Nature and Science, 2(4), 2004, Supplement, Ma, Cholesterol and Human Health

Cholesterol and Human Health

Hongbao Ma

Department of Medicine, Michigan State University, East Lansing, Michigan, USA

hongbao@msu.edu, (517) 432-0623

Abstract: Cholesterol plays a major role in human heart health and high cholesterol is a leading risk factor
for human cardiovascular disease such as coronary heart disease and stroke. There are 102.3 million
American adults who have total blood cholesterol values of 200 mg/dl and higher, and about 41.3 million.
Cholesterol can be good (high-density lipoprotein) or bad (low-density lipoprotein) to the cardiovascular
system. For the total cholesterol in blood: less than 200 mg/dl is desirable level, 200 to 239 mg/dl is the
borderline high for heart disease, and 240 mg/dl and above is High blood cholesterol. A person with this
level of 240 mg/dl or above has more than twice the risk of heart disease as someone whose cholesterol is
below 200 mg/dl. Statin drugs are very effective for lowering LDL cholesterol levels and have few
immediate short-term side effects. Some bacteria can change cholesterol in food to coprostanol that cannot
be readily absorbed by the body and some oral bacteria such as Lactobacillus acidophilus have been
commercial available for the cholesterol lowering. [Nature and Science. 2004;2(4) (Supplement): 17-21].

Keywords: cardiovascular; cholesterol; health; heart; lipoprotein

1. Introduction deciliter of blood (mg/dl). A persons health cholesterol

Cholesterol is a waxy substance made by animal liver content is based on other risk factors such as age,
and also supplied in diet through animal products such gender, family history, race, smoking, high blood
as meats, poultry, fish and dairy products. Cholesterol is pressure, physical inactivity, obesity and diabetes.
needed in the body to insulate nerves, make cell
membranes and produce certain hormones, and it is an 2. Chemical Structure of Cholesterol
important lipid in some membranes. However, the body Cholesterol is present in eukaryotes but not in most
makes enough cholesterol, so any dietary cholesterol prokaryotes. The oxygen atom in its 3-OH group comes
isn't needed. from O2 (Figure 1). Cholesterol evolved after the earths
Cholesterol plays a major role in human heart health. atmosphere became aerobic. The animal plasma
Cholesterol can be both good and bad. High-density membranes of eukaryotic cells are usually rich in
lipoprotein (HDL) is good cholesterol and low-density cholesterol, whereas the membranes of their organelles
lipoprotein (LDL) is bad cholesterol. High cholesterol in typically have lesser amounts of this neutral lipid
serum is a leading risk factor for human cardiovascular (Stryer, 1988).
disease such as coronary heart disease and stroke -
America's number one killer (Tabas, 2002). Excess
cholesterol in the bloodstream can form plaque (a thick,
hard deposit) in artery walls. The cholesterol or plaque
build-up causes arteries to become thicker, harder and
less flexible, slowing down and sometimes blocking
blood flow to the heart. When blood flow is restricted,
angina (chest pain) can result. A heart attack will result
when blood flow to the heart is severely impaired and a
clot stops blood flow completely. When there is too
much LDL cholesterol in the blood, it is deposited
inside the blood vessels, where it can build up to hard
deposits and cause atherosclerosis, the disease process
that underlies heart attacks. Figure 1. Chemical structure of cholesterol
There are 102.3 million American adults who have
total blood cholesterol values of 200 mg/dl and higher, 3. Good Cholesterol and Bad Cholesterol
and about 41.3 million American adults have levels of Cholesterol can be good or bad. HDL is called good
240 mg/dl of cholesterol or above. Total blood cholesterol that is good for the cardiovascular system
cholesterol is the most common measurement of blood and LDL is called bad cholesterol that is bad for the
cholesterol. Cholesterol is measured in milligrams per cardiovascular system. These are the form in which
cholesterol travels in the blood. LDLs have little protein

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 Nature and Science, 2(4), 2004, Supplement, Ma, Cholesterol and Human Health

and high levels of cholesterol and HDL has a lot of lipoprotein profile done to determine LDL cholesterol
protein and very little cholesterol. LDL is the main and triglyceride levels.
source of artery clogging plaque. HDL actually works to A persons LDL cholesterol goal depends on how
clear cholesterol from the blood. many other risk factors he/she has: (1) If he/she does not
The standard test of cholesterol is done after a 9-12 have coronary heart disease or diabetes and have one or
hours fast without food, liquids or pills. It gives no risk factors, his/her LDL goal is less than 160 mg/dl.
information about total cholesterol, LDL, HDL and (2) If he/she does not have coronary heart disease or
triglycerides (blood fats). The cholesterol content in diabetes and have two or more risk factors, his/her LDL
blood is the key data for the health information of goal is less than 130 mg/dl. (3) If he/she has coronary
cholesterol related (Table 1). If a persons total heart disease or diabetes, his/her LDL goal is less than
cholesterol is 200 mg/dl or more, or his/her HDL 100 mg/dl.
cholesterol is less than 40 mg/dl, he/she needs to have a

