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Heart Operation Surgery Information

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Welcome to this website about:  Heart  Operation Surgery Information,  Coronary Heart Bypass Surgery, Aneurysms of the Heart Muscle, Valvular Heart Surgery,The Atrial Septal Defect, How Your Heart Works, Reducing Your Risk Factors, Common Heart Problems, Contributing Factors, Non-Invasive Diagnostics, Medical Treatment, Patient Recovery, Invasive Procedures, Heart Disease, New Medicines for Strokes, Cardiac Heart Information, Open Heart Surgery,  Minimally Invasive Heart Surgery, Congenital Heart Defects Cardiothoracic Surgery, Coronary Artery Bypass, Causes of Common Heart Attack, Pediatric Heart Surgery, Endovascular Surgery,  Understanding Heart Surgery, Arthroscopic Surgery Treatment.
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Cholesterol, Statins and Heart Attack
Ischemic heart disease (IHD) is a condition whereby the heart muscle receives insufficient oxygen for continued healthy function, due to arterial blockages that prevent oxygenated cells from getting to their destination. The result is what is commonly called a heart attack.

As researchers examined those who died of IHD-related causes, what they often found were arterial cholesterol buildups that had become so large they blocked blood flow in the vessel. Cholesterol became public enemy #1 and reducing the amount in the blood became accepted as the way to avoid IHD.

Now, that is gospel. So much so that pharmaceutical research has been almost entirely devoted to developing drugs that block the body's production of cholesterol, the most common of which are a class called statins. Statins such as Lipitor®, Zocor®, Crestor®, Vytorin®, the now discredited Baycol®, and others all work in basically the same way. They're mevalonate inhibitors. Simply put, they attack the weak link in the cholesterol synthesis chain, by inhibiting the enzyme that activates cholesterol production inside the cell.

And they work. They both lower serum cholesterol and are proven to be effective in preventing heart attacks. Thus, statins have become the most prescribed (and profitable) drugs in the country, with tens of millions of Americans regularly taking them. Case closed. 

Or is it? As the anti-cholesterol era progressed, a few open-minded researchers began to question whether cholesterol buildup on arterial walls might be a symptom, rather than a root cause. To put it another way, is excess cholesterol a bad thing per se, or is the actual bad thing some underlying condition that causes the cholesterol to stick?

Before answering that question, a brief side trip into physiology is necessary. Many people have the mistaken impression that cholesterol is some evil, alien substance that we'd do much better without. Not so. It is present in every cell of our bodies. Its functions are numerous, and still not fully understood. Suffice it to say that without it, we wouldn't be alive.

Cholesterol is produced naturally by the body, as well as being absorbed from food. Generally lumped under the term are triglycerides, low-density lipoproteins (LDL--the "bad" cholesterol), and high-density lipoproteins (HDL--the "good" cholesterol).

Despite the labels, all do important things. The problem arises, according to conventional wisdom, when LDL levels become too high, and the elimination function performed by HDL breaks down. The excess LDL is not passed back through the liver, it clogs blood vessels, and it begins to coagulate and clump within them. But why should it? Furthermore, why is it that the majority of heart attack victims have normal cholesterol levels?

Those are key questions. Increasingly, the focus is shifting away from the cholesterol itself and onto chronic inflammation of the arterial walls. 

Inflammation is a killer. It can weaken blood vessels until they rupture, causing a heart attack (or stroke), regardless of cholesterol levels. It can also result in the weakened sites latching onto passing cholesterol molecules in the body's attempt to repair the damage, thereby initiating the process that ends with a cholesterol blockage.

Thirty years ago, at Harvard Medical School, research pioneer Dr. Kilmer McCully was looking for a better marker for heart attack risk by linking high levels of the inflammation-causing amino acid homocysteine to the disease. McCully's views were out of the mainstream at that time, and it would take until the late '90s for the profession to catch up, as homocysteine finally came under broad scrutiny.

