Are cholesterol and heart disease real

cholesterol : Beyond Good and Evil

Harald Voigtländer * goes for a check-up. It turns out that his blood lipid levels are increased. The doctor thinks this is a risk factor for serious heart disease. A lifestyle change is imminent. On television it was said that humans could not live without this steroid. The 54-year-old Berliner feels healthy himself - what should he believe now?

Many patients feel like Voigtländer: After the examination there are a lot of unanswered questions - so here are the answers. "Several relevant values ​​can be determined in the blood in one fell swoop," says Hartmut Kühn (photo), professor of medical biochemistry at the Charité: on the one hand the total concentration of cholesterol, on the other hand its subtypes. The LDL cholesterol is often referred to as bad, while the HDL form is considered good. HDL is the abbreviation for "high density lipoprotein", LDL stands for "low density lipoprotein" - what is meant is the high or low density of special transport vehicles that determine the effect of cholesterol in the body. "Cholesterol is a fatty alcohol and should therefore be chemically correctly referred to as cholesterol," says Kühn. Triglycerides can also be measured in the blood: these are naturally occurring fats in food. However, if there is a lack of exercise, the body can also produce it itself and then deposit it in the fatty tissue. * Name changed

Why does the body need cholesterol?

Cholesterol is found in foods of animal origin, but the body also makes it itself - especially in the liver. It is a component of cell membranes and a precursor of hormones, bile acids and vitamin D. "Due to its chemical composition, cholesterol is not soluble in water and therefore does not swim in the blood by itself," says Kühn. It needs transport vehicles, so-called lipoproteins. Their properties ensure a decisive difference in quality: by means of the often demonized LDL, cholesterol reaches all areas of the body, where it serves as a vital cell building block, i.e. not only does harm. However, it can accumulate in the vessel walls. The "good" HDL, on the other hand, leads excess cholesterol back to the liver, where it is metabolized into bile acid and thus excreted.

What is so harmful about cholesterol?

So it's true: HDL has a positive effect on the body due to the cholesterol being transported back to the liver, while LDL has a negative effect on the body due to the accumulation of cholesterol in the organs - but both forms are needed. The "bad" cholesterol only becomes bad when there is too much of it. Because then excess LDL from the blood is stored under the inner lining of arteries. "This activates the body's own phagocytes that want to absorb and remove the excess LDL," says biochemist Kühn. When these cells become too large or even burst, vasoconstricting fatty deposits form in the arterial walls. These so-called plaques narrow the diameter of the vessels, so that the blood can circulate increasingly poorly. "If a plaque tears, platelets quickly accumulate in these uneven areas and blood clots," says Kühn. Then a clot of blood forms, which closes the vessel. If the coronary arteries are affected, there is a risk of a heart attack. If vessels in the neck or in the brain are blocked, a stroke can result.

Which cholesterol levels are good?

That's a thing of the past with the established guidelines. Because there is no evidence that everything is okay below a certain limit and that above this there is an immediate risk of a heart attack. "The recommendations are based on statistical mean values ​​that were collected from supposedly healthy population groups," says biochemist Kühn. However, it is known from clinical experience and extensive studies that lowered cholesterol levels lead to a reduced heart attack rate. How far one should push the values, however, is discussed again and again controversially.

The benchmarks depend on the individual risk profile. The most illustrative example is the LDL reference value: it should be below 160 milligrams per deciliter (mg / dl) in healthy people with a low risk of heart disease. If there are risk factors in the family, such as obesity, nicotine consumption, high blood pressure or cardiovascular diseases, values ​​below 130 mg / dl are aimed for. It is reduced even further to below 100 mg / dl if a cardiovascular disease such as a heart attack or stroke has already occurred.

In accordance with this scheme, different orientation values ​​apply to each of the blood lipids. As an example, it is easy to remember: In healthy people, the total cholesterol level should not exceed 200 mg / dl. And with HDL values ​​over 40 mg / dl should be measured. The rule here is: the higher the better.

Better cholesterol levels through a healthier lifestyle?

A simple change in lifestyle - especially when it comes to eating and exercise habits - can have a positive effect on cholesterol levels: with a Mediterranean diet and two to three hours of physical activity per week - which have been scientifically proven to protect the heart - you can do a lot of good for your blood vessels. One glass of wine per evening is allowed, nicotine should be avoided entirely. There are types of margarines that are advertised as saying that they can lower LDL levels. "The underlying idea of ​​relying on phytosterols is not unfounded," says Kühn. Because these are vegetable equivalents to animal cholesterol and may have a blood lipid lowering effect. However, it is not yet clear whether consumption is really helpful. "With a balanced diet you don't need food supplements and switching from butter to margarine alone does not necessarily lead to a healthy lifestyle," says biochemistry researcher Kühn.

Wonder weapon statins?

In order to prevent serious consequential damage, many doctors set themselves the goal of "less LDL, more HDL" for their patients. They do this by prescribing statins for them. “These drugs were developed to inhibit the body's own cholesterol production, but they also have other interesting effects,” says biochemist Kühn. Statins are undoubtedly one of the sharpest weapons in the fight against cardiovascular diseases, but they also have undesirable side effects: reports of headaches up to muscle breakdown in extreme cases are known.

In addition, taking them falsely conveys a false sense of security, based on the motto: Why should I change my lifestyle if my daily pill protects me? Because those who take them must not do without exercise and a healthy diet. Over the past few decades, regular debates have flared up about blood lipid lowering drugs, as the guide values ​​for total cholesterol have been reduced again and again - most recently from 220 to 200 mg / dl. "The future will show to what extent this tightening of guidelines is clinically effective," says Kühn. Conversely, however, Kühn believes that accusing the pharmaceutical industry of having created a larger target group with the stroke of a pen is unlikely. He hopes that these revised recommendations will, at least in the long term, lead to fewer diseases. It remains to be seen whether this will actually happen in practice.

You can read more on the subject in the magazine for medicine and health in Berlin "Tagesspiegel Gesund - The best doctors for the heart and circulation".

Further topics of the edition:Sports. What training is good for your heart ?; stress can make you sick - and often hits the poor in society; Navigator. Route planner to a healthy heart; Bypass surgery. A report from the operating room; Heart transplant. The long wait for the donor; Lifesaving. How a patient survived a heart attack; heart valvesthat are pushed through the veins with a catheter; Cardiac catheter. A stent is deployed; Metabolic syndrome. Adolescents learn to say no in the obesity outpatient clinic; Cardiac rehab. Learning objective: radically change lifestyle; Telemedicine. When the doctor comes to a virtual home visit; Leg infarction. Vascular occlusions can be dangerous; Varicose veins. Therapy successfully; Thrombosis.Causes and treatment; and also in clear tables: clinics and doctors in comparison

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