Understanding Heart Disease and Cholesterol

Cholesterol is not bad. In fact cholesterol is necessary for normal body functioning. The concern only comes into play when cholesterol levels are too high or not in balance.

What is cholesterol? Cholesterol is packaged in a special molecule called lipoprotein that allows cholesterol  to move around the body. There are numerous lipoproteins and subtypes, including LDL, HDL,VLDL and their associated sub-particles.

The LDL or bad cholesterols are packaged and processed within the liver. From the liver they are transported and delivered anywhere in the body that it is needed. Inside of the blood vessels, the LDL packages are then unwrapped as they find their way inside the wall of the blood vessel, where LDLs cause damage to the walls of the blood vessel.

The HDL’s or good cholesterol are designed to remove excess  LDL’s and carry them back to the liver where its either recycled or eliminated. Problems occur when there are not enough HDL’s to carry LDL cholesterol back to the liver.

The LDL-cholesterol accumulates in your body, creating an environment where your body is vulnerable to plaque deposit build up. This is the process that leads to heart disease. Normally blood vessels have very slippery linings called the endothelium.  It’s very smooth and offers very little resistance to the blood flowing through the vessels. Problems develop when the surface of the endothelium is damaged or blockages develop inside of the blood vessel.  The cause of the damage to the blood vessel wall creates a microscopic tear.  High blood pressure, stress, smoking, diabetes and abnormally high cholesterol can cause this localized damage.

It is through this microscopic crack that LDL’s find a way through the surface of the blood vessel and migrate into the middle layers. They lodge into the middle layer of the blood vessel called the media. This is where these cholesterol packed cells begin the inflammatory process. It is like a blowfish that expands and irritates the inside of the vessel. These excess LDL particles migrate through the wall of the blood vessel and settle in the middle layers. The particles become inflamed causing injury to the inside of the blood vessel.

Natural cholesterol lowering agents, Coenzyme Q-10, selenium, and Policosanol are also effective in reducing this inflammation inside blood vessels and thus the development of heart disease.

Your body tries to fight this reaction which ends up causing the development of essentially scar tissue. The scar tissue narrows the blood vessel ultimately reducing the ability of the blood vessel to carry sufficient blood to the critical areas that need it. In addition, the surface where the crack occurs can set off a reaction where blood clots develop inside of the blood vessel. This results in the sudden and complete blockage of all blood flow to the heart or other vital organs.

Ideally we would like to reduce these bad LDL cholesterol molecules that burrow deep into the wall of the blood vessel. We would also want to increase the number of scavenging HDL’s to remove the excess bad cholesterol from the blood vessel before it causes a problem.

The process that leads to coronary artery disease and a heart attack involve a complex sequence of events.  First there has to be some kind of abnormality in your cholesterol metabolism causing high cholesterol levels, specifically the LDL’s. Then there has to be inflammation of the endothelium allowing LDL cholesterol to penetrate the blood vessel wall. If left untreated, this inflammation can lead to one of the various causes of heart attacks and strokes.

The incidence of elevated cholesterol is staggering. Over 105 million American adults have total cholesterol over 200 mg/dl, and 37 million have levels greater than 240 mg/dl. Don’t be passive! If your cholesterol levels are high, see your Doctor and take action. Don’t wait until it is too late. The sad fact is that the first sign of heart disease is often a heart attack or stroke.

Authored by:

Robert G. Carlson, MD FACS

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