Types of Cancer

Cancer statistics

A new report from the nation's leading cancer organizations shows cancer death rates decreased on average 2.1 percent per year from 2002 through 2004, nearly twice the annual decrease of 1.1 percent per year from 1993 through 2002.

Estimated new cases and deaths from cancer in the United States in 2008:

• New cases: 1,437,180 (does not include nonmelanoma skin cancers)



• Deaths: 565,650

What are the most common types of cancer?

The list of common cancer types includes cancers that are diagnosed with the greatest frequency in the United States. Cancer incidence statistics from the American Cancer Society and other resources were used to create the list. To qualify as a common cancer, the estimated annual incidence for 2008 had to be 35,000 cases or more.

The most common type of cancer on the list is nonmelanoma skin cancer, with more than 1,000,000 new cases expected in the United States in 2008. Nonmelanoma skin cancers represent about half of all cancers diagnosed in this country.

The cancer on the list with the lowest incidence is thyroid cancer. The estimated number of new cases of thyroid cancer for 2008 is 37,340.

Because colon and rectal cancers are often referred to as "colorectal cancers," these two cancer types were combined for the list. For 2008, the estimated number of new cases of colon cancer is 108,070, and the estimated number of new cases of rectal cancer is 40,740.

Kidney cancers can be divided into two major groups, renal parenchyma cancers and renal pelvis cancers. Approximately 85 percent of kidney cancers develop in the renal parenchyma, and nearly all of these cancers are renal cell cancers. The estimated number of new cases of renal cell cancer for 2008 is 46,232.

Leukemia as a cancer type includes acute lymphoblastic (or lymphoid) leukemia, chronic lymphocytic leukemia, acute myeloid leukemia, chronic myelogenous (or myeloid) leukemia, and other forms of leukemia. It is estimated that more than 44,270 new cases of leukemia will be diagnosed in the United States in 2008, with chronic lymphocytic leukemia being the most common type (approximately 15,110 new cases).

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What is Cancer?

Defining cancer

Cancer is a term used for diseases in which abnormal cells divide without control and are able to invade other tissues. Cancer cells can spread to other parts of the body through the blood and lymph systems.

Cancer is not just one disease but many diseases. There are more than 100 different types of cancer. Most cancers are named for the organ or type of cell in which they start -- for example, cancer that begins in the colon is called colon cancer; cancer that begins in basal cells of the skin is called basal cell carcinoma.

Cancer types can be grouped into broader categories. The main categories of cancer include:

• Carcinoma - cancer that begins in the skin or in tissues that line or cover internal organs.



• Sarcoma - cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue.



• Leukemia - cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of abnormal blood cells to be produced and enter the blood.



• Lymphoma and myeloma - cancers that begin in the cells of the immune system.



• Central nervous system cancers - cancers that begin in the tissues of the brain and spinal cord.

Origins of cancer

All cancers begin in cells, the body's basic unit of life. To understand cancer, it's helpful to know what happens when normal cells become cancer cells.

The body is made up of many types of cells. These cells grow and divide in a controlled way to produce more cells as they are needed to keep the body healthy. When cells become old or damaged, they die and are replaced with new cells.

However, sometimes this orderly process goes wrong. The genetic material (DNA) of a cell can become damaged or changed, producing mutations that affect normal cell growth and division. When this happens, cells do not die when they should and new cells form when the body does not need them. The extra cells may form a mass of tissue called a tumor.

Not all tumors are cancerous; tumors can be benign or malignant.

• Benign tumors aren't cancerous. They can often be removed, and, in most cases, they do not come back. Cells in benign tumors do not spread to other parts of the body.



• Malignant tumors are cancerous. Cells in these tumors can invade nearby tissues and spread to other parts of the body. The spread of cancer from one part of the body to another is called metastasis.

Some cancers do not form tumors. For example, leukemia is a cancer of the bone marrow and blood.

