High cholesterol: Common and silent

Cholesterol not really a villain

Karen Miller | 4/14/2016, 5:33 p.m.
Although cholesterol has a bad reputation, it is actually essential to the body and a part of every cell. If ...

Cholesterol gets a bad rap. But actually it’s one of the good guys. Your body could not survive without it. Cholesterol is a major component of the walls of cells, offering support as well as protection from unwanted invaders. It is a key component in several hormones, including estrogen, progesterone and testosterone. There’d be no vitamin D without cholesterol.

The liver makes most of the body’s cholesterol. In truth it makes enough for all the jobs it has to accomplish. Contrary to a commonly-used term, cholesterol is not “bad.” Nor is it “good.” There’s only one cholesterol. It’s actually a victim of circumstance. Because it is a waxy, non-soluble substance, it has to travel in the bloodstream on protein carriers called lipoproteins, which are named according to their density. LDL, or low density lipoproteins, escort cholesterol to the cells, while HDL or high density lipoproteins, clean up the excess leftovers and return them to the liver for disposal.

LDL’s biggest cargo is cholesterol, but it transports triglycerides and other lipids as well.

Here’s how cholesterol gets its bad rap.

The LDL particles, especially when dense and small in size, can cling to the walls of arteries causing a blockade that can eventually prevent the passage of blood and nutrients. Because cholesterol is a part of this transit system, it gets most of the blame for forming a plaque called atherosclerosis.

It is this plaque that is associated with heart attacks, strokes and peripheral arterial disease.

The LDL does not have affinity for a particular artery. All arteries — regardless of their location — are fair game. The reason it is so strongly linked to heart attacks is because of the devastating outcome. Heart disease is the number one killer in this country.

Pradeep Natarajan, M.D., M.MSc specializes in preventive cardiology at the Massachusetts General Hospital Corrigan Minehan Heart Center.

Pradeep Natarajan, M.D., M.MSc specializes in preventive cardiology at the Massachusetts General Hospital Corrigan Minehan Heart Center.


High cholesterol is common. “No race is spared,” said Dr. Pradeep Natarajan, who specializes in preventive cardiology at Massachusetts General Hospital. “But risk factors may vary among groups.” According to the Centers for Disease Control and Prevention, one out of every three adults has high cholesterol. Half do not get treated and two-thirds do not have it under control

People tend to ignore conditions that do not directly affect their daily activities. However, cholesterol is not to be ignored. It is linked to two leading causes of death. It can precipitate kidney failure if arteries leading to the kidney are attacked and it can result in amputation if the legs are afflicted.


High cholesterol is silent. Similar to high blood pressure, you don’t know you have it unless you are tested. The recommended test is called a lipid panel, which measures total cholesterol, HDL, LDL and triglycerides. Generally, desired readings are less than 200 for total cholesterol; more than 40 for HDL; less than 100 for LDL and less than 150 for triglycerides.

The results are not always that clear-cut. Total cholesterol could test as normal, but include higher than desired LDL. To get a better look, some health providers perform additional calculations to determine one’s risk of heart disease more accurately. For instance, the cholesterol to HDL ratio (chol/HDL) is considered a better risk predictor of heart disease. A number below five is acceptable, according to the American Heart Association.