How to translate test results into clinically meaningful values and how to profile individuals according to the number and intensity of their risk factors.

      Lipids (blood fats) are not the only risk factors that contribute to Atherosclerosis (dirtying of the arteries).  Others risk factors include smoking, abdominal obesity, diabetes, and hypertension.  Atherosclerosis is the leading cause of heart attacks, strokes, and aneurisms, all of which shorten life and severely damage its quality.  Abdominal fat is especially harmful and can be assessed by measuring the waistline.  The combination of a fat belly plus smoking is especially deadly even if the cholesterol is low.  Lipids are divided into four groups by laboratory measurements:

1. Total Cholesterol (normal <200 mg/dl) measures all the cholesterol in the blood from all its sources.
2. HDL Cholesterol (normal >46 mg/dl) measures the good cholesterol, which protects arteries from getting dirty with time.  A person who is genetically endowed with a low HDL is at risk even if his cholesterol is low.  And a person how is endowed with a high HDL is not at risk even if his Cholesterol is high.
3. LDL Cholesterol (normal <130 mg/dl) measures the bad cholesterol, which causes arteries to get dirtier with time.  It is commonly used as the single most important measure of atherosclerosis even though this is not always true.
4. Triglycerides (normal <150 mg/dl) are large fats formed by combining three oils (fatty acids) with half a sugar (glycerol), which are ingredients found in fried potatoes, all kinds baked sweets, and any food made with carbohydrates and fats.  They are commonly high in individuals with poorly controlled diabetes or obesity and may also be high because of genetic predisposition.
   
   To assess cardiovascular risk, one must look at the lipid profile as if it were one measurement.  The simplest way to do this is to ignore the individual values and divide the Total Cholesterol by the HDL Cholesterol to calculate the risk ratio:

1. If the ration is <3, then atherosclerosis is in regression, which means that as one gets older the arteries will get cleaner.
2. If the ratio is >3 and <5, then atherosclerosis is in average progression as it does with normal aging.
3. If the ration is >5, then atherosclerosis is in accelerated progression.  Each unit rise in the ratio translates to 55% acceleration per year.  As an example, if the ratio is 7, then for every year one lives the arteries age by > two years.
   Triglycerides, on the other hand, are lesser accelerators of atherosclerosis and are not computed into this ratio.  However, when they rise above 500 mg/dl they increase blood viscosity (heavy thickness that slows the flow of blood) and cause pancreatitis (necrotic inflammation of the pancreas) both of which are potentially fatal conditions.

      Statins (medications that lower Total and HDL Cholesterol) have stood the test of time and science; they are safe and save lives by preventing heart attacks and strokes.  They also cause a modest elevation in the HDL Cholesterol, which may help lower the risk ratio into the regression zone (<3).  They rarely cause serious adverse effects but often cause muscle aches, which can be circumvented by switching from one Statin to another.
      Niacin is the medicine of choice when Triglycerides need to be lowered and the HDL, raised.  The combination of high Triglycerides and low HDL is as deadly as high cholesterol and responds favorably to Niacin.  Niacin is not easy to take because it causes flushing and may cause liver trouble but there are ways of giving it that minimize these side effects.
      The decision to treat with medications plus diet and exercise or to use diet and exercise alone as the only treatments is complex and should be individualized.  The number and intensity of risk factors usually clarify the treatment plan.  The major risk factors are ten: High LDL, Hypertension, Diabetes, Obesity, Smoking, Sedentary Life, Personal Stress, Low HDL, High Triglycerides, and Genetic Disorders.   An obese, hypertensive diabetic with high Cholesterol should be treated more aggressively than a fit nonsmoker with high Cholesterol.
      Atherosclerosis is the major plight of humanity causing more death and disability that any other disease.  With the rising incidence of sedentary life styles and obesity, there is irrefutable proof that atherosclerosis begins in childhood and progresses, unhindered, throughout the life span of most untreated individuals.