HDL cholesterol: Protecting your heart and arteries  “What’s your cholesterol?” 
 As
men reach middle age, they’re more likely to ask each other about
health than sports, and when the talk turns from league leaders to
medicine, cholesterol is likely to be in first place. Yet for all its
notoriety, cholesterol is often misunderstood, especially when it comes
to HDL, the “good” cholesterol. It’s a shame, particularly since so
many men overlook the simple things they can do to boost their levels
of HDL cholesterol.  Good, bad, and neutral  Misconceptions
about cholesterol begin with the very nature of the chemical. Most
people think of it as a fat, but it’sactually a sterol, a waxy, fatlike
substance with a ringed structure not found in true fats.  Another
error is to think of cholesterol strictly as a health hazard. In fact,
cholesterol is essential for good health. It is the building block of
cortisol and all other steroid hormones. Without cholesterol, men
wouldn’t have testosterone, nor would women have estrogens.  The
third common mistake is to assume that the cholesterol in your blood
comes from the cholesterol in your food. In fact, about two-thirds of
the cholesterol in your blood is made right in your body by your liver.
Dietary cholesterol does contribute to the remaining third — but some
dietary fats have an even greater role, since they prod the liver to
produce more cholesterol, which then pours into the blood.  The
final misconception is that some cholesterol is good while some is bad.
In fact, there is only one type of cholesterol; the cholesterol in an
egg yolk has exactly thesame structure as the cholesterol that your
body incorporates into your brain cells, turns into testosterone, or
packs into an artery-blocking plaque. Like many misconceptions,
however, this one begins with a very important truth.  Instead
of floating free in your blood, cholesterol latches onto blood
proteins, which carry it through your body. Scientists separate these
lipoproteins by spinning blood plasma in an ultracentrifuge. The
lighter ones float to the top and are called low-density lipoproteins
(LDLs); the heavier ones sink to the bottom and are called high-density
lipoproteins (HDLs).  The nature of a specific lipoprotein
determines the fate of the cholesterol in your blood. LDLs deposit
their load of cholesterol just where it will do the most harm, in the
walls of arteries. That makes it the “bad” cholesterol. But where a
villain lurks, a hero can be found. In this case it’s HDL, which
snatches cholesterol away from artery walls. HDLcholesterol is very
good indeed thanks to the HDL, not the cholesterol.  HDL: Up close and personal 
 In
practical terms, the bottom line is simple: The higher your HDL
cholesterol, the better. But in biologic terms, it’s a good deal more
complex, and research into the molecular biology of HDL is on the verge
of generating new therapies.  HDL is a busy little world of
its own. Each particle is composed of a group of proteins that are
produced in the liver and intestines. In a typical HDL particle, about
70% of the protein is called apo AI, about 20% is apo AII, and at least
seven other proteins contribute to the final 10%. But some HDL
particles have different mixes of proteins. Various HDL subtypes also
have different properties, but studies disagree about which types are
most protective. As a result, clinicians are wise to measure total HDL
levels without fretting about subtypes.  Like all
proteins,the production of HDL’s proteins is directed by genes. Some
men are lucky enough to inherit genes that direct a high production of
HDL, while others are dealt a less favorable hand. Still, genes are
only part of the story, since lifestyle factors and, to a smaller
extent, medications have a powerful effect on HDL levels. In some men,
though, balky genes limit their ability to boost HDL levels with
exercise and other interventions.  How HDL helps  HDL
enters the blood on its own, but it soon picks up cholesterol to become
HDL cholesterol. That’s when it begins to fend off heart attacks and
strokes. At first, scientists believed that HDL was simply a garbage
collector that picked up cholesterol from an artery’s walls and
delivered it to the liver for disposal. That’s still considered the
main role of HDL, but as researchers have unraveled the many steps that
lead to arterial blockages, they have also accumulated evidence thatHDL
can help in many ways:  Reverse cholesterol transport. It’s
the updated take on the garbage man hypothesis. The first step in
atherosclerosis occurs when LDL cholesterol lodges in the wall of an
artery (see figure). If enough HDL is available, it will latch onto the
cholesterol in the artery wall, lug it back into the bloodstream, and
carry it to the liver. Since cholesterol is taken out of arterial
cells, the process is sometimes known as cholesterol efflux. Since
cholesterol is returned to the liver (where it was assembled in the
first place), reverse transport is another name for the process. By
either name, it’s good for vascular health, since the liver collects
cholesterol from the HDL particles, packages it into bile salts and
bile acids, and dumps it into the intestines for excretion in the feces.  HDL 
in action  Antioxidant
activity. The next step in atherosclerosis occurs when the LDL
cholesterol inthe artery wall is bombarded by oxygen free radicals that
turn it into oxidized LDL cholesterol. Oxidized cholesterol is the
stuff that’s actually responsible for arterial damage — and research
shows that HDL has antioxidant activity that can help protect LDL
cholesterol from free radicals.  Anti-inflammatory action.
