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September is National Cholesterol Education Month. Although you've probably heard a great deal about cholesterol over the last 10 years, sometimes there is so much information that it's hard to understand it all. I will try to put the most important facts and theories into perspective.

Before beginning, I want to remind you of the most important thing: Unless you use your knowledge about cholesterol -- or any medical issue -- to make better decisions, you quite simply increase your risk of disability and death.

Cholesterol is broken into three types, based on the kind of lipoprotein it is attached to in the bloodstream. These types are LDL, HDL and VLDL -- which stand for low density, high density and very low-density lipoprotein. The LDL and HDL, as well as the total amount of cholesterol, are used as guides for assessing health risk and the need for treatment.

Initially, research showed a high amount of total cholesterol increases your risk of diseases of the arteries, such as heart attacks and strokes. Later it was found that a high level of LDL cholesterol was the culprit. Because LDL makes up about two-thirds of total cholesterol, these numbers typically go hand in hand.

More recently, it was discovered that someone with a higher level of HDL cholesterol had a lower risk of disease. Because HDL cholesterol is a small fraction of the total, increases in HDL have little impact on the total value.

To summarize then: (1) The higher the total cholesterol, the higher the risk, (2) the higher the LDL, the higher the risk, and (3) the higher the HDL the lower the risk.

How high the risk is also depends on other factors, like age, whether you are pre- or postmenopause and if you already have disease.

The highest risk is for people who already have symptoms of diseases of the arteries. This includes heart attacks, strokes and narrowing of the arteries of the legs.

The next highest risk is for people with two or more other risk factors for artery disease. These include cigarette smoking, obesity, diabetes, high blood pressure and family members experiencing heart disease at an early age.

The third and lowest category of risk is for men below the age of 35 and women before menopause, neither of whom have other risk factors.

Like anything else, the higher the risk, the greater the benefits by removing that risk. Before you or your doctor can assess your risk and think about what to do next, you need to measure your cholesterol. So, if you haven't had your cholesterol measured, do it soon. Screening tests for total cholesterol, if high, should be followed up to check LDL and HDL cholesterol.

The following are recommendations of an expert panel of the National Heart and Lung Blood Institute -- the sponsor of the National Cholesterol Education Month.

If your LDL cholesterol is below 130, exercise, maintain a good diet and get rechecked in five years.

If your LDL cholesterol is 130 to 159, exercise, maintain a good diet and get rechecked in one year.

If your LDL cholesterol is 130 to 159 and you have two other risk factors, start drug treatment now to lower your cholesterol.

If your LDL cholesterol is 160 or above, start drug treatment now to lower your cholesterol.

Regardless of what types of drug may be used to lower cholesterol, exercise and diet are important to your overall success. Exercise directly increases HDL (remember, that's a good thing) and will help prevent or decrease other risk factors such as obesity, diabetes and high blood pressure.

Dietary therapy can help lower the amount of cholesterol and fats and also add elements to the diet that have been shown to lower cholesterol.

Keeping total fat below 30 percent of the diet, saturated fat below 10 percent and cholesterol below 300 mg may be all that is necessary. This can usually be accomplished without a radical change in diet. If the cholesterol level doesn't come down, more severe restrictions may help, but you may need a dietitian's advice as to how to best accomplish your goals.

Over the past few years, researchers have reported that some dietary additives are also effective in improving cholesterol levels. Psyllium seeds, diatomaceous earth and soy protein lower LDL. In addition, niacin and antioxidants raise HDL.

Several different classes of drugs can be used to lower cholesterol. The newest, most powerful and most expensive are called statins. They have been shown not only to be effective in lowering LDL cholesterol, but also in saving lives.

Depending on your level of cholesterol and your other risk factors, your doctor should discuss with you the benefits, risks and costs of all forms of treatment.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is

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