Diabetologists in Sahakara Nagar, Bangalore •
Sixty to seventy per cent of total cholesterol is transported as LDL, and total cholesterol
measurements usually reflect LDL levels. In both males and females, coronary heart disease
risk is proportional to LDL and total cholesterol. As seen above, LDL supplies cholesterol to
peripheral tissues. High concentrations of LDL in the serum accelerate atheroma by interacting
with damaged endothelium. Oxidation of LDL accelerates this process.
A total cholesterol of 5.5 mmol/L, or LDL of 3.5 mmol/L, is usually considered the upper
limit of normal but even these levels seem to be responsible for an increased population risk of
atheroma. Populations with lower average levels than these have less coronary disease. Lower
levels are beneficial for patients with established coronary disease or multiple risk factors.
It is not yet clear whether the lowering of total cholesterol to less than 4.0 (LDL 2.0) provides
further benefit or whether a target level is indeed the correct approach. Trials of more aggressive
cholesterol lowering are underway.14 Although a reduced HDL level (< 1) is associated with
increased risk, there is no evidence as yet that raising HDL has beneficial effects. An elevation of
triglyceride levels (> 1.7) is also considered a marker of increased risk, but there is no evidence
to what level they should be reduced.
(TG & Chol.)
(Lipoprotein lipase) Endothelium
Intestinal cell Carries 3/4 of