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June 11 , 2001
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Beyond Cholesterol
Half of the nation's 1.5 million heart attacks each year strike people with normal levels of cholesterol.
By H. Robert Superko, MD, FACC
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Standard testing and treatment of coronary heart disease (CHD) is largely concerned with measuring LDL cholesterol, the "bad cholesterol," and HDL cholesterol, the "good cholesterol." But, commenting on emerging factors for CHD, Dr. Superko notes that "normal cholesterol levels do not necessarily reflect low risk. Blood fat assessment of heart attack risk now requires more than just the standard blood cholesterol measurements."
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Focusing attention only on high blood cholesterol ignores 50 to 80 percent of the people who will develop heart disease. Recent studies have shown that it is not just the number of cholesterol particles that determines risk for heart disease, but also the size of these particles. Small, dense LDL are the bad guys that squeeze into the lining of arteries, damage blood vessel walls, lead to the buildup of plaque, and create the possibility of blood clot formation."
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For example, excess small LDL "helps explain approximately 50 percent of people who suffer a heart attack yet have 'normal' blood LDL levels. Similarly there are five HDL sub-types and one of these (HDL IIb) appears to be the best-of-the-best and high levels are associated with a lower risk of heart disease."
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What can you do? Dr. Superko recommends that you consult with your physician for an advanced cardiovascular risk assessment and personalized treatment plan. "Each individual has a unique set of risk factors and treatment must be matched to individual characteristics. The same treatment is not appropriate for all people."
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