Cholesterol Disorder  

There are three types of cholesterol that you should know about.

1.  HDL (high density lipoprotein) cholesterol, also known as the good cholesterol

2.  LDL (low density lipoprotein) cholesterol, also known as the bad cholesterol

3.  Triglycerides

HDL cholesterol removes cholesterol from the blood vessel wall and delivers it to the liver for final disposal. In this way, it serves to keep the walls of the blood vessels free of cholesterol deposits. That's why it’s known as the good cholesterol. Think of it as a roto-rooter for your blood vessels!

LDL cholesterol gets deposited into the blood vessel wall and subsequently leads to narrowing of the blood vessels. That is why it’s known as the bad cholesterol. Think of it as the growing clog in your pipes!

There are two types of LDL particles:

 A. Large, fluffy particles, also known as “pattern A”.

 B. Small, dense particles, also known as “pattern B”.

Small, dense LDL particles (pattern B) are more harmful than the large, fluffy type     (pattern A).

Triglycerides are a form of fat circulating in the blood. High triglycerides cause deposition of cholesterol in the blood vessel walls which leads to narrowing of the blood vessels.

What kind of cholesterol disorder is seen in patients with Insulin Resistance Syndrome?

 Patients with Insulin Resistance Syndrome typically have:

 Low HDL cholesterol (less than 45 mg/dl in males, less than 55 mg/dl in females)

 High triglycerides (more than 150 mg/dl).

 Their LDL cholesterol level may be normal, but the particle size of their LDL is small (Pattern B) which is more dangerous than the large sized LDL particles.

Therefore, cholesterol gets deposited easily in the blood vessels of these patients and the build-up of cholesterol cannot be cleansed out efficiently due to low level of HDL cholesterol. Consequently these patients are at very high risk for narrowing of the blood vessels.

HDL cholesterol and triglyceride level serves as an extremely useful test to diagnose Insulin Resistance Syndrome.  If your HDL is low and/or your triglyceride level is high, you have Insulin Resistance Syndrome.

A low HDL cholesterol has been known to be a strong risk factor for coronary artery disease for a long time.

In 1977, the results of the famous Framingham Heart Study  were published in the American Journal of Medicine. In this study HDL cholesterol was found to be the most potent lipid predictor of coronary heart disease.

Several other studies including the Coronary Primary Prevention Trial (CPPT), the Multiple Risk Factor Intervention Trial (MRFIT), and the Lipid Research Clinics Follow-up Study (LRCF) further confirmed the strong relationship between low HDL cholesterol and coronary artery disease .

Raising HDL cholesterol reduces the risk for heart attack.

A 1% increase in HDL cholesterol is associated with a 3% decrease in risk of heart disease.

This impressive role of HDL cholesterol in preventing heart attack was shown in the famous Veterans Affairs HDL Intervention Trial (VA-HIT). The results of this study  were published in the New England Journal of Medicine in 1999.

In the U.S., the National Cholesterol Education Program (NCEP) published new guidelines for cholesterol detection and treatment in 2001.

This national panel of experts strongly emphasize the importance of HDL cholesterol and Insulin Resistance Syndrome (also known as Metabolic Syndrome).

According to the new guidelines, cholesterol testing should include LDL cholesterol, HDL cholesterol and triglycerides.

For more information regarding cholesterol and insulin resistance, please read the section under "Heart."