3%.- West RO, Hayes OB. Diet and serum cholesterol levels: a comparison between vegetarians and nonvegetarians in a Seventh-day Adventist group. Am J Clin Nutr 1968;21:853-62
- Sacks FM, Ornish D, Rosner B, McLanahan S, Castelli WP, Kass EH. Plasma lipoprotein levels in vegetarians: the effect of ingestion of fats from dairy products. JAMA 1985;254:1337-41
- Fisher M, Levine PH, Weiner B, et al. The effect of vegetarian diets on plasma lipid and platelet levels. Arch Inter Med 1986;146:1193-7
- Burslem J, Schonfeld G, Howald M, Weidman SW, Miller JP. Plasma apoprotein and lipoprotein lipid levels in vegetarians. Metabolism 1978;27:711-9
- Cooper RS, Goldberg RB, Trevisan M, et al. The selective lowering effect of vegetarianism on low density lipoproteins in a cross-over experiment. Atherosclerosis 1982;44:293-305
- Kestin M, Rouse IL, Correll RA, Nestel PJ. Cardiovascular disease risk factors in free-living men: Comparison of two prudent diets, one based on lacto-ovo-vegetarianism and the other allowing lean meat. Am J Clin Nutr 1989;50:280-7
- Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? Lancet 1990;336:129-133
- Hunninghake DB, Stein EA, Dujovne CA, et al. The efficacy of intensive dietary therapy alone or combined with lovastatin in out patients with hypercholesterolemia. New Engl J Med 1993;328:1213-9
The ratio of HDL- to total-cholesterol has been shown to be significantly lower in vegans as compared to lacto-ovo-vegetarians. |
Animal/Saturated Fats Avoidance| | It should be noted that there is not necessarily a strict relationship between cholesterol intake and blood cholesterol level. A properly functioning liver regulates the blood cholesterol level by storing, producing, releasing and excreting cholesterol as appropriate - primarily as bile. Even vegans, whose dietary intake of cholesterol is by definition essentially zero, have cholesterol in their blood (usually at very healthy levels) because their bodies manufacture it. |
Processed Foods Avoidance
Increased Legume Consumption| | A study of 9,600 Americans found that those who ate plenty of legumes had lower total cholesterol. Legumes are rich in soluble fiber, which has been shown to help lower total cholesterol and LDL (''bad'') cholesterol levels, the study authors note. [Archives of Internal Medicine 2001;161: pp.2573-8]. |
Grain-free Diet| | It is important to realize that diet is the key to lowering cholesterol levels. Restriction of processed grains, sugars and dairy, and replacing all fluids with water are key. Many doctors are finding large and relatively quick drops (as much as 100 points in several weeks) in people who follow these recommendations.
Minor cholesterol (LDL) reductions can be achieved by adding whole grains (especially oats) to the diet. This may seem confusing! Although moderate grain consumption (due to its fiber content) can lower cholesterol somewhat in some individuals, radical grain restriction may substantially lower cholesterol levels in others. If large reductions are needed or other cholesterol-lowering methods are ineffective, grain and sugar restriction may be the answer. |
Increased Fruit/Vegetable Consumption| | Soluble fiber from fruit pectin has lowered cholesterol levels in most trials. Doctors often recommend that people with elevated cholesterol eat more foods high in soluble fiber. |
Coconut
Smaller, More Frequent Meals| | Controlling cholesterol levels may be a case of not only what is eaten but how often. Men and women who eat six or more times a day have cholesterol levels that are about 5% lower than those of less frequent eaters. The researchers found lower levels of cholesterol in the frequent eaters regardless of their body mass, physical activity or whether they smoked. From other studies we know that a 5% lowering of cholesterol may be associated with a 10% reduction in coronary heart disease risk. [British Medical Journal, Dec 1, 2001] |
Nut and Seed Consumption| | So-called "good fats" that come from raw nuts and seeds are an important part of protecting the cardiovascular system. Pecans, for example, will lower total cholesterol, triglycerides, apolipoprotein B and lipoprotein(a). [A Monounsaturated Fatty Acid Rich Pecan Enriched Diet Favorably Alters the Serum Lipid Profile of HealthyMen and Women, Jnu 2001;131: pp.2275-2279]
Whole almonds or almond oil (replacing half of the habitual fat intake) reduced plasma triglyceride, total and LDL-cholesterol concentrations, and increased HDL-cholesterol levels in a trial of 22 men and women with normal lipid levels. [J Nutr 2002;132(4): pp.703-707] |
High/Increased Fiber Diet| | The fiber supplements of choice for hypercholesterolemia are psyllium, pectin or guar gum. The amount of pectin in approximately two servings of fruit rich in pectin such as pears, apples, grapefruit, and oranges is 15gm. Psyllium or guar gum are obtained by supplement. The RDA for total fiber is 20-30gm. The fiber from whole grains - especially oats - does have a cholesterol-lowering effect, especially in someone on a previously low fiber diet.
