Total Cholesterol Means NOTHING!!!!

A question I get asked on a daily basis after someone has bloodwork drawn is "What was my total cholesterol?" Only problem is, total cholesterol means nothing. Nothing at all. The total cholesterol is simply the summation of all the 'carrier' molecules of cholesterol. That is,
Total Cholesterol=HDL+LDL+VLDL+IDL.

Now most of us have heard of the HDL and LDL, but most of us have never heard of the VLDL and the IDL. HDL is referred to as the 'good cholesterol' and the LDL is mistakenly referred to as the 'bad' cholesterol. The VLDL is a function of the triglycerides or fats in the blood and the IDL is a transient thing so it doesn't hang out in the blood too long to be an issue so we can simply ignore its value.

Now back to Total Cholesterol. So the total cholesterol number is derived by adding all those carrier molecules of cholesterol together. One can see that if the HDL goes up, it will most likely raise the total. I often tell my patients that they do not want to 'lower' their cholesterol, they want to raise it. I will get very strange looks from people when I say this, especially if their total cholesterols are above 200. Their immediate response is usually "But I thought my total cholesterol should be below 200" which prompts me down memory lane and the ever so changing incorrect recommendations of what the total cholesterol (and LDL) should be.

When I was growing up in medicine, we were told by the powers to be to try and get the total cholesterol below 250. If we did that, the reasoning went, we would see less heart disease. We were also told to try and get the LDL below 150. This didn't work; we still saw alot of heart disease.

Then we were told to try and get the Total below 220 and the LDL below 120. This didn't work either, we still saw alot of heart disease.

Next came the advice from the 'experts' to get the total below 200 and the LDL below 100 and we should really see a lowering of heart disease. Nope, this didn't work either. We are currently being told to try to get the total below 200 and the LDL below 70. This will not work to lower heart disease cases. Not at all.

You see, total cholesterol means nothing. Nothing at all. It is an irrelevant number. When people ask me what their total cholesterol is I tell them I just bought a goldfish and a kite for my kids and stored the kite in the garage and placed the goldfish on my kitchen table. I then get this puzzled look, as if to say "Er, I don't care what you bought and where you placed it, I just want to know my total cholesterol number."

Just like it was irrelevant what I bought and where I placed it, so too, is the total cholesterol. Again it means nothing. Yet we want to know it. We yearn to know it. We talk about it at cocktail parties, read about it in the paper, worry about it when we are eating. But it means nothing.

Absolutely zilch.

What we need to be focused on is the HDL and the triglycerides. Tomorrow I will tell you why the term 'cholesterol lowering medications' is a misnomer, and why the medical profession and pharmaceutical companies need to stop using that phrase and should focus more on a concept referred to as plaque stabilization.

Dr Jim

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