Inflammation theory got another big boost in 2003, when a massive longitudinal study at Boston's Brigham and Women's Hospital was published in the New England Journal of Medicine. It showed that the presence of a compound called C-reactive protein (CRP), a substance manufactured by the liver in response to the presence of inflammation in the body, was the best predictor of heart attack and stroke risk.

In this context, we can return to a consideration of statins. Suppose that their efficacy in reducing the risk of heart attack is due not to the fact that they inhibit cholesterol production, but to their powerful anti-inflammatory properties. That's precisely the conclusion reached by Dr. Duane Graveline, a flight surgeon and original NASA scientist/astronaut, who has been studying the subject for years.

Well, what does it matter? one might reasonably ask. If the drugs decrease the risk of heart attack, what's not to like?

As with all drugs, the answer is that there are trade-offs involved. No one knows the extent of them yet. The inhibition of mevalonate, for example, involves more than just cholesterol suppression, since it's a precursor of other substances with important biological functions.

What is known is a list of side effects associated with statins. According to Swedish researcher Dr. Ulle Ravnskov, these include fatigue, muscle soreness/weakness, peripheral neuropathy of the legs, short temper, aggressive behavior, and (rare) muscle problems leading to kidney failure. Pregnant women should avoid statins because of the likelihood of birth defects in their newborns.

Perhaps most disturbing is the possibility that statins may interfere with cognition. While reports linking the drugs to such disorders as transient global amnesia and other Alzheimer's-like symptoms are anecdotal at the moment, there is real cause for concern.

In a landmark 2001 study by Dr. Frank Pfrieger et al, of France's Centre de Neurochimie, the group discovered a link between brain cholesterol metabolism and nerve cell development, learning and memory. Cholesterol proved to be the heretofore elusive factor responsible for the development of synapses, the contact sites between adjacent neurons in the brain. We can't think properly without cholesterol.

Now, here's the rub. Cholesterol circulating in the bloodstream is unavailable to the brain; both LDL and HDL are too large to pass the blood/brain barrier. Cholesterol needed by the brain must be manufactured on-site.

Statins, however, do pass the barrier and enter the brain, where, it is reasonable to assume, they exercise their proven ability to inhibit cholesterol production. A scary possibility.

Dr. Graveline suggests that dosage levels be reconsidered. The relatively high dosages of statins required to lower cholesterol may not be necessary if the drugs' protective qualities are actually due to their anti-inflammatory action. A smaller, and far less risky, dose may work just fine. 

And who knows, future generations may marvel that we spent so much time and money developing ever more sophisticated cholesterol inhibitors when all we really needed was the simplest, least expensive anti-inflammatory of them all, aspirin

 
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Heart surgery data may go publicH

State looking at patient death rates for doctors

By Liz Kowalczyk, Globe Staff  |  July 4, 2006

State public health officials will decide this summer whether to publicize the patient death rates for individual physicians who perform two common heart procedures, giving Massachusetts patients unprecedented information about their doctors' performance.

Governor Mitt Romney has vowed to make the quality and cost of healthcare more transparent, but the mortality statistics, covering thousands of heart procedures performed annually, will test how far the governor is prepared to push openness. Health officials in New York, which has collected and released mortality data for individual cardiac doctors since 1991, said the program has lowered the mortality rate for patients.

But many Massachusetts cardiac surgeons and cardiologists strongly oppose making the mortality data available to consumers, saying this approach could actually hurt care by discouraging doctors from taking high-risk patients who are more likely to die. They are pressing health officials to keep private one of the most detailed and carefully analyzed physician data sets in the country.

``I understand there is a public desire for transparency and I don't want people to think things are being hidden from them," Dr. Richard Shemin, chief of cardiothoracic surgery at Boston Medical Center and president of the Massachusetts chapter of the Society of Thoracic Surgeons. ``Our fear is we'd hate to see a young surgeon who took too many risky cases be identified as a bad surgeon."