Table 1. Initial classification based on total cholesterol, HDL, LDL and Triglyceride
Cholesterol Cholesterol Level Category
Total Cholesterol Less than 200 mg/dl Desirable level.
200 to 239 mg/dl Borderline high for heart disease.
240 mg/dl and above High blood cholesterol. A person with this level has more than twice
the risk of heart disease as someone whose cholesterol is below 200
mg/dl.
HDL Cholesterol Less than 40 mg/dl Low HDL cholesterol. A major risk factor for heart disease.
40 to 59 mg/dl The higher HDL level, the better.
60 mg/dl and above High HDL cholesterol. An HDL of 60 mg/dl and above is considered
protective against heart disease.
LDL Cholesterol Less than 100 mg/dl Optimal
100 to 129 mg/dl Near or above optimal
130 to 159 mg/dl Borderline high
160 to 189 mg/dl High
190 mg/dl and above Very high
Triglyceride Less than 150 mg/dl Normal
150-199 mg/dl Borderline high
200-499 mg/dl High
500 mg/dl and above Very high

4. Triglyceride People should reduce the amount of saturated fat,

Triglycerides are another fat in the bloodstream. High trans-fat, cholesterol and total fat in their diet. Some
levels of triglycerides is also linked to heart disease. studies have shown a higher mortality in people with
Triglyceride is the most common type of fat in the low cholesterol levels - that is, lower than 160 mg/dl.
body. Many people who have heart disease or diabetes These deaths are from non-coronary causes (some
have high triglyceride levels. Normal triglyceride levels cancers, chronic respiratory disease, liver disease and
vary by age and sex. A high triglyceride level combined trauma). On the other hand, some evidence suggests that
with low HDL cholesterol or high LDL cholesterol total cholesterol levels below 160 mg/dl are not
seems to speed up atherosclerosis, which is the buildup dangerous. In many countries a major portion of the
of fatty deposits in artery walls that increase the risk for population has cholesterol levels in this range
heart attack and stroke. throughout life without serious health problems. Also,
less than 6 percent of the American population has a

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 Nature and Science, 2(4), 2004, Supplement, Ma, Cholesterol and Human Health

