The Flip Side

How harmful is high cholesterol?
All of us feel accountable and guilty after devouring fried snacks. Those who are caught while eating a triple chocolate fudge cake or that delicious lip-smacking cookie usually make an ignominious excuse and feel blameworthy. The primary explanation for this disposition is the relentless preaching for decades about detrimental effects of cholesterol by cardiologists. It is believed that blood cholesterol is directly responsible for heart diseases and strokes,so the higher your cholesterol level,the more prone you are to suffer these diseases. But as was discovered over time,a majority of patients who suffer heart attacks have normal levels of cholesterol. In addition,many of those who have high cholesterol levels never develop heart disease. Clearly,either we are missing a bit or there is something more than cholesterol in the development of these deadly diseases.  

Cholesterol Controversy: Fats are as essential to our body as water. Cholesterol is an integral component of all the cells in our body. It is essential for brain function,contributes to a healthy immune system and is needed for making body hormones and vitamins. For very long cardiologists believed that lowering cholesterol by drugs such as statins would reduce the mortality rate caused by heart diseases. It is only partially true– there is a growing body of evidence now that apart from cholesterol there are equally significant factors which are contributing to the menace of this deadly disease. Gradually,it is becoming clear that the majority of benefits afforded by wonder drugs like statins,are due to properties that work beyond cholesterol lowering.

Further,the quantity of cholesterol we get from food usually constitutes up to one-fourth of the blood cholesterol,while the rest comes from internal body metabolism. This is the reason that some people who eat food high in fats continue to have low blood cholesterol levels while those who eat foods low in cholesterol have high levels. It was also learned that it is the type of fat and not the amount of fat which is important. While certain fats such as trans-fats and saturated fats are harmful,others such as Omega-3 fatty acids,monounsaturated and polyunsaturated fats are actually good and should be consumed in required amounts. 

Beyond Cholesterol: It is increasingly being recognized that inflammation plays an important role not only in the genesis of heart disease,but in a host of other diseases including cancer. A new bio-marker called C-Reactive Protein (CRP) is a convenient measure of inflammation and its raised values signify ongoing inflammation. CRP is increasingly being endorsed and recommended by important world cardiology forums as an initial investigation for risk assessment of patients. The cholesterol legacy is perhaps drawing to a close and cardiologists are looking beyond it. Translated in clinical terms,perhaps in the coming years it would neither be too unfashionable nor unhealthy to eat those alluring deep fried pizzas and french fries!

(The writer is an interventional senior consultant cardiologist at INSCOL Hospital,Chandigarh and Fortis Hospital,Mohali )