Should You Be Concerned About Your Cholesterol Numbers?

"Cholesterol" is one of the big things people think about when evaluating their health.  It's been drummed into our consciousness.   (Largely by the drug companies who want to sell us drugs to lower our cholesterol).    This despite the fact that most people can't really tell you what exactly "cholesterol" is.   We are told things like "heart disease is the number one killer"...  We all have "ticking time bombs" inside, "heart attacks waiting to happen".

Standing around the water cooler, the subject might come up.   What's your cholesterol?   Umm... kind of high....  220.    Uh-oh.   Better do something about that!    What's yours? .... 165.    Hey!   That's great!  How do you stay so healthy?  How about you?  Umm..  265.   OMG!  We better call 9-1-1 right now!

What if I told you there is no correlation between total cholesterol and heart disease?  Hogwash, you would say.    You must be reading some "alternative" (i.e. "quack") website.   After all, anyone can put anything on the internets.  Just because you saw it does not mean it's true.

First, let me show you a couple charts.  The first shows a "risk vs. total cholesterol" for a 60 year old non-smoking male:

What???  A chart showing that total cholesterol does not matter?  What a bunch of crap!.   Which quack website did that come from?  Well, what if I told you this data came from the National Institute of Health?   Yes, the "N.I.H."...  The US Government!   Certainly that's about as far away from "quackery" as you can get, right.   (Well, that's "a whole 'nother subject", better leave that alone for now.)    The chart above came from entering numbers into this calculator.  Ok, what is the catch?   Well when I entered the numbers, I assumed a constant Total Cholesterol / HDL Cholesterol ratio of 2.5 to 1.   So, the low end point of 150 total cholesterol has an HDL of 60, while the high end point of 250 total cholesterol has an HDL of 100.  (Not out of the question... my own HDL has been as high as 99, and my ratio has been as low as 2.7.  So in other words, it's entierely possible for two people, one with a total cholesterol of 150 and the other with a total cholesterol of 250, to have the same heart disease risk, if as they have the same Total/HDL ratio.

Now let's look at another chart.  This one also shows CHD risk for the same 60 year old non-smoking male, but this one shows all points having at total cholesterol of 250:

The difference?  All of the points on this chart are for a person with a total cholesterol of 250.  However, they have differing HDL values, hence different Total/HDL ratios.   The point on the far left would be an HDL of 100 (actually same data as the far right point in graph #1) while the far right point has an HDL of only 44.   A range of 44 to 100 for HDL is not unreasonable for the general population.

So what's the message?  Should you be concerned about your "total cholesterol" number?  Probably not!   Should you be concerned about your Total/HDL ratio?  Yes!    Should you try to decrease your total cholesterol number?  Not if your HDL goes down too!

So here's what's crazy...  Look at these recommendations from the Mayo Clinic.    "Total Cholesterol" is the first thing on the list.   The recommendation is to be below 200, with 200-239 being "borderline" and 240 and over being "high".    But do you see any reference to Total/HDL ratio?   I don't either.   My own former doctor suffered from this same blind spot.  He would look at my lab results (total cholesterol is usually about 230) and immediately try to "put me on" as statin drug.   Once he even did this when my HDL result was 99!     A visit to this doctor sometimes seemed detrimental to my health, as my blood pressure would increase in anticipation of the debate we were about to have!

In my case, I find it much easier to increase my HDL thru "diet and execise" than decrease my total colesterol.   So what steps can accomplish this?   That's for another post.