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Cholesterol metabolism is a very complicated field. 

Lipids are the different forms of fat and cholesterol which perform a variety of functions within human physiology. There are many different types and subtypes of lipid particles, each with different yet interrelated functions and effects.  There is much basic science that’s not well understood. 

When this basic science is applied to the clinical care of patients, many more complicated issues arise.  The role of various lipid particles in contributing to atherosclerosis, the underlying cause of heart attacks and strokes, is still being determined.  It’s well-documented that many patients who have heart attacks or strokes have normal traditional lipid levels, which illustrates the fact that there are many other factors at work in determining whether your arteries become clogged with plaques and you subsequently suffer a heart attack or stroke.

The media coverage of cholesterol reflects this complexity, and is filled with confusing and conflicting reports of benefits and risks associated with cholesterol levels, as well as the diets, supplements, and (especially) the drugs used to modify lipid levels. The drug companies and supplement makers constantly run adds which sometimes seem contradictory.

For many people like yourself, it’s all very confusing.

Let me make it simple for you.  While there is much that’s not known when it comes to cholesterol, there is one statement that is as rock solid as any truth in all of medicine.  Write this down, and commit it to memory.  I promise, you can take it to the bank.

If your lipid levels are not ideal, you can dramatically lower your risk of heart attack, stroke, and death by optimizing your cholesterol numbers with diet, drugs, or both.

That statement has been proven over and over again.  There are so many large, powerful, well-designed studies demonstrating the truth of that statement that it is preposterous to argue otherwise at this point. 

Now the details we can squabble about.  We can debate the best diet and exercise program to help improve your lipid levels, or the best drug to use to optimize your levels, or whether various supplements are effective.  But the statement above is really beyond question.  There are a multitude of studies all of which have shown remarkably consistent results supporting that statement.  High risk patients, low risk patients, young, old, men, women, diabetics, smokers - every group ever studied has benefited from having their cholesterol levels optimized.

In future posts we’ll delve a lot more into the details and implications surrounding this statement.  We can talk about optimal cholesterol levels, diet, drugs, exercise, side effects of various treatments, various cholesterol subtypes, supplements, etc.  But in all those discussions, keep that statement in mind.  Since more people die in this country of heart attacks and strokes than of any other single cause, anything you can do to lower your risk for atherosclerosis is of critical importance.  If you’re interested in improving your expected longevity or life odds, then you need to be mindful of your cholesterol levels.  If they’re not in the optimal range, you should be constantly working on a strategy with your physician to get them there.