The cardiology patient page. Statins: powerful drugs for lowering cholesterol: advice for patients.

The underlying cause of heart disease is a process called atherosclerosis. Atherosclerosis has been described simply as hardening of the arteries, but in truth, it involves a complex interaction of biological processes in the walls of arteries. In atherosclerosis, plaque may build up in the vessels that carry blood to the heart (coronary arteries). When one of these plaques tears or ruptures, a blood clot forms that may block the vessel completely and lead to a heart attack (also called a myocardial infarction, or MI, in medical terminology). One of the key risk factors for the development of atherosclerosis is high cholesterol. Cholesterol is a fatty substance that is a normal component of the cells of the body. Cholesterol (measured in milligrams per deciliter of blood [mg/dL]) is carried through the blood by particles known as lipoproteins, which are classified by their densities. The cholesterol in low-density lipoprotein (LDL-C) is called the “bad” cholesterol, and high levels of LDL-C increase the risk for coronary heart disease. Cholesterol in high-density lipoprotein (HDL-C) is called the “good” cholesterol, and high levels of HDL-C decrease the risk for heart attack. High levels of triglycerides, fatty acids that your body uses to store energy that has been made by the body or obtained from food, also may be associated with increased heart attack risk. Table 1 may be used to help classify your lipid levels, using a scheme developed by the US National Cholesterol Education Program Adult Treatment Panel III.1 If I have an unfavorable cholesterol profile, what can I do to lower my risk for a heart attack? High-fat diets are associated with increased cholesterol and increased risk for heart disease. One can reduce these risks with regular exercise and a prudent diet low in animal fat and cholesterol. Dietary modifications may lower the bad cholesterol by about 10%, on average. Aerobic exercise will help strengthen the heart muscle, and such exercise, to the equivalent of running 12 to 15 miles per week, will help raise HDL-C in most people. It is also important to control other risk factors that may be present (Table 2). Whether or not you already have had a heart attack, you should follow a heart-healthy lifestyle program. Many helpful tips can be found on the American Heart Association’s website, www.americanheart.org.