Controlling Cholesterol For Dummies

By Carol Ann Rinzler and Martin W. Graf

The latest ways to lower cholesterol and reduce the risk of heart disease

Need to get your cholesterol in check? You’ll find the latest information about cholesterol, including treatments, drug information, and dietary advice, in Controlling Cholesterol For Dummies, 2nd Edition, an easy-to-understand guide to cholesterol control. You’ll learn how to lower your numbers and maintain healthy cholesterol levels. You’ll also find out how to eat and exercise properly, use vitamins and supplements, and quit unhealthy habits.

You’ll find out cholesterol’s positive functions and why too much can be a bad thing. You can also assess your cholesterol risk by taking your age, sex, ethnicity, and family history into consideration. Find out what you need to ask your doctor about stress tests, ECBT, and angiograms to check for plaque buildup. Design a cholesterol-crushing diet and understand which foods can help you lower your numbers. Find out how smoking, alcohol, exercise, excess weight, supplements, and prescription medications affect your cholesterol levels. Find out how to:

• Assess your cholesterol risk
• Understand the benefits and risks associated with cholesterol
• Design and adhere to a cholesterol-lowering diet
• Avoid dangerous drugs
• Reduce your risk of heart attack
• Choose fats and fibers correctly
• Check for plaque buildup

Complete with lists of ten important cholesterol websites, ten nutrition websites, ten cholesterol myths, ten landmarks in cholesterol history, ten foods that raise your cholesterol, and ten foods that lower your cholesterol, Controlling Cholesterol For Dummies, 2nd Edition will help keep your cholesterol levels under control for good!

• Language: English
• Publisher: Wiley
• Release date: Apr 27, 2011
• ISBN: 9781118052242

Book preview

Part I

Getting Up Close and Personal with Cholesterol

In this part . . .

To do the best job of controlling your cholesterol, you need to have a handle on the basics — info such as what cholesterol is, where it comes from, what it does, and why some varieties are more threatening than others. And being a Serious Seeker of Knowledge, you probably want to be able to perform a realistic evaluation of your own risk of developing cholesterol-related problems. The info you need is right here in this part. Go for it.

Chapter 1

Mapping the Heart Land

In This Chapter

bullet Picturing your heart

bullet Quantifying heart disease and tracking the stats on heart attacks

bullet Setting a sensible strategy to cut your personal risk

Heart disease is America’s number one health killer; it’s ahead of every type of cancer combined and every infectious and degenerative disease. Heart attack is the most common form of heart disease, and one significant risk factor for heart attack is high cholesterol or, more specifically, a high level of certain kinds of low-density lipoproteins (LDLs) — the bad fat and protein particles that ferry cholesterol into your arteries.

If you already know all this introductory stuff, feel free to skip Chapter 1 and head right into Chapter 2 where I describe cholesterol’s dual nature (yes, cholesterol has two sides).

But, then again, this chapter does lay out a statistical picture of heart disease and heart attack and explain the role cholesterol plays in placing you at risk. In fact, come to think of it, this chapter is a darn good intro to Controlling Cholesterol For Dummies, 2nd Edition.

No surprise there!

Ladies and Gentlemen, Meet Your Heart

Your heart is a pretty spectacular organ — a four-chambered, hollow muscle right smack in the middle of your chest. The heart’s job is to pump the blood that carries life-giving oxygen and other nutrients to every body tissue. To show how this works, the clever For Dummies artists have drawn a cross section of your heart in Figure 1-1 tracing the path of blood flowing in and out and in and out and in . . . you get the idea.

TechnicalStuff

Every second of every minute of every hour of every day, blood flows out from your heart to carry oxygen and other nutrients to every tissue and organ in your body, and then comes back to your heart to pick up more oxygen and nutrients. In other words, blood circulates, which is why your heart and the vessels through which blood travels are called the circulatory system.

The best way to explain this process is to begin at the beginning, the point at which blood flows back from your body, into your heart:

1. The blood enters your heart from the superior vena cava, a large vein that opens into the right atrium, the first chamber of your heart.

Tip

Yes, the vena cava and the right atrium are on the left side of the picture above. In this picture, you’re looking at the front of the heart as it sits in the chest of the person to whom it belongs. If he were to turn around so that you were looking at him from the back, the vena cava and the right atrium would be in the correct position, on the right side of his body. Got it? Good. Onward.

