Heart Shield

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CHOLESTEROL AND HIGH-DENSITY LIPOPROTEIN
There is growing evidence that part of the blood cholesterol behaves quite differently from the bulk of it which is carried in LDL and VLDL. This part (15 to 25 per cent) is carried in high-density lipoprotein (HDL). HDL may have a protective role against coronary heart disease. This was first suggested by Drs Eder and Nikkila in New York; the idea was lost sight of until Drs Norman Miller and George Miller revived it recently, on the basis of many lines of evidence. Patients with coronary disease often have rather low blood-HDL levels; but in a rare inherited condition in which blood HDL is high, a feature of those affected is their remarkable longevity. Having a high HDL level goes with a much lower risk of heart attack. HDL is higher in women than men, probably an important reason why heart disease is commoner in men. HDL may help remove cholesterol from the tissues of the body, or impede it from getting into cells such as those which make up the inner wall of the arteries.
At present we know all too little about how to increase HDL levels. Habitual exercise does this. Obese people have low levels, and weight reduction increases their HDL. No one has yet shown that increasing HDL will protect against heart attack.
Measurement of HDL, LDL and VLDL is more difficult than simply checking cholesterol levels, though some laboratories are beginning to undertake this. Fortunately, the ordinary test for cholesterol in blood plasma is chiefly a measure of LDL levels, and it remains useful in predicting the risk of heart attack.
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