Many doctors will confess to feeling frustrated by occasional patients who complain about some aspect of their health, but nonetheless appear to have no hard signs of disease. Members of the medical profession generally have their hands full dealing with those regarded as genuinely sick, and therefore tend not to have too much time for individuals broadly labelled as the ‘worried well’. However, it is also true that we doctors can actually be the instigators of a health neurosis in our patients, a prime example of which concerns the practice of cholesterol testing. While there may be merit in this form of screening, it is also true that the finding of a raised cholesterol (perhaps coupled with a dire warning about what this means) can be a cause of considerable concern. My experience is that a fair few individuals see their elevated cholesterol level as some sort of sword of Damocles – poised to cut short their lives.

Despite its death-inducing image, there is good reason to believe that a lofty cholesterol level need not disaster for our health. The reason for this rests on the fact that cholesterol comes in more than one form, and not all of it is bad for the body. The majority of cholesterol comes in what is known as low-density lipoprotein (LDL) form. LDL cholesterol is believed to be responsible for the narrowing of the arteries that may lead to heart disease and stroke. However, cholesterol’s other major type, termed high-density lipoprotein (HDL) cholesterol, is a very different animal. HDL cholesterol is believed to help clear cholesterol from the system, a quality that actually protects against any gumming up of the circulation.

Just last month, a study published in the Archives of Internal Medicine higher levels of HDL were associated with a halving in the risk of heart disease and stroke in a group of elderly individuals. Other studies have found that elevated levels of HDL are protective for heart disease and overall risk of death. Because LDL and HDL have roughly antagonistic actions in the body, then it is the relative amounts of these two substances (rather than the total amount of cholesterol) that seems to be critical factor in determining of our fate.

A good guide to cholesterol’s likely impact on the body can be had by dividing the total cholesterol (TC) level by the HDL score. Ideally, this number should be less than 5, and the lower the better. I’ve seen quite a few individuals who despite having cholesterol levels considered higher than ideal, nonetheless possess decent quantities of HDL in their blood streams, and have reassuringly low TC:HDL ratios too. Some researchers are keen for HDL levels to assume greater importance in the interpretation of cholesterol tests, and are calling for more emphasis to be placed on interventions that enhance HDL levels in the body.

Those keen to take a dietary approach to boosting their HDL score may like to eat more fish such as salmon, trout, mackerel and sardine. Studies show that consumption of oily fish (or fish oil supplements) can elevate blood levels of HDL. Exercise may also help in this respect, with one study showing that running as little as 7 – 14 miles each week was associated with significantly higher HDL levels. A better understanding of the HDL’s disease-protective role, and taking appropriate steps to raise its profile in the body, mean that a raised cholesterol need not necessarily be taken to heart.

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