The state already releases the mortality rates at individual hospitals for cardiac bypass surgery and angioplasty, procedures used to treat clogged arteries. In bypass surgery, doctors create a new blood vessel, or route, around the diseased artery, while in angioplasty, they open the clogged vessel with a balloon and may insert a stent to keep it open. The state's data collection program has not found huge variations among hospitals, with the exception of UMass Memorial Medical Center in Worcester, which temporarily suspended its cardiac surgery program last year because of a higher-than-average mortality rate.

But the six-year-old state law that requires collection of death statistics leaves open the question of whether the state must report publicly mortality rates for individual cardiac surgeons and cardiologists, said Paul Dreyer, director of the Division of Health Care Quality at the Public Health Department. When the law was enacted, he and other officials decided against it, saying they believed it was better for state agencies and hospitals to use the physician data internally to identify poor performers and push for improvements.

Now, Dreyer said, officials have decided to rethink the question, largely because of the growing national push by employers, insurers, and politicians to disclose information about medical care that previously has been kept from the public or not collected.

Senator Mark C. Montigny, a New Bedford Democrat and a lead author of the legislation, said his intent was to give consumers access to mortality rates of individual doctors. ``The consuming public should be able to say that doctor so-and-so has this track record, and this is where I'm going to get my heart surgery," he said last week.

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Advocates of public reporting believe that it holds providers accountable for the billions of healthcare dollars spent annually and helps patients decide where to seek treatment, creating market pressure on providers to improve care. This is especially important for common procedures like cardiac surgery and angioplasty, which are often planned for months in advance, giving patients time to shop around.

Doctors performed more than 4,393 bypass operations in Massachusetts in 2003, the most recent data the state has posted, and more than 12,657 angioplasty procedures from April though December of that year.

The idea of openness has flourished in Massachusetts. The Romney administration has established a transparency website where consumers can check how many times surgeons have performed 10 of the most common or complex operations, including hip and knee replacements and heart bypass surgery, among other quality and cost information. Most major insurers are posting the cost of common procedures on their websites. And the private, non profit Massachusetts Health Quality Partners provides performance ratings for 150 physician groups on its website.

Still, reporting mortality rates of individual physicians -- a measure that makes doctors nervous, because a bad number can ruin reputations and drive away patients -- is relatively new, and basic questions about its effectiveness remain unanswered.

New York initially released the results for hospitals in 1989, refusing to do so for individual doctors. But the newspaper Newsday successfully sued the state for access to the information, and the state began releasing death rates for doctors in 1991. Now, state officials credit the program with improving mortality rates for patients. In 2003, the most recent data available, New York's mortality rate for bypass surgery was 1.61 percent, compared to 3.52 percent in 1989. Massachusetts' mortality rate for bypass surgery in 2003 was 2.25 percent, though it's unclear whether the states' rates can be compared directly, because of differences in the way they're analyzed.

``The whole effort has led to better outcomes in New York State," said Edward Hannan, chairman of health policy management and behavior at University at Albany School of Public Health, who analyzes the data for the state. In some cases, hospitals refused to renew the privileges of poorly performing surgeons or those surgeons stopped performing the procedures.

But Massachusetts physicians who oppose public release of death rates for doctors see another reason for New York's improved mortality rate. They say that physicians, knowing their mortality rates will be made public, avoid performing procedures on high-risk patients, who are more likely to die, and refer them to doctors in nearby states.

``When you really start shining the light on individual doctors and their outcomes, then you really galvanize people who are worried about their results," said Dr. David Torchiana, head of the Massachusetts General Physicians Organization and a cardiac surgeon.

Several studies comparing cardiac patients in New York with those in other states have suggested that high-risk patients are leaving New York, Torchiana said. One recent study suggested that fewer patients suffering from shock following a heart attack, who are very high-risk, are getting angioplasty procedures in New York compared with other states.

But other studies have found the opposite, Hannan said, leaving the facts unclear.

