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Johns Hopkins Health - Cholesterol’s Bigger Picture

Winter 2015
Issue No. 27

Cholesterol’s Bigger Picture

Date: January 6, 2015

man tying his gym shoes

Simply knowing your numbers won’t tell you the whole story about your health. Johns Hopkins cardiologist Steven Jones, M.D., fills in some details

I keep hearing that I need to keep my cholesterol in a certain range. Why is that important?

Actually, the numbers aren’t as important as you might think. People who have high cholesterol levels might be in great health, while people who have what experts consider optimal cholesterol levels might be at risk for a heart attack. Cholesterol is only one aspect of your health, which is why you need a doctor to evaluate all the measures of health to get a complete picture.

Does that mean cholesterol isn’t important?

Not at all. Cholesterol is necessary in your body—it’s used to make hormones, for example. It’s not inherently bad or good. Cholesterol is a constituent of a diverse group of lipoproteins, which are microscopic particles of fats and proteins. The majority of cholesterol in your body is made in your liver, and it gets carried around your body by lipoproteins. Some of these lipoproteins are associated with more favorable health and a lower risk of heart attacks.

Is that why people talk about “good” and “bad” cholesterol?

To some degree, yes, but it’s misleading to throw all the different lipoproteins into one bucket called “cholesterol.” There is the high-density lipoprotein we call HDL, which has anti-inflammatory and antioxidant effects, so it’s generally considered “good cholesterol.” HDL also serves as the body’s janitorial service, cleaning up unwanted cholesterol in the arteries. The non-HDL variety is like a delivery truck from the liver that goes out in the bloodstream to deliver cholesterol, triglycerides and other molecules that are essential to the body’s cells. After everything is delivered, what’s left is low-density lipoprotein, or LDL, which is often called “bad cholesterol.”

So if I want to make sure my arteries don’t get clogged and cause a heart attack, do I need to watch my cholesterol?

What’s most important is correcting preventable behaviors that can lead to a heart attack, such as being overweight, smoking, eating a poor diet and not exercising. It’s also important to keep your blood pressure and blood glucose levels under control. Although cholesterol-lowering drugs often help people at risk for heart disease, they won’t do much good if you don’t address the lifestyle and controllable risk factors.

Putting Advice Into Action

Cardiologist Roger Blumenthal, M.D., gives helpful tips to lower cholesterol and improve overall health in “Cholesterol: The Good, the Bad and the Ugly.” Watch now