cholesterol level below 160 mg/dl. It's rarely necessary 8.1 Diet. Saturated fat, trans fat, and cholesterol in the
to lower total cholesterol below that. food you eat increase cholesterol levels. Reducing the
amount of saturated fat and trans fats and cholesterol in
5. Hyperlipidemia your diet helps lower your blood cholesterol level.
Hyperlipidemia is an elevation of lipids (fats) in the
bloodstream. These lipids include cholesterol, 8.2 Weight. In addition to being a risk factor for heart
cholesterol esters (compounds), phospholipids and disease, being overweight can also increase your
triglycerides. They're transported in the blood as part of cholesterol. Losing weight can help lower your LDL,
large molecules called lipoproteins. These are the five total cholesterol levels, and triglyceride levels, as well
major families of blood (plasma) lipoproteins: (1) as raise your HDL.
chylomicrons, (2) very low-density lipoproteins
(VLDL), (3) intermediate-density lipoproteins (IDL), 8.3 Exercise. Regular exercise can lower LDL
(4) low-density lipoproteins (LDL), (5) high-density cholesterol and raise HDL cholesterol. You should try
lipoproteins (HDL). When hyperlipidemia is defined in to be physically active for 30 minutes on most days.
terms of class or classes of elevated plasma lipoproteins,
the term hyperlipoproteinemia is used. 8.4 Age and Gender. As we get older, cholesterol
Hypercholesterolemia is the term for high cholesterol levels rise. Before menopause, women tend to have
levels in the blood. Hypertriglyceridemia refers to high lower total cholesterol levels than men of the same age.
triglyceride levels in the blood. The average American After menopause, however, women's LDL levels tend to
man gets about 337 mg of cholesterol a day from food rise.
and the average woman gets about 217 mg. I suggest
that a person should limit cholesterol from food to an 8.5 Heredity. Your genes partly determine how much
average of no more than 300 mg per day. cholesterol your body makes. High blood cholesterol
can run in families.
6. Cholesterol from Foods
Cholesterol from food is hard to get away from, even 8.6 Medical conditions. Occasionally a medical
though one may be watching his/her diet. All foods of condition may cause an elevation of cholesterol levels in
animal origin contain cholesterol, including eggs, red the blood. These include hypothyroidism (an
meat, and shrimp. Generally, foods that are high in underactive thyroid gland), liver disease and kidney
saturated fats or trans fats should also be limited. These disease.
include foods you may not even think of, such as
grilled-cheese sandwich, margarine, potato with butter 8.7 Medications. Some medicines, like steroids and
and chicken pot pie, etc. As we eat, cholesterol from progestins may increase the "bad" cholesterol and
food is absorbed by our digestive tract. It then makes its decrease the "good" cholesterol.
way into our liver and can circulate through our body in
the bloodstream. Thats one source. Theres also a little- 9. Medications
known second source of cholesterol human body. The main goal in lowering cholesterol is to lower
your LDL and raise your HDL. To lower cholesterol,
7. Cholesterol Produced by Body Based on Genetics eat a heart-healthy diet, exercise regularly, and maintain
Like many people, one may not know that his/her a healthy weight. Some may also need to take
body produces cholesterol naturally, based on family cholesterol lowering medications. Cholesterol-lowering
history genetically - despite the fact that its where more medicine is most effective when combined with a low-
of ones total cholesterol comes from. The liver makes cholesterol diet and exercise program.
cholesterol, as do other individual cells throughout the The drugs of first choice for elevated LDL cholesterol
body. Once cholesterol is produced, it can make its way are the HMG CoA reductase inhibitors, e.g. lovastatin,
into the bloodstream. pravastatin and simvastatin. Statin drugs are very
What does this process mean to people? Take the effective for lowering LDL cholesterol levels and have
cholesterol the body makes and add it to the cholesterol few immediate short-term side effects (Jongh, 2002).
one gets from food. Now one can see how easily They are easy to administer, have high patient
cholesterol can build up in the bloodstream and how the acceptance and have few drug-drug interactions.
overall cholesterol level can increase. Patients, who are pregnant, have active or chronic liver
disease, or those allergic to statins shouldn't use statin
8. The Factors Affect Cholesterol Levels drugs. The most common side effects of statins are
A variety of factors can affect your cholesterol levels. gastrointestinal, including constipation and abdominal
They include: pain and cramps. These symptoms are usually mild to
severe and generally subside as therapy continues.

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 Nature and Science, 2(4), 2004, Supplement, Ma, Cholesterol and Human Health

