Total cholesterol does not indicate anything IGNORE THIS Total is a sum of HDL and LDL
If your doctor argues with this get a new doctor, hell, have him contact me, I'll put him in his place.
your LDL is what you need to be concerned with. If your LDL is high, then your cholesterol is more than likely exploding in your boold system at your heart. If your LDL is low, you are extremely healthy. HDL carries refuse away from the cells, these in excess is not a problem.
Actually, it's a lot more complicated than that.
HDL doesn't "carry refuse". It functions by a mechanism called reverse cholesterol transport where it takes peripheral cholesterol and returns it to the liver. The liver then uses it to synthesize cell membranes and other essential hormones. Cholesterol is a vital precursor to a myriad of different endogenous hormones.
While total cholesterol is rarely used by doctors as an indicator of anything, current cholesterol panels don't stop at just LDL vs. HDL. For example, there are sub-categories of LDL, with small dense LDL (sdLDL) being the most associated with cardiovascular risk and plaque formation. New research is pointing to different sub-types of HDL as well. Even crazier are the EPIC and IDEAL studies (long-term prospective research protocols that look at large populations over time) which are showing INCREASED risk of cardiovascular disease associated with elevated HDL levels. This is likely because not all HDL is equal. More needs to be discovered before we have a better picture of what's really happening.
Doctors are well beyond simply saying "if your LDL is low, you are extremely healthy". Nope.
Also, this may be nit-picking, but plaque formation isn't limited to your heart. It can take place anywhere in the body, most commonly in larger, high-pressure vessels. However, it is most noticeable when pieces break off and lodge in small, end arteries. The coronary arteries are the most infamous because there is little collateral circulation. If the LAD (a major coronary artery feeding the left ventricle, often called The Widowmaker) gets jammed up, you're dead. There's nowhere else for the blood to come from. Most other muscles in the body get blood from multiple small arteries. An ischemic stroke is another example of a plaque blocking blood flow to a vital organ (in this case, the brain). (There are other causes of ischemic stroke, plaque rupture is just one.)
Then there's the issue of triglycerides, which are actually the most susceptible to dietary changes. Oh, and I almost forgot to mention VLDL and IDL, both of which are associated with cardiovascular risk.
Anyhow, I'm rambling, and I'm sure you know all of this, considering you can put doctors in their place.
Cheers,
Erich R., MD