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Diabetes Mellitus 1

What is diabetes?

Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels, that result from defects in insulin secretion, or action, or both. Diabetes mellitus, commonly referred to as diabetes (as it will be in this article) was first identified as a disease associated with "sweet urine," and excessive muscle loss in the ancient world. Elevated levels of blood glucose (hyperglycemia) lead to spillage of glucose into the urine, hence the term sweet urine. Normally, blood glucose levels are tightly controlled by insulin, a hormone pr

oduced by the pancreas. Insulin lowers the blood glucose level. When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas to normalize the glucose level. In patients with diabetes, the absence or insufficient production of insulin causes hyperglycemia. Diabetes is a chronic medical condition, meaning that although it can be controlled, it lasts a lifetime.

What is the impact of diabetes?

Over time, diabetes can lead to blindness, kidney failure, and nerve damage. These types of damage are the result of damage to small vessels, referred to as microvascular disease. Diabetes is also an important factor in accelerating the hardening and narrowing of the arteries (atherosclerosis), leading to strokes, coronary heart disease, and other large blood vessel diseases. This is referred to as macrovascular disease. Diabetes affects approximately 17 million people (about 8% of the population) in the United States. In addition, an estimated additional 12 million people in the United States have diabetes and don't even know it.

From an economic perspective, the total annual cost of diabetes in 1997 was estimated to be 98 billion dollars in the United States. The per capita cost resulting from diabetes in 1997 amounted to $10,071.00; while healthcare costs for people without diabetes incurred a per capita cost of $2,699.00. During this same year, 13.9 million days of hospital stay were attributed to diabetes, while 30.3 million physician office visits were diabetes related. Remember, these numbers reflect only the population in the United States. Globally, the statistics are staggering.

Diabetes is the third leading cause of death in the United States after heart disease and cancer.

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Exercise: How Much Is Enough?

If you don't mix up your exercises during a single session, vary them from session to session, Massaro suggests.

"Once your body gets used to doing something, you don't get as many benefits from doing it. So either you have to increase the time or intensity or keep changing up the movements to keep your body guessing," he says.

Among Massaro's favorite quickie exercises are basic jumping jacks and squat thrusts, along with walking -- but with a twist.

"To make it into a challenge, try walking in a zigzag pattern, or even walking backwards. It looks a little weird but it definitely challenges your muscles more," he says.

If you are going to do a short workout, Ryan says, make it as intense as you can to get some cardio benefits.

"You need to put some kind of intensity behind whatever activity you're doing if you really want to continue to gain benefits from these short bursts of activity," he says.

So, if you're walking, speed it up. If you're bending and reaching, challenge yourself to do more repetitions in the same time frame.

Getting Motivated to Exercise

While it might seem as if doing just a little exercise won't require much motivation, experts say that isn't so. Because the sessions are so short, it's easy to put them off, or even blow them off, without guilt.

"If you miss an hour of working out with a personal trainer or an hour at the gym, there's a certain amount of guilt attached that can motivate you not to skip out. But when you can skip 5 minutes, of exercise on your own, it doesn't seem like such a big deal. … So unless you stay motivated, it's easy to get sidetracked away from your goals," says Shina.

To stay focused, Massaro says, keep your eye on the prize: how good you'll feel and how much healthier you will be if you stick with your exercise program.

"Don't think about what you have to do, think about what you will get if you do it. Namely, you'll feel better, you'll look better, your health will be better," he says.

If you still need more motivation, pick an exercise buddy and set up a competition, Shina suggests. "First, each of you buys a gift card to a favorite store. Then, each of you must write down all your fitness activities -- when you did them and for how long. And at the end of the week, compare notes. Whoever did the most for the longest gets to have both gift cards."

Ryan says you can also stay motivated by competing with yourself. "Staring out with short bouts of exercise is a good way to establish the fitness mind-set, but you should continually challenge yourself by making your end goal the ability to work out for 30 minutes at a time, three times a week. That can be a very motivating challenge," he says Read More......

