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Cholesterol Reducing Agents (Part I)

July 16th, 2014


Cholesterol Reducing Agents (Part I)

It is not possible to talk about blood cholesterol level without bringing up heart diseases. However, this does not mean high cholesterol level is always or only the cause of heart disease.

There are many terms that need to be clarified before we talk further about “high cholesterol level” and whether it causes heart diseases. First, let’s be clear that “fat” and “oil” are different. “Fat” in general is slimy and shiny substance. It can be in two forms – solid and liquid. I will call them “fat” and “oil”. Solid fat is in solid form, like what you see in refrigerated or frozen food. Candles are also made from animal fat.

Therefore, there is no solid fat in our blood as blood is liquid. There can be “oil” in it, but the most correct term would be oil dissolved in blood and “fat”  is something build up on the wall of the blood vessel.

This is to say the oil in your blood (measured by a blood test) is different from the waxy fat on the wall of your blood vessel, visible through a special X-ray and contrast (dye test).


The dissolved fat (oil) in your blood stream can be measured by a test that requires a 12-hour period of fasting before your blood is drawn. The fat collected on the blood vessel’s wall is the bad guy that causes hardening of arteries, which eventually leads to narrowed arteries. In the event that the blood vessel cannot allow enough blood flow to the heart muscles, myocardial ischemia and angina symptom can occur.

The collection of fat on the artery wall, which causes this hardening, can be measured by checking the plaque build-up on the artery wall because the hardening is a result of plaque, calcium and fat. The more the plaque, the harder the artery wall. This also means an increased chance of fatality from heart disease.

Blood fat can be checked by a blood test and the amount of blood fat is directly related to artery wall thickness. However, those with high blood fat level might or might not have myocardial ischemia (or coronary artery disease), and those with coronary artery disease might or might not have thick fat on the artery wall.

High blood fat is a risk factor that can trigger myocardial ischemia and infarction, but it is not the only risk. Other than that, it is not associated with other kinds of heart disease. A blood test can show different types of fat in your blood, and you should get to know them to understand what is going on with your body.

The most famous star of this matter would be cholesterol, and its counterpart triglyceride. Cholesterol can be classed into 2 types: LDL cholesterol and HDL cholesterol. LDL cholesterol is the “bad guy” as it collects in the walls of blood vessels, causing hardening and narrowing of the artery.  The narrowed artery then will not be able to supply enough blood to the heart causing myocardial ischemia and angina.  The density of this type of cholesterol is low, but the amount is high and the danger is great.

The “good guy” is HDL, which is higher in density and lower in amount. HDL collects bad cholesterol from all over the body and takes it to the liver to prevent the formation of LDL.

In a blood test, the cholesterol level that we see is the total cholesterol, which includes both LDL and HDL cholesterol. In general (as in general and healthy people with no record of artery wall problems or diabetes), the total cholesterol level should not exceed 200mg/dl. People with hardened artery walls or diabetes should have even lower level.

To control triglyceride level, the best way is to lose weight, exercise and avoid high-calorie foods such as fat and sugar. If these methods fail to help, medication can help. High triglyceride level is highly relevant to diet, exercise and obesity. It is also commonly found in those with blood glucose level problem (diabetes or tendency toward diabetes).

High triglyceride level, when in conjunction with low HDL level, can be as much a great risk for artery hardening as high LDL level alone. This is because total cholesterol comprises LDL and HDL as well as other fats. When taking care of cholesterol level, we have to look at both LDL and HDL. The lower the LDL level, the better. The higher the HDL, the better.

As if these fats are not confusing enough for us to comprehend, let’s talk about CRP or C-reactive protein level. A high or increasing amount of CRP in your blood suggests that you have an acute infection or inflammation. It is related to the subject I am talking about because when fat collects on the blood vessel’s wall, there will be inflammation. Therefore, it is best to keep your CRP level low.

LDL level can be lowered when you steer clear from animal fat and its byproducts, as well as increase the amount of calories expended in daily life by exercising regularly. If these still do not do the trick, medication can be used in conjunction with a healthier lifestyle.

To increase HDL level, exercise hard on a regular basis is the only asnwer. At present, there is no medication that can significantly boost the HDL level.

As for decreasing CRP level, exercise can help as well. Some cholesterol reducing agents and heart disease medications can also help lower the CRP level.

I had a female patient aged around 50. She was easily exhausted for 3-4 months without tightness in the chest. From her health record, there was no risk factor for narrowed artery disease. However, in a year, she had gained 10 kilograms, and she had been menopausal for 2 years.

I checked her blood pressure and found that it was too high. Her blood test confirmed that her total cholesterol, LDL, cholesterol and triglyceride levels were within the healthy range, but her HDL level was very low. I suggested her to start exercising and controlling her food.

In 3 months, she returned to me with yet 5 kilograms more on her body. Her blood test results remained the same. This conversation followed my curiosity.

Me: Have you been careful with food and exercising at all?
Her: I hardly exercise, but I am very careful with food!

Me: How?

Her: You said I needed more “good” cholesterol, so I only eat good fat! For 3 months I have been eating Kobe beef steak and Australian beef! I choose only the most expensive ones, so I can guarantee that they are good fat!

Prof Nithi Mahanonda is consultant cardiologist and interventionist, Perfect Heart Institute.

Reference :


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