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Q
Questioning Cholesterol?

A good friend recently suffered a terrible heart attack only a week after tests showed that his cholesterol numbers were practically perfect. How could this happen?

A
Answer (Published 10/1/2007)

Cholesterol levels are important, but they’re not the whole story when it comes to heart disease. Indeed, more than half of all first heart attacks occur in people with normal cholesterol levels. Some of these result from spasms of coronary arteries and may be stress related.

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In my view, our single-minded focus on cholesterol – especially on lowering LDL cholesterol with statin drugs – has obscured other important risk factors for heart disease in the public mind. A new book, by a Chicago cardiologist who graduated from the Arizona Center for Integrative Medicine here at the University of Arizona, can bring you up to speed on all heart disease risks and what you can do about them. What Your Doctor May Not Tell You About Cholesterol, by Stephen R. Devries, M.D., director of the Integrative Program for Heart Disease Prevention at the University of Illinois at Chicago, is an outstanding and eye-opening book that I recommend to anyone concerned about his or her risks of heart disease.

You may not know that LDL ("bad") cholesterol comes in two main forms – small, dense particles and large, fluffy ones. Dr. Devries explains that the small ones are the dangerous ones – because of their size, they’re much more likely to get stuck in coronary arteries while the big, fluffy ones just roll on through. The size of your LDL particles has a strong genetic basis. Dr. Devries recommends that anyone at increased risk of heart disease have tests for LDL particle size: best results are those that show you have few particles and that they’re big and fluffy.

But if your LDL particles are small, Dr. Devries explains that you can change both their size and number with some simple lifestyle changes including weight control, a low glycemic index diet (see www.glycemicindex.com for details), fish oil supplements and regular exercise. You’ll also find a discussion of the most useful tests and scans for heart disease, a chapter on supplements that specifies what you need if your LDL is high, your HDL is low, or your triglycerides are high. Dr. Devries also emphasizes mind-body approaches that can help you dial down the stress that plays a major role in triggering heart disease irrespective of cholesterol.

Learning techniques that help people change from a stressed state to one that is more relaxed may have dramatic consequences on heart rhythms and may determine whether arteries go into spasm during times of acute anxiety. Other risk factors equal to or greater than cholesterol focus on the tendency for the blood to clot. Regardless of how narrowed arteries are from atherosclerotic plaque, a heart attack cannot occur unless blood clots form within them. Keeping the blood thin naturally, along with stress-reduction training should be included with the advice given to lower cholesterol.

If you’re concerned about your heart, as everyone should be, What Your Doctor May Not Tell You About Cholesterol can help you better understand your risk so you can take appropriate action and work productively with your physician to optimize your health.

Andrew Weil, M.D.

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