Dear Dr. Garner,

I am totally confused about cholesterol. I thought I finally had it down pat,  with good and bad cholesterol. According to a new report I read this week, there is no such thing as good cholesterol.
Do you think you could explain what is going on and what I should still be worried about?
 Wondering about the Good Bad and the Ugly of Cholesterol

Dear Wondering,

I must admit that I agree with you.  This is a very confusing subject.

This week a new study came out which showed that those people who had a lot of good cholesterol (HDL) had heart attacks at rates equal to those with low levels of good cholesterol.  The study did not question the importance of maintaining low levels of bad cholesterol (LDL). For this type of cholesterol there is definite  proof that  increased  numbers of heart attacks and strokes occur,  as the LDL  level rises.

There are many questions regarding the way the  study was done and its conclusion, but the results seemed to indicate that good cholesterol is not  helpful in reducing heart attacks and other disease related to build up of plaques  and  blockage of the blood vessels.

Cholesterol is necessary for the body to be healthy, as it is a building block in many of the body’s functions and helps to produce many of the chemicals our body needs to live.

The problem occurs, when the cholesterol level builds up above normal.  The elevated levels of  cholesterol cause  fatty deposits to form in the blood vessels  and eventually may lead to strokes and heart attacks.

Previous studies have indicated that not all cholesterol is created equal and that some in large amounts  was actually good for  you.

Having high cholesterol can be due to lifestyle issues such as obesity and lack of exercise, or due to  genetics (inherited from your parents).

The only way to detect the cholesterol level is with a blood test.  The fat particles in the blood circulate as Cholesterol including LDL and HDL (good and bad cholesterol)  or a substance known as triglycerides which can be very bad for your blood vessels.

Bad cholesterol (LDL) – brings cholesterol particles throughout the body, and builds up fatty deposits  in the walls of your arteries.

Good cholesterol (HDL) (prior to last week ) was thought  thought to pick up excess cholesterol, and take it back to the liver  where it could  be digested and removed safely.  In other words, it was thought to mop up  the bad cholesterol.

Now that we are confused about good cholesterol and what it does, let’s review some of the facts that we do know.
Bad cholesterol builds up with lack of exercise, unhealthy diet, and obesity.Smoking, high blood pressure, diabetes, increased alcohol intake  and family history, are all factors that can be associated with high bad  cholesterol

Triglycerides   are a type of fat in the blood.  Having high triglycerides can lead to increased risk of heart disease.  The triglycerides store unused energy or calories and provide the body with energy. When there is too much of it,  it  plays  a role in causing heart attacks and strokes.  Why?  It is not clear, but if you regularly eat more calories than you burn, the triglycerides will be high.

The best way to lower your triglyceride  level is to lose weight, avoid sugary and refined foods, limit the cholesterol in your diet, limit how much alcohol  you drink and exercise regularly.

The article that started the confusion appeared  last week  in the Lancet Medical Journal. The article   basically refuted the long standing notion that the more good cholesterol you have the lower your chance for heart attacks. This is now no longer believed by most scientists, although some may  argue that the final answer is not  in yet.

I think it is important to take a conservative position regarding this study.[hr] Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on NET, Tuesdays at 8 p.m. on Ch. 97 Time Warner and Ch. 30 Cablevision.