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. In a country ravaged by heart disease, 50% of those who have heart attacks do NOT have elevated cholesterol. Although an elevated total cholesterol 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]

Elevated cholesterol levels have been seen in atherosclerosis, diabetes, hypothyroidism and pregnancy.

Here are several statistics about total cholesterol:

1. Among middle-aged men, 9%-12% of those men with cholesterol at 240mg/dL or greater will develop symptomatic CHD over the next 7-9 years. The problem is, however, that amongst men who do develop CHD, the majority also had one or more other risk factors that predispose them to developing CHD.
2. Mortality is greatest in men over the age of 45 and specifically in those men who smoked or had elevated blood pressure along with elevated total cholesterol.
3. Highest mortality occurrs in men who have total cholesterols greater than 300mg/dL.
4. Women generally have about one-half the CHD risk as men for the same cholesterol levels.
5. 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.
6. 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.

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. When LDL becomes oxidized, it is considered to be in its most dangerous forn. Tests for oxidized LDL are just now becoming available.

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.

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