An atherosclerotic plaque is not simply a mechanical build-up of
cholesterol but a site of intense inflammation triggered by oxidized
cholesterol and perpetuated by white blood cells called T lymphocytes
and macrophages. Elevated levels of C-reactive protein (CRP) reflect
the inflammation. HDL helps to quiet the inflammation, and it may also
neutralize CRP’s tendency to perpetuate the inflammatory cycle.  Plaque
stabilization. As the cholesterol-laden inflammatory plaque enlarges,
it may fill an artery enough to cause angina. If the plaque develops a
fibrous cap that holds it together, things don’t get any worse. But if
an unstable plaqueruptures, it can trigger a heart attack or stroke.
Although the evidence that HDL can help stabilize plaques is less
compelling than the data supporting its other benefits, research
suggests HDL may help prevent plaque rupture.  Antithrombotic
activity. Plaque rupture is dangerous because it triggers the formation
of an artery-blocking blood clot, or thrombus. By halting the flow of
oxygen-rich blood, the clot kills heart muscle cells (heart attack) or
brain cells (stroke). HDL reduces clot formation and accelerates the
healing process that dissolves clots.  Endothelial function.
Even without advanced blockages, the arteries of patients with
atherosclerosis are damaged goods. In particular, the endothelial cells
that line the arteries’ inner surface fail to produce normal amounts of
nitric oxide (NO), the tiny chemical that allows arteries to dilate
(widen) when tissues need more oxygen. HDL helps preserve nitric oxide
production and protectendothelial function.  With all these
activities, HDL cholesterol sounds as though it deserves the nickname
“good.” But laboratory and clinical experiments don’t tell the whole
story. Does HDL actually reduce the risk of human cardiovascular
disease?  How much does HDL help?  The
Framingham Heart Study was responsible for many landmark discoveries
about HDL cholesterol. Harvard researchers are rarely credited with
making things simpler, but that’s just what happened in the early days
of HDL research, when the Physicians’ Health Study confirmed that HDL
was protective and reported that various HDL subtypes are all helpful.
Doctors have learned a lot about HDL since then, and the data show that
the good cholesterol is very good indeed.  Heart disease.
Low HDL levels are associated with an increased risk of heart attacks,
while high levels are protective. The protective value of high HDL
levels is evidentat all LDL (“bad”) cholesterol levels, from very low
to very high. According to the Framingham Heart Study, cardiac risk
rises sharply as HDL cholesterol levels fall below 40 milligrams per
deciliter (mg/dL). Low HDL cholesterol levels are particularly
hazardous when triglyceride levels are high or other cardiac risk
factors are present. But raising HDL levels does help. In general, each
1 mg/dL rise in an HDL cholesterol level can be expected to cut cardiac
risk by 2% to 3%.  Stroke. Strokes come in many forms, but
the most common type, ischemic stroke, shares many risk factors with
heart attack. High HDL cholesterol levels reduce the risk of stroke; in
several studies, HDL cholesterol is a much better predictor of risk
than LDL cholesterol, particularly in people older than 75.  Erectile
dysfunction (ED). Normal erections depend on many things, including
healthy arteries that produce good amounts of nitric oxide. It’s no
surprise, then, that theMassachusetts Male Aging Study found that 16%
of men with low levels of HDL cholesterol had ED, but none of the men
with the highest levels had the problem.  Longevity. Several
investigations suggest that high HDL levels are linked to longevity,
particularly exceptional longevity. Other research links high levels of
HDL cholesterol to preserved cognitive function in old age. More
research is needed to learn if HDL deserves the credit or if other
genetic factors are responsible. But if HDL’s role is confirmed, it may
someday be known as the “great” cholesterol.  Your goal  There
is no “normal” level for HDL cholesterol. The higher your level, the
better. Still, targets are important. The National Cholesterol
Education Program (NCEP) and the American Diabetes Association advise
men to aim for HDL levels of at least 40 mg/dL. According to the third
National Health and Nutrition Examination Survey, over 35% ofAmerican
men do not meet this goal. And a great many more fail to meet the
NCEP’s more protective goal of 60 mg/dL or higher.  Another
way to determine your target is to take your “bad” cholesterol into
account by calculating your cholesterol risk ratio. The math is easy:
Just divide your total cholesterol by your HDL cholesterol:  TC (mg/dL) / HDL 
(mg/dL) = Risk ratio  The
lower your ratio, the better. A ratio of 4.5 indicates average risk;
the lower you go below that, the lower your risk — but the higher you
go, the higher your risk.  Most doctors advise reducing the
risk ratio by lowering LDL cholesterol levels, and many do that by
prescribing a statin drug. It does work well — but since statins reduce
cardiac risk by roughly 40%, it doesn’t work well enough for many men.
Boosting HDL levels is one of the ways to get better results, but it’s
often overlooked because it’s easier to lower LDL cholesterol than to
raise HDLcholesterol. Hard or not, it can be done.  © Group [EMAIL PROTECTED] 
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