Cholesterol is a blood fat needed by the body in moderate amounts. However, high cholesterol levels can lead to atherosclerosis and coronary artery disease (CAD). Angina is chest pain caused by the restriction of blood flow to the heart (cardiac ischemia). Nitrates may be used to relieve angina.
Most people will have cholesterol blood tests regularly, including triglycerides, HDL, LDL and total cholesterol. Methods for increasing good cholesterol or lowering cholesterol levels may include cholesterol reducing drugs, such as statins, fibrates, niacin (nicotinic acid) and bile acid resins. However, these drugs do not reverse calcification. A heart attack occurs when the coronary arteries become blocked. Cholesterol has many types. The two big components are called LDL (low-density lipoprotein) and HDL (high-density lipoprotein). And simplistically, we talk about the LDL being the bad cholesterol and the HDL being the good cholesterol.
That means that the bad cholesterol tends to accumulate in the arteries, tends to form plaques, tends to be the precursor to what eventually might end up being a heart attack.
The good cholesterol actually acts in part in reversing the cholesterol transport, takes cholesterol out of the plaque in the artery and may return it to the circulation, to the liver, to be excreted. So these are the two major categories, but within each one there are different particles, different cholesterols, different lipoproteins that carry the cholesterol, and they are differentially difficult players.
Some of the LDL cholesterol, i.e., the bad cholesterol, is worse than others. And it tends to be the small particle size that is very dense. You can think of the cholesterol particles as marbles, maybe, the small dense ones, and the larger, lighter ones might be ping-pong balls. And so the small marble ones are more dangerous.
On the other side, HDL the good cholesterol, posseses some components that are better than the others. So cholesterol is quite a complicated subject, and we’re developing more and more therapies that aim not just at the total cholesterol, but in altering the good and the bad.