To worry about your cholesterol. And we internists are professional worriers. But at least in this case, for good reason. High cholesterol and the many health conditions associated with it, are big-time killers in this country, responsible in some degree for diseases that kill 50% of people in western cultures. Coronary artery disease, stroke, peripheral vascular disease, kidney failure and diabetes are just a few of these conditions.

The basic problem behind most cholesterol related diseases is atherosclerosis. The Greek root “athero” means paste or gruel, “sclerosis” means hard. Does that make you hungry? Probably not for gruel, though ironically “gruel”, which in my family was porridge, usually with oatmeal, is ANTI-atherosclerotic. Etymology aside, high levels of cholesterol promote arterial hardening, which leads to diminished blood flow to the heart, brain, kidneys, in fact virtually everywhere. This often starts in childhood.

Like most medical issues, this one is not simple. There are other variables besides one's cholesterol which influence the presence and degree of atherosclerosis: family history, blood pressure, weight and so on. Even cholesterol itself is complex, being made up of several subtypes, one of which is actually beneficial. We've all been buttonholed by a wiseguy who tells us how his “Auntie Marion died at 99, lived on butter, and who's cholesterol was over 300,” all while mowing down a plate of wings dipped in bleu cheese dressing. Nod politely and realize that your tormenter is probably missing a few key facts. Among them, the fact that Marion's GOOD cholesterol, called HDL, was probably quite high and thus protective. And she probably did not smoke, was lean and fit, had normal blood pressure, and had a family history of longevity. She never once ate wings with bleu cheese.

What is clear is that atherosclerosis and related conditions are major killers, that lowering ones LDL (bad) cholesterol is beneficial at almost any starting level, and that the benefits are huge for those at highest risk. There is absolutely no reasonable excuse for not knowing your numbers and considering their importance for your particular health situation. Just as you should be discerning in your reading of ads from the big pharmaceuticals that push cholesterol lowering medications, be equally careful in your digestion of information from the large and exponentially growing “anti-pharmaceutical” industry (and it is an industry) out there. They too have something to sell – and they often distort their interpretation of the cholesterol literature to match their personal views and interests.

This issue is terrifically complex – there are multiple factors to consider, nuances to interpret and application. The decision whether to treat your numbers, how, when, and to what target level, must be individualized. So get a cholesterol panel and make an appointment with your primary provider. Come in with a good idea of your family's atherosclerosis history, as well as some good questions.

Below are some links to sites where you can begin your homework:

www.webmd.com/cholesterol-management/guide/diseases-linked-high-cholesterol

www.americanheart.org/presenter.jhtml?identifier=4440

www.heart.org/HEARTORG/Conditions/What-Your-Cholesterol-Levels-Mean_UCM_305562_Article.jsp