What You Need to Know About Cholesterol, Cholesterol Testing, and Cholesterol Medications

Cholesterol is one of the most common of all health concerns, but if we are pressed on the question of “What is cholesterol?” most of us would have to answer “Something we need to lower.” The fact is, cholesterol is essential to every cell in the human body, and every cell in the human body can make at least part of its supply.

Why getting enough cholesterol is as important to your health as avoiding too much. The principle use of cholesterol is as a building material for the membranes that surround cells. Cholesterol is a fatty, waxy substance that isn’t soluble in water. The bloodstream, on the other hand, is mostly water. Without cholesterol in the cell membranes, the contents inside cells would dissolve into the blood. Cholesterol helps cells build flexible membranes that allow them to bend and stretch as necessary, keeping their contents safe.

Cholesterol is also a building block of most hormones and also of vitamin D. The cholesterol content of the adrenal glands and sex organs, which make hormones, and the skin, which makes vitamin D, is especially high.

The greatest part of the body’s cholesterol, however, is made in the liver. Only about 15% of all the cholesterol the body uses is digested from food. The other 85% is assembled from triglycerides and fatty acids, and about 50% of the body’s cholesterol is recycled.

The differences between VLDL, LDL, and HDL cholesterol. Recycling is the process that creates VLDL, LDL, and HDL cholesterol. The abbreviations stand for very low-density lipoprotein, low-density lipoprotein, and high-density lipoprotein. The lipoproteins surround cholesterol so it can travel in the bloodstream. A very low-density lipoprotein surrounds a relatively large particle of cholesterol. A low-density lipoprotein surrounds a somewhat smaller, somewhat denser cholesterol particle, and a high-density lipoprotein surrounds the “nugget” of cholesterol that remains after cells siphon off the cholesterol they need.

The liver uses HDL cholesterol to regenerate VLDL cholesterol by adding new layers of light, fluffy cholesterol to the HDL core. Then the VLDL travels through the body until it is used up, captured by the liver as LDL, or returns as HDL once again.

Before scientists knew about the differences between VLDL and LDL cholesterol, they assumed that the larger particles of LDL cholesterol somehow got stuck in blood vessels, causing plaques, and the smaller HDL particles of cholesterol eased through small passageways and did not cause atherosclerosis. It turned out that cholesterol plaques aren’t really 100% cholesterol.

What really causes clogged arteries. The cholesterol plaque that clogs an artery is actually made of both cholesterol and dead white blood cells. The white blood cells that destroy bacteria also use cholesterol as fuel, “swallowing” either bacteria or cholesterol whole. VLDL cholesterol is too large for these white blood cells to surround and absorb, and HDL is too small to meet their energy needs.

The larger particles of LDL attract these white blood cells where they need to go to kill bacteria, but they are too large to be absorbed. The smaller particles of LDL are just the right size for the macrophages to use as an energy source.

When a macrophage feeds on LDL in the lining of a blood vessel, sometimes it gets “stuck.” This depends on other factors, including the presence or absence of antioxidants in the bloodstream. The macrophage can live out its life cycle and die, still stuck in the blood vessel’s wall. Then other macrophages can come to attempt to remove it and also get stuck themselves.

The mass of macrophages and cholesterol can calcify and form a plaque. But without the action of the immune system, LDL cholesterol does not cause arteries to narrow, and not all LDL cholesterol is harmful.

The cholesterol tests that really count. Medical researchers and many doctors have been aware of this phenomenon for over 30 years-but little attempt has been made to educate the public because the old ways of measuring LDL and HDL cholesterol make a “good guess” of cardiovascular risk.

To really know an individual’s risk of cardiovascular disease, however, it is best to measure the ratio of the particles of protein attached to the atherosclerosis-causing, smaller particles of LDL, compared to the particles of protein attached to the larger, harmless particles of LDL.

These two lipoproteins are known as apo-B (the harmful one) and apo-A (the harmless one). Changes in these two proteins are what really give you protection from heart disease, not changes in LDL and HDL. However, many cholesterol medicines that are described in terms of what they to do LDL and HDL actually change the ratio of apo-B and apo-A.

What you need to do for good cardiovascular health. The realities of how cholesterol relates to the risk of heart disease make a huge difference in the validity of cholesterol medicines, cholesterol testing, cholesterol charts, and how doctors honestly answer the question “What causes high cholesterol?” The most up-to-date way to use natural methods or medication to reduce the risk of heart disease includes not just appropriate cholesterol testing, but also control of blood pressure, triglycerides, and inflammation though medication, cholesterol control diets, and cholesterol-lowering foods.