How Much Exercise Do You Really Need?

You say you don't have time to exercise? You're hardly alone. For many people, lack of time is the single biggest obstacle to fitness. But, experts say, you may be overestimating how much exercise you really need to get at one time. Instead of investing an hour at the gym, what if you could get fitter with 10 minutes here, 10 minutes there through your day?

There's building evidence that short but frequent bouts of exercise can yield plenty of health benefits. Consider the following fitness findings:

• A study published by the American Journal of Sports Medicine in 2006 showed that short walks after dinner were more effective than long exercise sessions in reducing the amount of fat and triglyceride levels in the bloodstream after a hearty meal.
• Research published in the Journal of Epidemiology and Community Health showed that short bouts of exercise helped lower blood pressure as well as shave inches off the hips and waistline.
• In a study published in Preventive Medicine in 2006, researchers found that multiple workout sessions as short as 6 minutes apiece could help sedentary adults reach fitness goals similar to those achieved by working out for 30 minutes at a time.
• In a finding published in the journal Psychopharmacology, doctors found that short bursts of exercise could help reduce the craving for cigarettes and help people quit smoking.

"There is no question that short amounts of exercise can help you get fit, help you stay fit, and help you maintain your health," says personal fitness coach Susie Shina, author ofSixty Second Circuits. "You can stay fit in increments as short as 4 and 5 minutes at a time."

The best part about that is that everyone can find 5 minutes a few times a day, says Shina, owner of a mobile personal training center called Fitness 180.

"Some of these exercises can fit into a 5-minute time period at work, at your desk, waiting on line in the grocery store, even driving in your car," says Shina. "It's not an overwhelming task, and the benefits can be enormous."

Strength and conditioning coach Jim Massaro agrees.

"This is the way I personally work out -- and it's how I train others," says Massaro, founder of the Advanced Personal Training Center in Nyack, N.Y. "It works for beginners and, by increasing the intensity of what you do in those short increments, it can also work for advanced fitness training."

That said, some fitness experts warn that short workouts can have a downside.

"The bad part about short workouts is that they send the message that you can skimp on your health -- that less is more, that you don't have to invest in yourself to be healthy -- and that's the wrong message," says Mike Ryan, a personal trainer and member of the Gold's Gym Fitness Board.

While Ryan says brief bouts of exercise are a good way to get into the fitness mindset, he believes the eventual goal should be to do longer workouts. "Whatever you think you can accomplish with short workouts, you can accomplish that much more with longer workouts," he says.

Exercise: How Much Is the Bare Minimum?

While incorporating more exercise into our lives is a worthwhile goal, for many of us, just getting up off the couch is a big step toward better health.

So how much exercise do you really need? Most of the studies show that 5 minutes of continuous movement repeated during the day is about the bare minimum to have any effect, and fitness experts believe 10 minutes is more realistic.

"If 3 minutes is all you can do, if 2 minutes is all you can do, it's all better than nothing -- but you should be working up to a goal of at least 5 continuous minutes, and 10 is even better," says Shina.

It's important to make the most of those few minutes, she says. "You should come away from your 2 minutes or your 5 minutes or your 10 minutes of exercise feeling as if you have accomplished something," she says. "There is a certain amount of pushing your body that has to take place, even if it's just for 5 minutes."

And how often do you need to do these 5- to 10-minute bursts of activity?

According to the American College of Cardiology and the American College of Sports Medicine, good health really comes with 30 minutes of activity, at least 3-5 times a week. If you do the math, that means you'll need to fit in six daily sessions of 5 minutes apiece, or three daily bouts of 10 minutes apiece.

"It takes about 5-7 minutes to begin to feel the endorphin rush that comes from exercise, so most people find the 10-minute workout three times a day may actually be more pleasurable than the 5 minutes six times a day," says Shina.

What Types of Exercise Work Best?

