People and populations with favorable blood lipid patterns have low rates of cardiovascular
disease. Like Mexico’s Tarahumara and Bolivia’s Tismane, people living
on whole-food plant-based diets in the poor developing countries in Asia and Africa
typically have total-cholesterol levels in the range of 100-140 mg/dl, and they almost
never develop clinically significant coronary artery disease.
About 38% of adult Americans have total cholesterol levels of 200 mg/dl or higher.
About 12% of the adult U.S. population 20 years of age or older have total cholesterol
levels of 240 mg/dl or higher and more than twice the heart attack risk of
someone whose cholesterol is 200 mg/dl. For years it was thought, and the public
was led to believe that a blood cholesterol level of 200 mg/dl was normal, of no
particular concern to health, or even a desirable level. In fact, this level is just an
average among Americans with our usual high-risk, unhealthy diet and lifestyle.
Fully 35% of heart attacks occur among people with total cholesterol between 150
mg/dl and 200 mg/dl.
Evidence from the Framingham Heart Study and many subsequent investigations strongly suggest that atherosclerotic heart disease is extremely rare among individuals with a total cholesterol of 150 mg/dl or lower. There is
good evidence that lowering LDL-C, whether it is by drugs such as statins or diet
and weight loss, is associated with lower CVD risk. The Coordinating Committee
of the National Cholesterol Education Program recommends attaining an LDL-C
level of 70 mg/dl or lower for those at high risk of cardiovascular heart disease—
and that includes almost all of us. In short, a lower level of total cholesterol and
LDL-C is healthier.
High HDL-C is associated with protection against heart attack. Smoking, obesity,
and being sedentary, lowers HDL-C levels, exercise raises HDL-C levels. According
to one guideline, an HDL-C level of 60 or above is protective, and levels of
HDL-C less than 40 mg/dl for men and less than 50 mg/dl for women are correlated
with an increase in the risk of heart disease. At one time, it was a common practice
to assess CVD risk by measuring total cholesterol and HDL-C levels and then dividing
the total level by the HDL-C level. The Framingham study and other studies
suggest that ideally, the ratio of total cholesterol to HDL-C should be less than four
to one or even better, less than three to one, the average ratio for American men is
higher than that, vegetarians, on the other hand, average only about 2.8 to 1.3.
If LDL-C is in a healthy low range, a high HDL-C does not seem to provide additional benefits for CVD prevention.
High levels of HDL may just be a sign that the body is better at disposing of excess
cholesterol and preventing the build-up of plaque in the presence of unhealthy high
levels of LDL-C. Additional evidence that high HDL-C is not cardioprotective
comes from studies of individuals with a genetic predisposition to high HDL-C.
Their high HDL-C does not seem to lower the risk of CVD, and some research has
found that very high HDL-C, 80 mg/dl or higher, increases CVD risk. Trials of
drugs that more than doubled levels of HDL-C failed to reduce the rate of cardiovascular
This blog presents opinions and ideas and is intended to provide helpful general information. I am not engaged in rendering advice or services to the individual reader. The ideas, procedures and suggestions in that are presented are not in any way a substitute for the advice and care of the reader’s own physician or other medical professional based on the reader’s own individual conditions, symptoms or concerns. If the reader needs personal medical, health, dietary, exercise or other assistance or advice the reader should consult a physician and/or other qualified health professionals. The author specifically disclaims all responsibility for any injury, damage or loss that the reader may incur as a direct or indirect consequence of following any directions or suggestions given in this blog or participating in any programs described in this blog or in the book, The Building Blocks of Health––How to Optimize Your Health with a Lifestyle Checklist (available in print or downloaded at Amazon, Apple, Barnes and Noble and elsewhere). Copyright 2021 by J. Joseph Speidel