Dreyer said public health officials are deciding this summer whether to release mortality data for individual doctors because they now have three years worth of data, 2002, 2003, and 2004, enough to be statistically reliable for doctors whose annual caseload is small.

Amy Lischko -- commissioner of the state division of Health Care Finance and Policy and the person in charge of the administration's transparency initiative -- said that health officials will try to convince doctors that publicly reporting the death rates is the right thing to do. But if not, said Lischko, the state is likely to go ahead anyway.

``It could be private the first year and then public the second year. That would be a reasonable compromise," she said. ``Eventually it will be public, unless someone comes out with a definitive study saying the information had a negative impact in New York. We're in an era where people want access to good information."
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Heart Surgery

Valvular Heart Surgery
Your cardiac surgeon will discuss with you whether he will repair or replace your diseased heart valve.

If your heart valve must be replaced, your doctor will decide which valve is more appropriate for your heart. There are two types of valves:

  1. The tissue valve (also known as a porcine valve)
  2. The mechanical valve

Atrial Septal Defect
Sometimes at birth the wall that divides the heart's upper chambers (the right and left atrium) does not close all the way and there may be a hole that lets blood flow between the chambers of the heart. If the hole size is significant and needs to be repaired the cardiac surgeon may sew the hole closed or may use a "patch" to sew it closed.

Aneurysms of the Heart Muscle
Bulging or ballooning of an area of the heart muscle may occur after a heart attack. This bulging or ballooning area is referred to as an aneurysm. The area of heart muscle that is bulging or ballooning does not contract or pump well. During surgery, the bulge is cut out or patched.
Pacemakers and ICDs: A Patient Guide
 

These electronic medical devices monitor heart rhythm and deliver appropriate electrical therapy when the heart rate is irregular (a condition called arrhythmia). Pacemakers and ICDs can be effective in extending and improving the lives of heart patients. Millions of people are affected by arrhythmias, which contribute to about 500,000 deaths each year in the US.

What are artificial pacemakers?

As the name implies, an artificial pacemaker "paces" the heartbeat in patients who have a slow heart rate. It is a device equipped with a battery-powered pulse generator and one or more wires. A pacemaker detect a heartbeat that is too slow or irregular and provides electrical signals that tell the heart to beat at a proper rate by delivering signals to the appropriate chambers of the heart.

Many pacemakers are programmed to lie dormant for as long as the heart is beating at a steady rate of 60-70 pulses per minute. When the heartbeat is too slow, a pacemaker sends an electrical impulse to pace the heart back to an appropriate rate.

What is an implantable cardioverter defibrillator (ICD)?

ICDs represent a major revolution in the field of cardiology for patients at high risk for suffering serious, potentially life-threatening arrhythmias. More sophisticated than pacemakers, ICDs are small electric generators that monitor the heart constantly, but only initiate an electrical signal when it detects an incorrect heart rhythm. ICDs not only function as pacemakers for slow heart rates, but may also deliver high-energy electrical therapy for fast heart rates, called defibrillation shocks. Surgically implanted like a pacemaker, an ICD is a miniature version of the shock paddles used by paramedics and emergency room doctors.

Who needs an artificial pacemaker?

Normal heartbeat is controlled by a natural pacemaker in the heart called the sinus node. An electrical signal is generated by the sinus node, a group of special cells in one of the upper chambers of the heart, called the atria. The signal spreads through the heart to the lower chambers, called the ventricles, and causes the heart to beat.

A pacemaker is needed when the function of the sinus node becomes too slow from age, heart disease, or heart medications. Another leading cause for pacemaker implantation is heart block-the failure of the electrical signal to reach the main pumping chambers of the heart, which in turn causes a slow heart rate.

When the heart beats too slowly, the brain and body do not get enough blood flow, leading to fainting, dizziness, lack of energy, fatigue, shortness of breath, and low tolerance for exercise and physical activity. Extreme slowing or complete stopping of the heartbeat can be fatal.

Who needs an ICD?