Experts say that while almost any fitness activity you enjoy doing is good, if you want to get the most from your 10 minutes of training, choose activities that move several large muscle groups at once.

"Using exercises that engage more than one body part at a time will guarantee getting the biggest bang for the exercise buck," says Shina.

Her clients' favorites include simple movements, such as standing up super-straight, with shoulders rolled back, abdominals tight, and chin up. "The trick is to set a timer for 5 minutes and hold that posture," says Shina.

Shina says your quickie fitness routines can include functional movements such as repeatedly standing up and sitting down in a chair, bending down and picking objects up off the floor, or putting something on a high shelf, taking it down, and putting it back up again, until your five minutes are up. (Think cleaning your closet every day for 5 minutes!)

"You can actually do 60 seconds on each of these movements, and then repeat them -- I call it '60-second circuits' -- and it works great because you're only doing it for a minute, and everybody can do something for just a minute," says Shina.

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Kidney Stone 2

What are symptoms of kidney stones?

While some kidney stones may not produce symptoms (known as "silent" stones), people who have kidney stones often report the sudden onset of excruciating, cramping pain in their low back and/or side, groin, or abdomen. Changes in body position do not relieve this pain. The pain typically waxes and wanes in severity, characteristic of colicky pain (the pain is sometimes referred to as renal colic). It may be so severe that it is often accompanied by nausea and vomiting. Kidney stones also characteristically cause blood in the urine. If infection is present in the urinary tract along with the stones, there may be fever and chills.

How are kidney stones diagnosed?

The diagnosis of kidney stones is suspected by the typical pattern of symptoms when other possible causes of the abdominal or flank pain are excluded. Imaging tests are usually done to confirm the diagnosis. A helical CT scan without contrast material is the most common test to detect stones or obstruction within the urinary tract. Formerly, an intravenous pyelogram (IVP; an x-ray of the abdomen along with the administration of contrast dye into the bloodstream) was the test most commonly used to detect urinary tract stones, but this test has a greater risk of complications, takes longer, and involves higher radiation exposure than the non-contrasted helical CT scan. Helical CT scans have been shown to be a significantly more effective diagnostic tool than the IVP in the diagnosis of kidney or urinary tract stones.

In pregnant women or those who should avoid radiation exposure, an ultrasound examination may be done to help establish the diagnosis.

What is the treatment for kidney stones?

Most kidney stones eventually pass through the urinary tract on their own within 48 hours, with ample fluid intake. Pain medications can be prescribed for symptom relief. There are several factors which influence the ability to pass a stone. These include the size of the person, prior stone passage, prostate enlargement, pregnancy, and the size of the stone. A 4 mm stone has an 80% chance of passage while a 5 mm stone has a 20% chance. Stones larger than 9-10 mm rarely pass on their own and usually require treatment.

Some medications have been used to increase the passage rates of kidney stones. These include calcium channel blockers such as nifedipine and alpha blockers such as tamsulosin. These drugs may be prescribed some people who have stones that do not rapidly pass through the urinary tract.

For kidney stones which do not pass on their own, a procedure called lithotripsy is often used. In this procedure, shock waves are used to break up a large stone into smaller pieces that can then pass through the urinary system.

Surgical techniques have also been developed to remove kidney stones. This may be done through a small incision in the skin (percutaneous nephrolithotomy) or through an instrument known as an ureteroscope passed through the urethra and bladder up into the ureter.

How can kidney stones be prevented?

Rather than having to undergo treatment, it is best to avoid kidney stones in the first place. It can be especially helpful to drink more water. (The National Institutes of Health recommend drinking up to 12 full glasses of water a day, if you've already had a kidney stone.) Water helps to flush away the substances that form stones in the kidneys.

Depending on the cause of the kidney stones and an individual's medical history, dietary changes or medications are sometimes recommended to decrease the likelihood of developing further kidney stones. It is particularly helpful, if one has passed a stone, to have it analyzed in a laboratory to determine the precise type of stone so specific prevention measures can be considered.

