Column: The how and why of cholesterol


Submitted column courtesy of IU Health


Cholesterol isn’t just an interloper, clogging our arteries and causing heart disease. It is also a necessary part of our biology that generates hormones, vitamin D and helps us digest foods. It gets a bad rap because it is also a primary ingredient in creating plaque — the thick, hard substance that clogs arteries.

“Cholesterol by itself is not an evil molecule or bad in our food,” said Dr. Ed Harlamert, interventional cardiologist at IU Health Saxony. “The problem is how it gets deposited in the arteries creates a process that leads to heart attacks, strokes and other vascular disease. Those are the three things we’re trying to prevent by understanding and reducing cholesterol.”

How buildup forms

Over time, our blood vessels experience wear and tear from constantly pushing blood through our system. When a tear in the vessel wall occurs, the body repairs the erosion by patching it with platelets and attracting white blood cells to heal the spot. The white blood cells remain in the wall. Since they’re designed to attack foreign bodies, they recognize cholesterol passing through the vessel as such and pull it into the vessel wall. This is how buildup naturally begins.

“In the past, we used to think it was pure cholesterol buildup that was coating our arteries and causing problems,” Harlamert said. “But now we know the culprit is plaque — a mixture of cholesterol, white blood cells and fibrotic cells that form atherosclerotic plaque tissue in your blood vessels.”

Risk factors

While most of us experience typical cholesterol buildup, people with other risk factors experience additional problems due to family history, smoking, diabetes, obesity and even gingivitis of the gums.

“With smoking, it may seem strange that inhaling something into your lungs would affect your cholesterol levels,” Harlamert said. “But it’s all about inflammation. Smoking creates inflammation in your lungs. Uncontrolled diabetes and gum gingivitis also create inflammation. This triggers overactive white blood cells which deposit more cholesterol into your vessel walls.”

Get moving

Exercise is often a key to reducing cholesterol because it reduces inflammation. Plus, your body can use extra body fat to create additional cholesterol. The American Heart Association suggests just 40 minutes of moderate aerobic exercise three to four times a week can lower both cholesterol and high blood pressure.

“Even five pounds of weight makes a difference,” Harlamert said. “People who lose five pounds can see their cholesterol levels drop 20 points. If they gain five more, it goes right back up.”

Lower your risk

Regardless of your family history of heart disease, you can lower your risk for high cholesterol if you:

  • Quit smoking.
  • Control your diabetes, viruses or infections.
  • Brush and floss regularly.
  • Exercise three to four times a week.
  • Consider getting a heart scan.

“Heart scans don’t tell us if you have heart disease, they tell us if you already have plaque buildup,” Harlamert said. “I would encourage people in their 50s and 60s who haven’t had a heart scan to schedule one and discuss this with their physician.”

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