Three months of supplementation with ground flax seed at 40gm per day reduced serum total cholesterol in a study of postmenopausal women. [J Clin Endocrinol Metab 2002;87(4): pp.1527-32] |
Soy Isoflavones (genistein, daidzein)| | Soybean isoflavone fraction, which contains primarily genistein, daidzein and glycetein, has been shown to have a hypocholesterolemic effect.
A soy protein isolate reduced total and LDL-cholesterol concentrations in a study of 60 patients with high cholesterol levels. [Eur J Clin Nutr 2002;56(4): pp. 352-35] |
Olive Oil |
Drug |
GHB (Gamma-Hydroxybutyrate)| | In a study of 100 patients at the Warsaw Institute of Hematology, GHB was shown to lower cholesterol levels. |
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Extract |
Policosanol/Octacosanol |
Habits |
Aerobic Exercise |
Mineral |
Selenium
Magnesium
Potassium| | In experiments, potassium-supplemented individuals not only had their high blood pressure reduced but reduced their cholesterol measurements as well, confirming that a deficiency of potassium is associated with hypercholesterolemia. |
Zinc
Manganese
Chromium| | Chromium recently has been shown to lower blood cholesterol while mildly raising HDL (high-density lipoprotein), the good portion of cholesterol. This lowers the risk ratio for coronary artery disease.
Chromium picolinate supplementation at 1,000mcg per day over a 13-week period combined with exercise decreased total cholesterol, LDL cholesterol and insulin levels in a recent small study of both males and females. [J Nutr Biochem, 1998;9: pp.471-475]
Henry Schroeder, MD, who has done numerous studies with chromium, has shown that 2mg of inorganic chromium given daily reduced cholesterol levels by about 15%. |
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Nutrient |
TMG (Tri-methyl-glycine)
Inositol |
Oxygen / Oxidative Therapies |
Ozone / Oxidative Therapy |
Vitamins |
Inositol Hexaniacinate
Vitamin B3 (Niacin)| | Probably the best form of vitamin B3 to use for the purpose of cholesterol reduction is inositol hexoniacinate (flush-free niacin). It is often given at 500mg tid for two weeks, then increased to 1,000mg tid. If using regular niacin, start out with 100mg tid working up to 1,000mg tid with meals.
Niacinamide is not effective for lowering cholesterol. Niacin may also be helpful by transforming small unprotective HDL particles into larger ones which do offer a protective effect to the cardiovascular system. |
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KEY | | Weak or unproven link |  | | Strong or generally accepted link |  | | Proven definite or direct link |  | | Weakly counter-indicative | | | May do some good | | | Likely to help | | | Highly recommended |
GLOSSARY
Alzheimer's Disease (Alzheimer's)
A progressive disease of the middle-aged and elderly, characterized by loss of function and death of nerve cells in several areas of the brain, leading to loss of mental functions such as memory and learning. Alzheimer's disease is the most common cause of dementia.