Naming the blood vessels

Blood vessels are grouped according to the job they perform in your body, which means they’re grouped in terms of whether they carry blood to your heart or away from your heart. This list explains how the groupings work:

bullet Veins: Blood vessels that carry blood toward your heart. The word vein comes from vena, the Latin word for hollow.

bullet Venules: Small veins.

bullet Capillaries: Teensy, little veins that connect arteries to veins right under the skin. When blood flows into your capillaries, the red liquid under the skin gives you a rosy glow — a blush.

bullet Arteries: Blood vessels that carry blood away from your heart. The word artery comes from arteria, the Latin word for windpipe.

bullet Arterioles: Very small arteries.

I have no idea why the person who named the blood vessels picked a word that means hollow for veins and a word that means windpipe for arteries. If it were up to me, I would’ve used a word that means bring to for veins, and a word that means go away from for arteries.

In fact, the words afferent (from the Latin ad = toward and ferro = carry) and efferent (ferro plus the Latin ex = away) are used to describe, respectively, nerves that carry impulses to or away from the central nervous system. Maybe whoever named the blood vessels picked veins and arteries because afferent and efferent were already taken. Works for me.

2. From the right atrium, blood spills down through a one-way trapdoor called the tricuspid valve and into the right ventricle.

3. When the right ventricle contracts (squeezes together), the blood is sent out of your heart through the pulmonary artery and into your lungs where it picks up a plentiful supply of oxygen.

4. The newly oxygenated blood flows back into your heart through the pulmonary vein into the left atrium.

5. Then the blood spills down through a second one-way trapdoor called the mitral valve and into the left ventricle.

6. When the left ventricle contracts, blood is pushed up through the large artery called the aorta and out into your body.

In real life, as opposed to a drawing, the right atrium and the left atrium receive blood simultaneously from the vena cava and the pulmonary vein respectively. The right and the left atria (plural for atrium) contract simultaneously to send blood down through the tricuspid valve and the mitral valve respectively. And the right and left ventricles contract simultaneously to push blood up into the pulmonary artery and the aorta respectively. All this without missing a beat. Hey, I told you this was a spectacular organ!

TechnicalStuff

Talking heart disease

The phrase cardiovascular disease (CVD) means all medical conditions affecting the heart and blood vessels. CVD includes heart attack, high blood pressure, stroke, rheumatic heart disease, congenital defects, and congestive heart failure.

Coronary artery disease (CAD) or coronary heart disease (CHD) means conditions affecting the heart and its major blood vessels — heart attack and angina pectoris (chest pain due to narrowed blood vessels).

Myocardial infarction (myo = muscle, cardio = heart, infarction = blockage) is the formal name for a heart attack. The name pretty much describes what happens, but you can read all the truly excruciating details in Chapter 2.

Attack of the Killer Heart Disease

Heart disease is the leading killer of Americans, and heart attacks are the most common form of heart disease. But you don’t have to take my word for it. Many U.S. government agencies, including the Centers for Disease Control and Prevention and the National Center for Health Statistics, have piled up a ton of stats and translated all the numbers into dozens of charts to show exactly how lethal heart disease can be.

Heart disease versus everything else

First things first. Table 1-1 lists the ten leading causes of death in the United States for 2004. See what’s in first place? Check it out. Note: Stroke, a form of cardiovascular disease known medically as cerebrovascular disease, is counted as a separate category.

Table 1-1Table 1-1

Heart disease versus heart attack

The United States isn’t alone in its battle with cardiovascular disease (CVD) and coronary heart disease (CHD) — heart attack. According to the World Health Organization (WHO), CVD and CHD are the Numero Uno nasties around the globe. Grouping the rich countries, poor countries, and countries in-between, WHO statisticians discovered one common thread: Heart disease kills more people every year than any other illness or medical condition.

Table 1-2 lays out the WHO statistics for causes of death in 2002 and the predicted figures for 2005. Some points of interest in these figures are as follows:

bullet Yes, as you read this, 2005 is already several years in the past, and 2002 is practically ancient history. But as every math major knows, in the statistics game, several years must pass before you can gather all the numbers you need to draw a firm conclusion. Hence the lag time.

bullet Yes, the percentage of the world’s population that succumbs to the various forms of cancer is lower than the percentage in the United States. Why? Because in many poor countries, so many infants die at birth or expire young of preventable illnesses that there are fewer people who grow old enough to develop and eventually die of illnesses of older age, such as cancer or Alzheimer’s disease.

Table 1-2

Getting to the Point of This Book

Congratulations! By plunking down some of your hard-earned cash for a copy of Controlling Cholesterol For Dummies, 2nd Edition, (or borrowing it from a smart friend), you’ve made a commitment to, well, try to control your cholesterol before it controls you.