ICDs have been proven to prolong survival in patients with abnormal heart rhythms, usually those who have damaged hearts. Patients may be survivors of cardiac arrest caused by ventricular tachycardia (VT), a heart rhythm disorder that originates in the ventricles . VT is a rapid rhythm during which patients may feel faint or dizzy, or even pass out. During VT, the heart does not pump blood as efficiently as it does during a normal rhythm because rapid contractions prevent it from filling adequately with blood between beats. VT can be dangerous, even life threatening, if not properly treated.

Patients may also have atrial fibrillation (AF) or ventricular fibrillation (VF), heart rhythm disorders that originate in the ventricles. AF and VF are abnormally rapid heart rhythms that are highly unstable and irregular.

During fibrillation, electrical signals move chaotically through the heart, preventing it from pumping blood and beating properly. This often results in loss of consciousness. If left untreated, it may result in sudden cardiac death.

An ICD can deliver several types of therapies. These therapies include defibrillation, which delivers a brief, high-energy electric shock, and cardioversion, which consists of synchronized shock impulses that may progress from low-energy to high-energy levels, depending on what is needed to stop the rapid rhythm.

An ICD can act like a pacemaker by stimulating your heart if the rhythm is too slow. This requires little energy, so you may not feel anything. If an ICD detects a rapid beat, it can emit a series of pulses, which may feel like a fluttering in your chest. If this fails, the ICD can deliver one or more mild shocks, which may feel like thumps, to put you back into normal rhythm.

If your heart begins to beat dangerously with a very fast, irregular rhythm, the ICD provides a high-energy shock to give your heart's natural pacemaker time to get control of the rhythm again. The defibrillating shock is a strong one that feels like a kick in the chest and may even knock you out. But it may also save your life.

Implantation

An artificial pacemaker or ICD is implanted by a minor surgical procedure performed under local anesthesia. The surgery usually takes 1 to 2 hours and the risk of complications is approximately 1 to 2 percent. A pacemaker, which is about as large as 3 silver dollars, is placed beneath the skin just below the right or left collarbone. The wire or wires are threaded through a large vein into the heart. Using an X-ray, a physician attaches the electrodes at the end of the wires to the inner wall of the heart. The other end of the wire is attached to the device.

An ICD is larger than a pacemaker-about as big as a pager-and is implanted in a similar manner.

Pacemaker and ICD precautions

These devices generally will not prevent you from performing everyday activities, but certain precautions should be considered. First, remember to tell your doctor and dentist that you have the device before having any test or procedure. It is also wise to carry a medical ID card in your wallet because medical equipment that uses electromagnetic and radio wave technology may interfere with how your device performs. For example, magnetic resonance imaging (MRI), which uses a magnet to produce images of organs, may interrupt your device’s operation.

Other medical equipment used to dissolve kidney stones, treat irregular heart rhythms, treat acute or chronic pain, and deliver radiation for treatment of cancerous tumors may interfere with your device’s performance or require reprogramming of the device.

Home appliances do not pose a threat to your device’s operations, but large motors, high-voltage and radar machinery, such as transmitters and arc welding equipment, could temporarily affect your device.
How Your Heart Works

About a hundred times a minute, 100,000 times a day, 36.5 million times a year, your heart keeps the beat... the beat of life. That familiar thump, thump, thump tells you that your heart is doing its job pumping blood from the veins to the heart and lungs, where it is replenished with oxygen and then distributed back to the body through the arteries. How does the heart work? Read on.

The human heart is really a pump, a powerful muscle the size of your fist that circulates blood to and from the body's millions of cells. It's divided into four chambers. There are two chambers on each side with a wall-like divider between them called a septum that separates the left side from the right side. These two receiving chambers have two passageways called valves. Each side of the heart has two valves that allow blood to pass through the heart. The tricuspid valve on the right and the mitral valve on the left regulate blood flow between the atrium and the ventricle on each side. The right valve is called the pulmonary valve and it allows blood to flow from the right ventricle to the pulmonary arteries, which supply the lungs. The left valve is called the aortic valve, which regulates blood flow from the left ventricle to the aorta.