Arterial (Arteries, Artery)
Blood that leaves the heart. When it leaves the right ventricle, it is venous blood; and when it leaves the left ventricle, through the aorta, it is fresh and oxygenated. After it has passed out to the capillaries and started to return, it is venous blood.
Atherosclerosis
Common form of arteriosclerosis associated with the formation of atheromas which are deposits of yellow plaques containing cholesterol, lipids, and lipophages within the intima and inner media of arteries. This results in a narrowing of the arteries, which reduces the blood and oxygen flow to the heart and brain as well as to other parts of the body and can lead to a heart attack, stroke, or loss of function or gangrene of other tissues.
Bile
A bitter, yellow-green secretion of the liver. Bile is stored in the gallbladder and is released when fat enters the first part of the small intestine (duodenum) in order to aid digestion.
Cardiovascular
Pertaining to the heart and blood vessels.
Choleretic
Agent stimulating the liver to increase bile production.
Cholesterol
A waxy, fat-like substance manufactured in the liver and found in all tissues, it facilitates the transport and absorption of fatty acids. In foods, only animal products contain cholesterol. An excess of cholesterol in the bloodstream can contribute to the development of atherosclerosis.
Chromium
Chromium is a mineral that becomes a part of the glucose tolerance factor (GTF). Chromium aids in insulin utilization and blood sugar control. By controlling blood sugar, chromium helps prevent the damage caused by glucose, which is called glycation. Chromium helps maintain normal cholesterol levels and improves high-density lipoprotein levels. Chromium is also important in building muscle and reducing obesity.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Congestive
Pertaining to accumulation of blood or fluid within a vessel or organ.
C-Reactive Protein (CRP)
A sensitive measure of inflammation in the body.
Cysteine
A nonessential amino acid but may be essential for individuals with certain diseases or nutritional concerns. Cysteine is a sulfur-bearing amino acid with antioxidant properties. It is important for keratin synthesis, a protein found in skin, hair and nails and is a component of coenzyme A and glutathione.
Deciliter (dL)
0.1 or one tenth of a liter.
Diabetes Mellitus (Diabetes, Diabetic, Diabetics)
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Dietary Fiber (Insoluble Fiber, Insoluble Fibers, Soluble Fiber, Soluble Fibers)
There are two types of dietary fiber - soluble and insoluble. Insoluble fiber acts like a sponge; it absorbs water and moves solid waste out of the intestines. It is found mainly in whole grains and on the outside of seeds, fruits, and legumes. Soluble fiber is found in fruits, vegetables, seeds, brown rice, barley, oats and oat bran. It forms a gel when mixed with liquid producing a softer stool. It also prevents and reduces the absorption of certain substances from the intestines into the bloodstream.
Flax (Flax Oil, Flax Seed)
Flax Seed or Flax Oil. Flax oil is nutty-flavored oil that is pressed out of flax seeds and is one of the richest sources of Essential Fatty Acids (EFAs), a vital element for good health. The oil making process removes many of the seed's phytoestrogens which offer several health-related benefits including reducing the risk of cancer and alleviating menopausal symptoms. Many choose to use the whole seed because of its fiber and lignan content. Flaxseed oil is light- and temperature-sensitive and must be stored in the refrigerator.
Gastrointestinal (GI, GI Tract)
Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.
Gout
A disease characterized by an increased blood uric acid level and sudden onset of episodes of acute arthritis.
Gram (gm, gms, Gramme, Grammes, Grams)
A metric unit of weight, there being approximately 28 grams in one ounce.
High-Density Lipoprotein (HDL)
Also known as "good" cholesterol, HDLs are large, dense, protein-fat particles that circulate in the blood picking up already used and unused cholesterol and taking them back to the liver as part of a recycling process. Higher levels of HDLs are associated with a lower risk of cardiovascular disease because the cholesterol is cleared more readily from the blood.
