When I wrote my previous article on cholesterol, one reader commented that it was "too basic" and that cholesterol is far more complex than simply being labelled as "good" or "bad". I actually agree with that. The challenge with writing for the general public is finding the balance between accuracy and simplicity. We don't want to overwhelm readers with medical jargon, but we also don't want to oversimplify something as important as cholesterol.
So, let's look a little deeper.
The first thing to understand is that cholesterol itself is not the enemy. In fact, without cholesterol, we simply could not survive. Every single cell in our body contains cholesterol. It forms part of the cell membrane, helping cells maintain their structure and function. Cholesterol is also the raw material used to make important hormones such as testosterone, oestrogen and cortisol. It is needed to produce vitamin D when our skin is exposed to sunlight, and it helps the liver make bile acids, which allow us to digest fats.
Our body is so dependent on cholesterol that the liver manufactures around 70 to 80 per cent of what we need. The remainder usually comes from our diet. This is why someone can eat very little cholesterol yet still have high cholesterol levels in their blood.
So why do doctors become concerned?
The issue is not cholesterol itself. It is where it ends up.
Because cholesterol is a type of fat, it cannot dissolve in blood, which is mostly water. Imagine trying to mix cooking oil into a glass of water. It separates almost immediately. Cholesterol faces the same problem, so the body packages it into tiny particles called lipoproteins that act as transport vehicles.
This is where LDL and HDL come into the picture.
LDL, or low-density lipoprotein, carries cholesterol from the liver to tissues throughout the body. HDL, or high-density lipoprotein, performs the reverse journey by collecting excess cholesterol and returning it to the liver, where it can be recycled or removed.
This is why LDL has traditionally been called "bad cholesterol" and HDL "good cholesterol". In reality, they are neither good nor bad. Both are doing essential jobs. The problem arises when there is too much LDL circulating in the bloodstream or when the particles remain in the blood for prolonged periods.
Think of LDL as delivery vans. Delivery vans are useful because they bring supplies where they are needed. However, if there are too many vans on the road, traffic builds up, accidents become more likely, and congestion follows. LDL behaves in much the same way.
Under normal circumstances, LDL delivers cholesterol to cells for repair, growth and hormone production. However, when there is an excess, some LDL particles can squeeze beneath the lining of artery walls. Once trapped there, they can undergo oxidation, a chemical change caused by free radicals. The immune system mistakes these altered particles as a threat and sends white blood cells to deal with them.
Over many years, this creates inflammation inside the artery wall. The white blood cells become loaded with cholesterol, forming what are known as foam cells. These gradually build into fatty streaks and eventually form the plaques that narrow arteries. If one of these plaques ruptures, a blood clot can form rapidly, blocking blood flow and causing a heart attack or stroke.
Notice that cholesterol itself is not attacking the artery. It is the combination of excess LDL, inflammation and the body's own repair processes that leads to plaque formation.
This also explains why cholesterol is only one piece of the puzzle.
Smoking damages the lining of blood vessels, making it easier for LDL to enter. High blood pressure places extra stress on artery walls. Diabetes and insulin resistance promote inflammation and alter the behaviour of LDL particles. Excess body weight, physical inactivity and certain inherited conditions also increase risk.
That is why two people with exactly the same cholesterol level may have very different risks of developing heart disease.
In recent years, scientists have also learned that not all LDL particles are identical. Some people mainly have larger, less dense LDL particles, while others have many small, dense LDL particles. The smaller particles appear more likely to penetrate artery walls and contribute to plaque formation. This helps explain why some individuals develop heart disease despite having cholesterol levels that are only mildly raised, while others with higher levels remain healthy for many years.
HDL is equally complex. Although higher HDL levels have generally been associated with lower cardiovascular risk, simply raising HDL with medication has not consistently reduced heart attacks. Researchers now believe that how well HDL functions may be more important than how much of it is present.
Modern medicine therefore looks beyond a single cholesterol number. Doctors increasingly assess overall cardiovascular risk by considering age, blood pressure, diabetes, smoking, family history, kidney disease and other factors alongside cholesterol measurements. This provides a much more accurate picture than cholesterol alone.
The good news is that many of the same lifestyle measures improve several risk factors simultaneously. Regular exercise helps increase the body's ability to handle fats and sugars. A diet rich in vegetables, whole grains, beans, nuts, fish and healthy oils can reduce LDL while improving overall heart health. Maintaining a healthy weight, avoiding smoking, managing blood pressure and controlling diabetes all work together to reduce cardiovascular risk.
For some people, lifestyle changes alone are enough. For others, particularly those with established heart disease, diabetes or inherited high cholesterol, medications such as statins remain one of the most extensively researched treatments in medicine. Their benefit extends beyond lowering LDL; they also reduce inflammation within artery walls and help stabilise plaques, making them less likely to rupture.
Perhaps the most important message is this: cholesterol is not something to fear, nor is it something to ignore. It is a vital substance that keeps us alive, but like many things in biology, balance matters. Understanding cholesterol means moving beyond the simple labels of "good" and "bad" and appreciating the remarkable way our bodies transport, use and regulate this essential molecule.
Until next time, look after your heart—it works hard for you every second of every day.
The Daily Durian (zaynp100@yahoo.com) is a content creator under the Newswav Creator programme, where you get to express yourself, be a citizen journalist, and at the same time monetize your content & reach millions of users on Newswav. Log in to creator.newswav.com and become a Newswav Creator now!
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