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Cholesterol and Heart Disease

Cholesterol is a wax-like substance. The liver makes it and links it to carrier proteins called lipoproteins that let it dissolve in blood and be transported to all parts of the body. Cholesterol plays essential roles in the formation of cell membranes, some hormones, and vitamin D.

Too much cholesterol in the blood, though, can lead to problems. Deposits of cholesterol can build up inside arteries. These deposits, called plaque, can narrow an artery enough to slow or block blood flow. This narrowing process, called atherosclerosis, commonly occurs in arteries that nourish the heart (the coronary arteries). When one or more sections of heart muscle fail to get enough blood, and thus the oxygen and nutrients they need, the result may be the chest pain known as angina. In addition, plaque can rupture, causing blood clots that may lead to heart attack, stroke, or sudden death. Fortunately, the buildup of cholesterol can be slowed, stopped, and even reversed.

Cholesterol-carrying lipoproteins play central roles in the development of atherosclerotic plaque and cardiovascular disease. The two main types of lipoproteins basically work in opposite directions.

Low-density lipoproteins (LDL) carry cholesterol from the liver to the rest of the body. When there is too much LDL cholesterol in the blood, it can be deposited on the walls of the coronary arteries. Because of this, LDL cholesterol is often referred to as the "bad" cholesterol.

High-density lipoproteins (HDL) carry cholesterol from the blood back to the liver, which processes the cholesterol for elimination from the body. HDL makes it less likely that excess cholesterol in the blood will be deposited in the coronary arteries, which is why HDL cholesterol is often referred to as the "good" cholesterol.

In general, the higher your LDL and the lower your HDL, the greater your risk for atherosclerosis and heart disease.

For adults age 20 years or over, the latest guidelines from the National Cholesterol Education Program recommend the following optimal levels:

Total cholesterol less than 200 milligrams per deciliter (mg/dl)
HDL cholesterol levels greater than 40 mg/dl
LDL cholesterol levels less than 100 mg/dl
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