Hypercholesterolemia
Excess cholesterol in the blood.
Hyperlipidemia
Increased cholesterol level: Elevated blood fats, either from heredity, from having so many calories in the diet that they are ending up as liver-synthesized storage fats, from an excessively anabolic metabolism. Also from a constellation of less
common disease causes.
Hypertension
High blood pressure. Hypertension increases the risk of heart attack, stroke, and kidney failure because it adds to the workload of the heart, causing it to enlarge and, over time, to weaken; in addition, it may damage the walls of the arteries.
Hypothyroidism (Hypothyroid)
Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.
Inositol
Usually considered part of the vitamin B complex. It is thought that along with choline, inositol is necessary for the formation of lecithin within the body. Involved in calcium mobilization.
Insulin
A hormone secreted by the pancreas in response to elevated blood glucose levels. Insulin stimulates the liver, muscles, and fat cells to remove glucose from the blood for use or storage.
Lipid (Lipids)
Fat-soluble substances derived from animal or vegetable cells by nonpolar solvents (e.g. ether); the term can include the following types of materials: fatty acids, glycerides, phospholipids, alcohols and waxes.
Lipoproteins (Lipoprotein)
Molecules composed of lipids and proteins that carry fats and cholesterol through the bloodstream.
Liver (Hepatic)
The largest and one of the most complex organs of the body, the liver is responsible for much of the metabolism of fats, proteins and carbohydrates. It is the site of much of the body's detoxification. It is connected very closely with digestion and the regulation of blood sugar, among many other functions. Found behind the ribs on the right side of the abdomen, it has many important functions such as removing harmful material from the blood, making enzymes and bile that help digest food, and converting food into substances needed for life and growth. Hepatic: Pertaining to the liver.
Low-Density Lipoprotein (LDL)
Also known as "bad" cholesterol, LDLs are large, dense, protein-fat particles composed of a moderate proportion of protein and a high proportion of cholesterol. Higher levels of LDLs are associated with a greater risk of cardiovascular disease.
Manganese
An essential mineral found in trace amounts in tissues of the body. Adults normally contain an average of 10 to 20mg of manganese in their bodies, most of which is contained in bone, the liver and the kidneys. Manganese is essential to several critical enzymes necessary for energy production, bone and blood formation, nerve function and protein metabolism. It is involved in the metabolism of fats and glucose, the production of cholesterol and it allows the body to use thiamine and Vitamin E. It is also involved in the building and degrading of proteins and nucleic acid, biogenic amine metabolism, which involves the transmitting of nerve impulses.
Metabolism (Metabolic, Metabolize, Metabolizes, Metabolizing)
The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds. Also defined as the sum total of changes in an organism in order to achieve a balance (homeostasis): Catabolic burns up, anabolic stores and builds up; the sum of their work is metabolism.
Microgram (mcg, Micrograms, ug)
0.000001 or a millionth of a gram.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Monounsaturated Fatty Acid (Monounsaturated Fatty Acids, MUFA, MUFAs)
A Monounsaturated Fatty Acid is missing one pair of hydrogen atoms in the middle of the molecule. The gap is called an "unsaturation". Monounsaturated fatty acids are found mostly in plant and sea foods. Olive oil and canola oil are high in monounsaturated fatty acids.
Niacin (B3, B-3, Niacinamide, Vitamin B3)
A coenzyme B-complex vitamin that assists in the breakdown of carbohydrates, fats and proteins. Essential for the health of the skin, nerves, tongue and digestive system. It is found in every cell of the body and is necessary for energy production. Niacin is also needed for DNA formation.
pH
A measure of an environment's acidity or alkalinity. The more acidic the solution, the lower the pH. For example, a pH of 1 is very acidic; a pH of 7 is neutral; a pH of 14 is very alkaline.
Platelets (Platelet)
Cells that help the blood to clot.