Diagram of the heart

In the normal adult, the heart pumps five liters of blood, which is recirculated continuously through the body. The blood moves from the heart into tubes called arteries, then into tiny tubes called capillaries and finally into the veins that lead back to the heart.

The entire cycle takes about 60 seconds, during which the blood brings nourishment and oxygen to all the body's cells in the tissues, organs, muscles and bones.

Here's a more complex description of the blood's journey through the body: The blood moves from the left atrium to the left ventricle through the mitral valve. As the left ventricle contracts, it pushes open the aortic valve and the blood is carried into the aorta, which distributes it to all other body organs including the heart by way of the coronary arteries. These arteries wind around the heart to keep the heart muscle supplied with oxygen and nutrients for its continuous pumping job.

As wastes are produced, they are delivered through the blood to the right atrium through the vena cava. The accumulated blood pushes open the tricuspid valve, allowing the blood to pass from the right atrium to the right ventricle. After the chamber fills, the heart contracts and the pulmonary valve opens. Blood then flows from the right ventricle into the pulmonary artery.

The pulmonary artery, which has two branches, carries blood to the right and left lungs. From the lungs, the capillary vessels carry the blood along the lungs' tiny air sacs. As the lungs breathe, carbon dioxide is passed from the body and oxygen is taken in. As this transfer occurs, the blood changes from purple or dark red to bright red.

After passing through the lungs, the blood is brought by the pulmonary veins into the left atrium. From there, the blood starts its course through the left ventricle and aorta again.

 
Reducing Your Risk Factors

What Is A Risk Factor?
A risk factor is a specific condition or behavior associated with the development of heart and blood vessel disease. The more risk factors, the greater chance you have of developing heart disease. Therefore, reducing these risk factors is the key to a healthier heart.

What Are The Risk Factors?
There are risk factors that cannot be controlled or changed, and there are risk factors that can be controlled or changed.

Major Risk Factors That Cannot Be Changed
Heredity
Gender
Age

 
Major Risk Factors That Can Be Controlled or Changed
Smoking
High Blood Pressure
Blood Cholesterol Levels
Stress

 
Contributing Factors
Obesity
Lack of Exercise
Diabetes
 

Common Heart Problems

Coronary Artery Disease/Myocardial Infarction

Valvular Heart Disease

Valvular Heart Disease and Endocarditis

Mitral Valve Prolapse

Mitral Valve Prolapse Syndrome

Heart Failure

Wolff-Parkinson-White Syndrome

Atrial Fibrillation

Supraventricular Tachycardia

AV Nodal Re-entrant Tachycardia

Non-Invasive Diagnostics

Upright Tilt Table Test

Signal-Averaged Electrocardiogram (SAECG)

Echocardiogram

MUGA Scan

Cardiopulmonary Stress Test

Stress Test

Thallium Stress Test

Holter Monitor

Stress Echocardiogram
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Medical Treatment

Medical Management of Heart Disease

Cardiac Outpatient Drug Infusion Therapy

Thrombolytic Therapy

Medication

 
This page is about these topics. Welcome to this website about:  Heart  Operation  Information,  Coronary Heart Bypass , Aneurysms of the Heart Muscle, Valvular Heart , Atrial Septal Defect, How Your Heart Works, Reducing Your Risk Factors, Common Heart Problems, Contributing Factors, Non-Invasive Diagnostics, Medical Treatment, Patient Recovery, Invasive Procedures, Heart Disease, New Medicines for Strokes, Cardiac Heart Information, Open Heart ,  Minimally Invasive Heart , Congenital Heart Defects Cardiothoracic , Coronary Artery Bypass, Causes of Common Heart Attack, Pediatric Heart , Endovascular ,  Understanding Heart , Arthroscopic  Treatment.

