The 'forgotten' cholesterol

BASED on current evidence, there is little doubt that cholesterol is a major cause of heart artery disease. For decades, doctors and patients alike have been talking about "bad cholesterol" (low density lipoprotein cholesterol or LDL-C) and "good cholesterol" (high density lipoprotein cholesterol or HDL-C). However, most have forgotten about the remaining cholesterol fractions. This "forgotten" cholesterol, also termed remnant cholesterol, comprises all the cholesterol in the blood that is not LDL-C or HDL-C.

The 'good cholesterol' myth

Even today, some doctors still tell patients about the need to increase HDL-C. However, over the past 15 years, evidence from well-designed trials have failed to show any benefit despite significant HDL-C elevation with medication, and genetic studies have established that a low HDL-C is not a causal factor for atherosclerotic disease of the heart arteries. Rather, the low HDL-C is just a surrogate indicator of high levels of triglycerides. Triglycerides are a type of non-cholesterol fat (lipid) that is found in your blood. After a meal, the excess unutilised calories in the blood are converted into triglycerides. The relationship between HDL-C and triglycerides is a see-saw relationship, with high triglyceride levels being associated with a low HDL-C and vice-versa.