If the blood supply to a portion of the heart is completely cut off by total blockage of a coronary artery, the result is a heart attack. The first thing that comes to mind when one hears about heart disease is almost always cholesterol. Importantly, while many cardiologists insist that lowering cholesterol is correlated with a reduction in the risk of heart attacks; few can say that there is a reduction in the risk of mortality (death). There may be a weak correlation of elevated cholesterol with heart attacks, however this does not mean it is the cholesterol that caused the heart attack. However, the bottom line is that a high level of plasma cholesterol is one of the major risk factors for heart disease and strokes. For a healthy heart, the best course of action is often to lower cholesterol in large part by losing weight.

If high cholesterol were the most important cause of cardiovascular disease, it should be a risk factor in all populations, in both sexes, at all ages, in all disease categories, and for both heart disease and stroke. Fish and fish oils are said to help prevent cardiovascular disease including fatal and non-fatal heart attacks, strokes, sudden cardiac death, and coronary artery disease (angina). High cholesterol and triglyceride levels are common among diabetics and are major contributors to their increased risk of cardiovascular disease.

People suffering from type II diabetes often have high blood levels of triglycerides and are therefore prone to coronary heart disease. Many people with hypertension also suffer from diabetes and there has been concern that fish oil supplementation may aggravate problems with glucose intolerance. It is also known that a high fish intake can delay the development of diabetes in glucose-intolerant individuals. Obesity is also strongly associated with type 2 diabetes, which itself poses a significant risk for high cholesterol levels and heart disease. Overweight and obese children who have high cholesterol should also get tested for high blood pressure, diabetes, and other conditions associated with metabolic syndrome. The establishment of diabetes as a CHD risk equivalent reflects the prevalence of heart disease as a cause of death in the diabetic population.

Although most studies that prove that lowering cholesterol saves lives are done using drug therapy, the absolute mandate for improving cholesterol levels is to first make changes in lifestyle (both diet and exercise). Aerobic exercise helps to open up blood vessels and, in combination with a healthy diet, may improve blood-clotting factors. If you are unable to lower your cholesterol to safe levels through diet and exercise, then your doctor may prescribe cholesterol-lowering medication. I am sure many of you have been reminded by doctors, nurses, and public health officials to lose excess weight, quit smoking cigarettes, exercise regularly, and eat less saturated fat and sweets. You will also find information on cholesterol-lowering diets, recipes, exercise, weight loss, and lifestyle changes.

Again, high cholesterol is not necessarily the direct cause but may only be a marker. Now consider that more than 90 % of all cardiovascular disease is

seen in people above age 60 also and that almost all studies have found that high cholesterol is not a risk factor for women. Of particular interest is the finding that a high ratio of triglycerides to HDL cholesterol is a powerful risk factor for a major cardiac event even when LDL cholesterol levels are normal.