And, by slogging your way through a discussion of how your heart works and a slew of charts with figures proving what I bet you already knew — heart disease and heart attack send a great many folks to their ultimate reward — you’ve shown just how serious you are about getting a handle on those nasty cholesterol numbers. As a reward, now, by gosh, you’ve reached the heart of the matter: cholesterol.

Why counting cholesterol numbers counts

In the past half century, literally hundreds of well-run scientific studies, run by thousands of different researchers in dozens of different countries, have shown beyond a shadow of a doubt that having high cholesterol — specifically, high levels of LDLs, particularly the smaller ones described in Chapter 2 — is a strong warning that Mr. Heart Disease and Ms. Heart Attack are lying in wait somewhere in the future. Luckily, a similar long list of studies shows that what you eat and how you live your life to stay fit and relatively trim can help reduce your risk

How to control your cholesterol risks

What you eat and drink plays an important role in controlling your cholesterol, as I explain in Part II of this book. So does maintaining a healthful weight, engaging in a realistic exercise program, and avoiding tobacco (in all its ugly forms) — three subjects covered in Part III. And if these basic first steps don’t do the job, cholesterol-lowering medications, discussed in Part IV, offer yet another option.

Each of these methods for lowering your cholesterol — diet, weight control, exercise, and medicines — has its own chapter (or two or three) in this book. As a health-conscious consumer, you get to pick and choose among them — like a gourmet at a gorgeous buffet table. A low-fat, low-cholesterol buffet table, of course. After which you can relax with the grab bag of factoids and funny stuff in Part V — the well-known For Dummies Part of Tens.

Go for it. Your heart will thank you.

Chapter 2

Comparing Cholesterol’s Risks and Benefits

In This Chapter

bullet Locating the cholesterol in the human body

bullet Proving that cholesterol has a good side

bullet Confirming cholesterol’s risks

bullet Identifying other harmful compounds in your blood

bullet Mastering CPR

This chapter starts off by covering the ways in which your body uses cholesterol for everything from powering your brain to building your sex hormones. Then — fair is fair — you can find out why something so good can also be hazardous to your heart health.

Finally, because cholesterol isn’t the only bad guy to be found in your blood, I provide you with a short description of some of the other unhealthy criminals floating through your bloodstream.

After you’ve made your way through the heavy stuff, reward yourself with a bit of fun by taking the heart art quiz at the end of this chapter. The quiz asks you to match literary, musical, and other heart-related titles with their authors.

Shaking Hands with Cholesterol

Cholesterol is the Dr. Jekyll and Mr. Hyde of the nutrition world. This fat-like substance is both essential for your healthy body and potentially hazardous to your heart.

Making the most of cholesterol’s Jekyll-like good characteristics while counteracting its Hyde-like bad impulses can be a delicate but not impos- sible balancing act. The task begins with understanding how and where cholesterol does its good work and how and where it can cause problems. Begin your mission, in the true scientific spirit, at the beginning.

Double trouble

The split-personality title character in Robert Louis Stevenson’s novel, The Strange Case of Dr. Jekyll and Mr. Hyde (1886), embodies both good and evil — the two sides of human nature. (Pop quiz: Which personality is the good guy? Which one isn’t? See the end of this sidebar for the answers.)

This sort of duality isn’t uncommon in religion, philosophy, and literature. For example, the Aztec god Quetzalcoatl was both male and female. And Janus, the Roman god of doors, had two faces, one in the front of his head and one in back, because every door faces two ways — in and out. By the way, Janus is the namesake of January, the door to the New Year.

The Chinese symbol of two-sidedness is the yin and the yang. The yin symbolizes the female, and the yang stands for the male. The yin and yang also symbolize the coexistence of other opposing concepts, such as life and death, good and evil, black and white, and love and hate. What makes this even more interesting is the fact that the word yin, which sounds totally non-Western, is a variant on the Scottish word for one.

So, you can see that cholesterol has some company when it comes to having two sides to a story. And Jekyll is the good guy; Hyde isn’t.

Where cholesterol comes from

Yes, you get some cholesterol from food, but the curious fact is that most of the cholesterol in your blood and body tissues is produced right in your very own liver. Your liver uses the proteins, fats, and carbohydrates in food to manufacture and churn out about 1 gram (1,000 milligrams) of cholesterol a day.

How cholesterol travels around your body

Whether your cholesterol comes from food or your liver, it travels through your bloodstream in particles called lipoproteins, a name derived from lipos (the Greek word for fat) and protos (Greek for first or most important).