 
 

Cholesterol, Part One: A Patient Guide

 By Barbara A. Laurencio
 Introduction

Cholesterol – friend or foe? Without it, we couldn’t survive. But too much of this waxy substance in your blood can lead to heart disease, the number one killer of men and women in the United States. The higher your blood cholesterol, the greater your risk for developing heart disease and suffering a heart attack, according to the National Heart, Lung, and Blood Institute (NHLBI).

Every year, more than 1 million Americans suffer a heart attack and about 500,000 people die from heart disease. However, because high blood cholesterol does not cause any symptoms, many people (more than 50 percent by recent estimates) are either inadequately treated or unaware that their cholesterol level is too high. Considering that 41 million estimated American adults have high cholesterol (according to the American Heart Association), the failure to appreciate high cholesterol’s importance places many people at unnecessary risk for developing future heart disease.
What is cholesterol?

Cholesterol is a waxy, fat-like substance that is naturally found in all parts of our bodies. It is present in the walls and membranes of every cell, including cells in the brain, nerves, muscle, skin, liver, intestines, and heart. Without cholesterol, our bodies could not function properly. It acts as the backbone of hormones like estrogen and testosterone, vitamin D, and bile acids that help us to digest fat.

Cholesterol in the body comes from two major sources. The first is from the liver, which is the body’s major cholesterol-producing organ. We also consume foods that contain cholesterol – red meat and eggs have particularly high levels. Because the liver is usually able to make enough cholesterol to satisfy all of our bodily needs, however, too much dietary cholesterol can lead to high bodily levels of cholesterol. (Some liver disorders also lead to excess cholesterol levels.)

These high levels are undesirable because it is difficult for our bodies to appropriately dispose of excess cholesterol. Excess cholesterol has a tendency to deposit into the walls of our arteries, particularly the arteries that lead to our hearts (or coronary arteries). It is these deposits that lead to development of "hardening of the arteries," or atherosclerosis (see accompanying image).

Left untreated, atherosclerosis is a condition that causes progressive narrowing of the arteries. Narrowing may even occur to the point where the artery becomes either severely or completely blocked. If the blockage occurs in a coronary artery, you may have severe chest pain (called angina) or a heart attack. If the blockage  involves an artery in the brain, you may have a stroke.

The difference between LDL and HDL cholesterol

Cholesterol does not travel freely in the bloodstream. Rather, cholesterol is carried through the blood by particles called lipoproteins. Cholesterol also behaves differently depending on which type of lipoprotein carries it. Low-density lipoproteins (LDL) deposit excess cholesterol on the artery linings (LDL cholesterol is the "bad" cholesterol), and high-density lipoproteins (HDL) remove excess cholesterol from the blood (HDL cholesterol is the "good" cholesterol). Triglycerides  are another type of substance closely related to cholesterol. They are mostly carried throughout the bloodstream by particles called chylomicrons or very low-density lipoproteins (VLDLs). While less is known about triglycerides, in general, there is some evidence to suggest that they are a particularly important cause of coronary artery disease among women and people with other risk factors such as diabetes and obesity.

According to the new guidelines released in May 2001 by the NHLBI's National Cholesterol Education Program (NCEP), everyone age 20 and older should have their cholesterol and triglyceride levels measured at least once every five years. This blood test is done after a nine- to 12-hour fast and provides information about your total cholesterol (TC), LDL and HDL cholesterol, and triglycerides. If your total blood cholesterol is 200 milligrams (mg) per deciliter (dL) or more, or if your HDL level is less than 40 mg/dL, you should talk to your doctor about ways to lower your cholesterol, which may include changing your diet, increasing exercise, or medication.  

HDL cholesterol protects against heart disease. This means that higher numbers of HDL cholesterol are better. A level less than 40 mg/dL is considered low and a major risk factor for the development of coronary artery disease. HDL levels of 60 mg/dL or more help to lower your risk for heart disease.

Triglycerides also can raise heart disease risk. Levels that are borderline high (150-199 mg/dL) or high (200 mg/dL or more) may require treatment for some people.