Postmenopause (Postmenopausal)
The postmenopausal phase of a woman's life begins when 12 full months have passed since the last menstrual period and any menopausal symptoms have become milder and/or less frequent.
Potassium
A mineral that serves as an electrolyte and is involved in the balance of fluid within the body. Our bodies contain more than twice as much potassium as sodium (typically 9oz versus 4oz). About 98% of total body potassium is inside our cells. Potassium is the principal cation (positive ion) of the fluid within cells and is important in controlling the activity of the heart, muscles, nervous system and just about every cell in the body. Potassium regulates the water balance and acid-base balance in the blood and tissues. Evidence is showing that potassium is also involved in bone calcification. Potassium is a cofactor in many reactions, especially those involving energy production and muscle building.
Protein (Proteins)
Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Pycnogenol
A trademark for specific bioflavonoids extracted from pine bark.
RDA (RDAs, US RDA, USRDA)
Recommended Daily Allowance of vitamins or other nutrients as determined by the FDA. U.S. RDAs are more widely used than RDAs, and focus on 3 age groups: Infants of 0-12 months; Children of 1-4 years; Adults and children of more than 4 years.
Selenium
An essential element involved primarily in enzymes that are antioxidants. Three selenium- containing enzymes are antioxidant peroxidases and a fourth selenium-containing enzyme is involved in thyroid hormone production. The prostate contains a selenium-containing protein and semen contains relatively large amounts of selenium. Clinical studies show that selenium is important in lowering the risk of several types of cancers. In combination with Vitamin E, selenium aids the production of antibodies and helps maintain a healthy heart. It also aids in the function of the pancreas, provides elasticity to tissues and helps cells defend themselves against damage from oxidation.
Serum
The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.
Statins (Statin)
A class of drugs that lower cholesterol.
Taurine
A nonessential amino acid but may be essential for individuals with certain diseases or nutritional concerns. May be needed for the proper development and maintenance of the central nervous system. Taurine's role in bile formation is important for fat metabolism and blood cholesterol control.
TID
Three times a day.
Triglyceride (Triglycerides)
The main form of fat found in foods and the human body. Containing three fatty acids and one unit of glycerol, triglycerides are stored in adipose cells in the body, which, when broken down, release fatty acids into the blood. Triglycerides are fat storage molecules and are the major lipid component of the diet.
Vegan (Veganism, Vegans)
A person who consumes no animal products of any kind. In other words, vegans do not consume meat, fish, fowl, dairy products, eggs, honey, or products containing gelatin or any other animal-derived ingredients such as whey powder or food colorings.
Vegetarian (Lacto-Ovo-Vegetarian, Vegetarianism, Vegetarians)
A person who consumes no meat, fish or fowl (chicken, turkey, etc.), but who may consume animal products such as dairy products (milk, cheese, butter, etc.), eggs or honey.
Venous
Pertaining to the veins.
Very Low Density Lipids (VLDL)
These are blood transport fats, consisting mainly of triglycerides (made from sugar by the liver) and loosely covered in specialized proteins and phospholipids so they don't dissolve in the blood and the target tissues can recognize them. Chronic elevation occurs when the tissues cannot absorb them or the liver is overwhelmed by carbohydrates, such as in alcoholism, some hepatitis, and diabetes.
Zinc
An essential trace mineral. The functions of zinc are enzymatic. There are over 70 metalloenzymes known to require zinc for their functions. The main biochemicals in which zinc has been found to be necessary include: enzymes and enzymatic function, protein synthesis and carbohydrate metabolism. Zinc is a constituent of insulin and male reproductive fluid. Zinc is necessary for the proper metabolism of alcohol, to get rid of the lactic acid that builds up in working muscles and to transfer it to the lungs. Zinc is involved in the health of the immune system, assists vitamin A utilization and is involved in the formation of bone and teeth.
Last updated: Apr 13, 2008
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