The fatty substances in lipoproteins include cholesterol and triglycerides, the most common fatty substance in the human body (more about triglycerides in the section Focusing on Other Blood Baddies). The proteins that combine with fats to produce lipoproteins are called apolipoproteins, often abbreviated as apo.

Lipoproteins develop through five distinct phases as they mature into the particles that carry cholesterol around your body:

bullet Phase 1: Chylomicrons

bullet Phase 2: Very low-density lipoproteins (VLDLs)

bullet Phase 3: Intermediate-density lipoproteins (IDLs)

bullet Phase 4: Low-density lipoproteins (LDLs)

bullet Phase 5: High-density lipoproteins (HDLs)

How does a chylomicron become a VLDL, then an IDL, then an LDL, and finally, maybe, an HDL? The following roadmap marks the route.

Bringing up baby lipoproteins

A lipoprotein is born as a chylomicron, a particle that your intestinal cells assemble from the proteins and fats you eat. Chylomicrons are very, very low-density particles.

Remember

Why are some lipoproteins called low-density and others high-density?

bullet The term density refers to a lipoprotein’s weight.

bullet Protein weighs more than fat.

bullet Lipoproteins containing proportionately less protein than fat are low-density lipoproteins, also known as LDLs. LDLs are the bad particles that carry cholesterol into your arteries.

bullet Lipoproteins containing proportionately more protein than fat are high-density lipoproteins, also known as HDLs. HDLs are the good particles that ferry cholesterol out of your body.

Now, back to chylomicrons. These lipoproteins start out with very little protein and a lot of light and fluffy fat and cholesterol. But as they flow through your bloodstream from your intestines on their way to your liver (your body’s lipoprotein factory), the chylomicrons release their fats, known as triglycerides, into your blood.

The stripped-down chylomicron, also known as a chylomicron remnant, still has its cholesterol and protein. Now, the remnant slides into your liver, and fat comes back into the picture.

Moving through the fat factory

As anyone who has ever read a nutrient chart knows, liver (as a food) is very high in fat and cholesterol. In fact, your liver is a veritable fat and cholesterol factory that collects fat fragments from your blood and uses them to make cholesterol and new fats that your body can use to build tissue and perform other physiological functions.

The next few sections explain exactly how lipoproteins are made.

Putting the fats in lipoproteins (and taking them out again)

When the chylomicron hits the liver, it picks up fat particles and mutates into the largest kind of lipoprotein, a fluffy particle called a very low-density lipoprotein (VLDL).

Then your liver sends the VLDL out into the wide world — your body. As the VLDL travels far and wide, it drops globs of fat, picks up globs of cholesterol, and changes into a slightly smaller, heavier particle called an intermediate low-density lipoprotein (IDL), and then a slightly smaller, heavier low-density lipoprotein (LDL).

The last step in the transformation of the baby lipoprotein (the chylomicron) occurs when an LDL has dropped so much fat and cholesterol into body tissue that it’s mostly protein. Now, you’re looking at a high-density lipoprotein (HDL).

Naming the proteins in lipoproteins

The primary proteins in VLDLs, IDLs, and LDLs belong to a class of apolipoproteins called apoB. The primary proteins in HDLs belong to a class of apolipoproteins called apoA. Other less prominent apolipoproteins found in lipoproteins are apoC and apoE .

TechnicalStuff

You may have heard about a blood test for apoA; this test is interesting because a high level of apoA indicates a high level of protective HDLs (the good particles that haul cholesterol out of your body).

Pinning a blue ribbon on good lipoproteins

HDLs truly deserve the name good cholesterol. These particles don’t carry cholesterol into your arteries for the simple reason that they’re so compact and dense that they can’t squeeze through the spaces in the walls of your arteries. As a result, HDLs — and their cholesterol — travel away from your arteries and out of your body with the rest of your, um, solid waste.

What a neat set of facts to park in the back of your brain for the next time you’re at a party and someone asks you to explain the differences between VLDLs, IDLs, LDLs, and HDLs. Well, you can say, it’s all a question of density, which, as you know, means. . . . Don’t you just love being the smartest kid in class?

The good news about HDLs

You can think of HDLs as scavenger molecules that remove cholesterol from the arteries. Having a lot of HDLs reduces your risk of heart attack regardless of your total cholesterol levels.

In fact, X-ray studies have shown that people who raise their HDLs by exercising, stopping smoking, or taking medication not only reduce the cholesterol in the arteries but also remove the plaque — thus opening the arteries.

Having read that paragraph carefully, you may assume that all LDLs are bad guys, right? Wrong.

With LDLs, size may make all the