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 Why is cholesterol bad? An interview with a heart specialist

We often hear about how cholesterol is bad for us and that we need to keep our cholesterol count low. But why?

To answer that question, interventional cardiologist Varadendra Panchamukhi, MD, offered some expert insight about cholesterol.

Cholesterol is a waxy, fatlike substance (lipid) that the body needs for producing bile that serves many important functions, such as producing new cells. To deliver the cholesterol, or lipid, to where the body actually needs it, the lipid attaches itself to a protein, which becomes a lipoprotein. There are two kinds of lipoproteins, low density (LDL), which is mostly made of fat, and high density (HDL), which is mostly made of protein. Highdensity lipoproteins, or “good” cholesterol, will actually help reduce the LDL in one’s body. Cholesterol gets in the body two ways: absorbed through digestion of foods or produced in the liver. Foods eaten account for most of the LDL in our bodies.

However, the body only uses as much cholesterol as it needs and cannot effectively break down any excess. If one’s metabolism naturally produces too much cholesterol or one eats a high cholesterol diet, the excess is left floating in the bloodstream as lowdensity lipoproteins, or “bad” cholesterol.

“The blood vessels of your body are designed for smooth flow. But elevated levels of cholesterol in the blood stream will result in it being deposited on the vessel walls and becoming plaque, which is rough. This results in a turbulent blood flow and the blood circulation is compromised,” Panchamukhi said.

Smoking brings nicotine to the bloodstream, which also reduces the smoothness of the blood vessel, making plaque buildup even easier and causing the blood vessels to constrict.

Panchamukhi described the long-term results of high cholesterol. As plaque forms on the blood vessel walls they become rougher, which makes it increasingly easier for more plaque to form.

“As plaque builds in critical places such as the arteries to your heart, legs, kidneys or brain, the blood flow becomes restricted. These plaques can rupture and result in clot formation which completely occludes the artery, which leads to stroke or heart attack.”

In the event of a heart attack, Panchamukhi performs a cardiac catheterization to insert a stent, a metal, scaffoldlike device “to squish the plaque so it is pushed out of the way against the vessel wall to create a channel for the blood.” Or, if the plaque has become very hard, he may use a rotablator procedure to actually chip it away and break it into tiny pieces that can then be eliminated by the body.

However, there is a better way, Panchamukhi said, and that is to make lifestyle choices now to avoid needing a catheterization later.

“Elevated LDL puts you at risk. It needs to be addressed, and the best place to begin is by watching what you eat.”

Number one, lower the amount of fat in your diet. See your doctor about what is right for your diet. Fried foods taste good, for example, but are high in the fatty acids that produce bad cholesterol and are not good for you.

“Low fat, boiled and baked food is much healthier. As you grow older the quality and quantity of your food makes a big difference.”

Make sure you know what kinds of fat produce good and bad cholesterol and avoid the bad ones. For example, anything that is high in hydrogenated fat produces bad cholesterol. Hydrogenated fats come from vegetable oils that have been altered to be more solid at room temperature. They are found in almost all packaged and fast foods. However, butter is high in saturated fat, which will also raise one’s LDL.

Finally, get exercise. “It increases the HDL production in your body. There are medications to decrease the LDL, or bad cholesterol, and increase the HDL, or good cholesterol. But exercise is the single most important way to increase the good cholesterol. There is no substitute for a good, regular exercise workout,” Panchamukhi said.

Dr. Panchamukhi in the cardiac catheterization lab at Memorial Hospital of Carbondale.