Cholesterol in General

General Information
Cholesterol and the associated problems that it causes in arterial blood vessels are a concern of adults living in developed countries. It is a preventable and treatable cause of vascular disease. The first changes in the walls of the arteries begin to occur in the teenage years. Many seniors feel that by their fifties, the benefits of preventive treatment are trivial. This is not true. Benefits from dietary reduction in cholesterol accrue to both the older and younger patient.

Arteriosclerosis (hardening and narrowing of the arteries) related to elevated cholesterol levels in the blood progresses if the blood cholesterol remains elevated. This progression can be stopped. Lowering the levels of cholesterol in the blood can slow and at times arrest the further deposition of fat in the walls of the arteries. There is excellent evidence that some of these changes in the walls of the arteries are reversible with stringent dietary management.

Not only does arteriosclerosis narrow the arterial passages but the fatty deposits may split open or ulcerate, causing a clot to form. A clot of this sort may cause sudden occlusion of the artery. Lowering of the levels of one kind of cholesterol in the blood seems to prevent the development of these splits and ulcers. These are excellent reasons for seniors to be concerned with maintaining a normal blood cholesterol level.

Many patients participate in cholesterol screening programs. These programs use small quantities of blood, often from a simple finger stick, for a rapid test for cholesterol. However, a screening test showing an elevated level is not adequate to permit the diagnosis of elevated blood cholesterol. This is only an indication that a careful test for the various forms of cholesterol in the blood should be done. In patients with borderline levels, several tests may be needed to be sure of the elevation in the cholesterol. Do not undertake treatment with lifestyle modification or powerful drugs, or both, unless the diagnosis of elevated cholesterol is clearly and carefully made.

Cholesterol is a kind of fat. Like all other fats, it mixes poorly with water (or blood). In the blood it attaches to a carrier. There are several kinds of carriers. The simple test for cholesterol measures the total cholesterol in all the carriers. Your physician may order additional tests to measure the amount of cholesterol associated with each different carrier. The cholesterol associated with one carrier, HDL (high-density lipoprotein), seems to prevent the development of arteriosclerosis. The cholesterol associated with two of the carriers, LDL (low-density lipoprotein) and VLDL (very low-density lipoprotein), seems to be associated with promoting the development of arteriosclerosis. Your physician needs to know the kind of cholesterol present before deciding if it is necessary to begin a cholesterol-lowering program.

Important Points in Treatment
The lowering of blood cholesterol can be accomplished by changes in diet and by administration of cholesterol lowering drugs. Except in patients with very high levels of cholesterol, change in the diet is the preferred initial therapy. Dietary changes cause few if any side effects and complications, whereas the drugs used are powerful agents and can cause side effects.

Most adults eat a diet set by custom and lifelong habit. The dietary changes necessary to lower blood cholesterol are major and extensive and require a change in lifelong eating habits. The usual reason for a diet’s failure to lower blood cholesterol levels is that it is not rigorously and carefully followed. Drug therapy to lower blood cholesterol should always be added to a program of an adequate diet, never substituted for dietary indiscretions.

If you are having problems with your diet, ask your physician for help. Excellent diet books, often with recipes, are available. Books also can be obtained with lists of fat and cholesterol content of prepared and restaurant foods that can help you maintain a diet program at home and when eating out. In selected cases, a discussion with a dietitian may be necessary.