Another class of drugs for lowering LDL is the bile acid triglycerides, lower LDL cholesterol and raise HDL
sequestrants - cholestyramine and colestipol - and cholesterol.
nicotinic acid. These have been shown to reduce the risk
for coronary heart disease in controlled clinical trials. 9.1.4 Resins. Resins are also called bile acid-binding
Both classes of drugs appear to be free of serious side drugs. They work in the intestines by promoting
effects. But both can have troublesome side effects and increased disposal of cholesterol. There are three kinds
require considerable patient education to achieve of medications in this class: (1) Cholestryamine
adherence. Nicotinic acid is preferred in patients with (Questran, Prevalite, Lo-Cholest), (2) Colestipol
triglyceride levels exceeding 250 mg/dl because bile (Colestid), (3) Coleseveiam (WelChol).
acid sequestrants tend to raise triglyceride levels.
Other available drugs are gemfibrozil, probucol and 9.1.5 Statins. Statins block the production of cholesterol
clofibrate. Gemfibrozil and clofibrate are most effective in the liver itself. They lower LDL, the "bad"
for lowering elevated triglyceride levels. They cholesterol, and triglycerides and have a mild effect in
moderately reduce LDL cholesterol levels in raising HDL, the "good" cholesterol. Statin drugs are
hypercholesterolemic patients, but the American FDA very effective for lowering LDL cholesterol levels and
hasn't approved them for this purpose. Probucol also have few immediate short-term side effects. They work
moderately lowers LDL levels and it has been received by interrupting the formation of cholesterol from the
FDA approval for this purpose. circulating blood. These drugs are the first line of
If a patient doesn't respond adequately to single drug treatment for most people with high cholesterol. Side
therapy, combined drug therapy should be considered to effects can include intestinal problems, liver damage,
further lower LDL cholesterol levels. For patients with and in a few people, muscle tenderness or weakness.
severe hypercholesterolemia, combining a bile acid Examples of statins include: (1) Altocor, (2) Baycol
sequestrant with either nicotinic acid or lovastatin has (cerivastatin), (3) Crestor, (4) Lipitor (atorvastatin), (5)
the potential to markedly lower LDL cholesterol. For Lescol (Fluvastatin), (6) Mevacor (lovastatin), (7)
hypercholesterolemic patients with elevated Pravachol (pravastatin), (8) Zocor (simvastatin).
triglycerides, nicotinic acid or gemfibrozil should be Advicor is a combination of a statin and niacin. Caduet
considered as one agent for combined therapy. is a new drug that is a combination of a statin (Lipitor or
atorvastatin) and a blood pressure-lowering drug called
9.1 Drugs amlodipine (Norvasc). Commonly prescribed statins
There are a variety of medications available for include: (1) Atorvastatin (Lipitor), (2) Cerivastatin
lowering blood cholesterol levels. They may be (Baycol), (3) Fluvastatin (Lescol), (4) Lovastatin
prescribed individually or in combination with other (Mevacor), (5) Pravastatin (Pravachol), (6) Simvastatin
drugs. Some of the common types of cholesterol- (Zocor).
lowering drugs include (1) Clofibrate, (2) Gemfibrozil,
(3) Nicotinic acid (niacin), (4) Resins, (5) Statins, (6) 9.1.6 Bile Acid Sequestrants. These drugs work inside
Fibric acid derivatives (7) Fibrates: the intestine, where they bind to bile and prevent it from
being reabsorbed into the circulatory system. Bile is
9.1.1 Clofibrate (Atromid-S). This drug raises the made largely from cholesterol, so these drugs work by
HDL cholesterol levels and lowers triglyceride levels. reducing the body's supply of cholesterol,, thus lowering
total and LDL cholesterol. The most common side
9.1.2 Gemfibrozil (Lopid). This drug lowers blood fats effects are constipation, gas, and upset stomach.
and raises HDL cholesterol levels. Examples of bile acid resins include: questran and
questran light (cholestyramine), colestid (colestipol),
9.1.3 Nicotinic Acid (niacin). Niacin is a B-complex WelChol (colesevelam).
vitamin. It's found in food, but is also available at high
doses by prescription. It lowers LDL cholesterol and 9.1.7 Fibrates. Fibrates lower triglyceride levels and
raises HDL cholesterol. The main side effects are can increase HDL and lower LDL cholesterol. The
flushing, itching, tingling and headache. Niacin or mechanism of action is not clear but it is thought that
nicotinic acid, includes the brand names Niacor, fibrates enhance the breakdown of triglyceride-rich
Niaspan, or Slo-niacin. Over-the-counter preparations particles and decreases the secretion of certain
include extended-release, timed-release, and controlled- lipoproteins. In addition, they induce the synthesis of
release. Niacin found in dietary supplements should not HDL. Examples of fibrates include: tricor (fenofibrate),
be used to lower cholesterol. The doctor or lipid lopid (gemfibrozil), lofibra (fenofibrate).
specialist will let patients know what type of niacin is
best for them. This drug works in the liver by affecting 9.1.8 Side Effects of Cholesterol-Lowering Drugs
the production of blood fats. It's used to lower

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 Nature and Science, 2(4), 2004, Supplement, Ma, Cholesterol and Human Health

The side effects of cholesterol-lowering drugs maintain cholesterol and triglyceride levels, (4)
include: (1) Muscle aches, (2) Abnormal liver function, maintain healthy blood sugar levels (Ma, 2004).
(3) Allergic reaction (skin rashes), (4) Heartburn, (5)
Dizziness. (6) Abdominal pain, (7) Constipation, (8) Correspondence to:
Decreased sexual desire. Hongbao Ma
One newer drug is Zetia. This drug works by 138 Service Road
inhibiting the absorption of cholesterol from the blood. Department of Medicine
Side effects include back pain, joint pain, diarrhea and Michigan State University
abdominal pain. East Lansing, Michigan 48824
As of August 8, 2001, Bayer Pharmaceutical Division The United States
voluntarily withdrew the drug Baycol (cerivastatin) Telephone: (517) 432-0623
from the U.S. market because of reports of fatal muscle Email: hongbao@msu.edu
damage caused by the drug.
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