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Kidney Stone

What is a kidney stone?

A kidney stone is a hard mineral and crystalline material formed within the kidney or urinary tract. Kidney stones are a common cause of blood in the urine and often severe pain in the abdomen, flank, or groin. Kidney stones are sometimes called renal calculi. One in every 20 people develops a kidney stone at some point in their life. The condition of having kidney stones is termed nephrolithiasis or urolithiasis.

What causes kidney stones?

Kidney stones form when there is a decrease in urine volume or an excess of stone-forming substances in the urine. The most common type of kidney stone contains calcium in combination with either oxalate or phosphate. Other chemical compounds that can form stones in the urinary tract include uric acid and the amino acid cystine.

Dehydration through reduced fluid intake or strenuous exercise without adequate fluid replacement increases the risk of kidney stones. Obstruction to the flow of urine can also lead to stone formation. Kidney stones can also result from infection in the urinary tract; these are known as struvite or infection stones.

Men are especially likely to develop kidney stones, and whites are more often affected than blacks. The prevalence of kidney stones begins to rise when men reach their 40s, and it continues to climb into their 70s. People who have already had more than one kidney stone are prone to develop more stones. A family history of kidney stones is also a risk factor for the development of kidney stones.

A number of different conditions can lead to kidney stones:

• 
  
Gout results in an increased amount of uric acid in the urine and can lead to the formation of uric acid stones.


• Hypercalciuria (high calcium in the urine), another inherited condition, causes stones in more than half of cases. In this condition, too much calcium is absorbed from food and excreted into the urine, where it may form calcium phosphate or calcium oxalate stones.



• Other conditions associated with an increased risk of kidney stones include hyperparathyroidism, kidney diseases such as renal tubular acidosis, and some inherited metabolic conditions including cystinuria and hyperoxaluria. Chronic diseases such as diabetes and high blood pressure (hypertension) are also associated with an increased risk of developing kidney stones.



• People with inflammatory bowel disease or who have had an intestinal bypass or ostomy surgery are also more likely to develop kidney stones.



• Some medications also raise the risk of kidney stones. These medications include some diuretics, calcium-containing antacids, and the protease inhibitor Crixivan (indinavir), a drug used to treat HIV infection.

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Heart Attack 2

What is angina pectoris?

Angina pectoris is chest pain or pressure that occurs when the oxygen supply to the heart muscle cannot keep up with oxygen consumption by the heart muscle. (Oxygen consumption by the heart muscle increases with physical exertion or excitement and decreases with rest and relaxation.) Most commonly, the inadequate supply of oxygen is due to narrowing of the coronary arteries by atherosclerosis. When coronary arteries are narrowed by more than 50% to 70%, the arteries cannot increase the supply of blood to the heart muscle during exertion or other periods of high oxygen demand. An insufficient supply of oxygen to the heart muscle causes chest pain (angina). Chest pain that occurs with exercise or exertion is called exertional angina. Please read the MedicineNet Angina article for more information on the different types of angina.

What is a heart attack?

A heart attack (myocardial infarction) is the death of heart muscle due to the sudden and complete blockage of a coronary artery by a blood clot. A coronary artery blockage usually occurs in arteries that contain cholesterol plaques. A plaque can rupture and initiate the formation of a blood clot next to it. A blood clot can completely block blood flow through a coronary artery and deprive the heart muscle of needed nutrients and oxygen. The heart muscle then dies, which produces a heart attack. For additional information, please read the Heart Attack article, and the Heart Attack Photo Essay, with real pictures of coronary artery blockage.

Ventricular fibrillation

A heart attack can trigger the sudden onset of ventricular fibrillation. Ventricular fibrillation is a chaotic electrical rhythm of the heart that causes cardiac arrest (the heart stands still and ceases to pump blood). Ventricular fibrillation causes permanent brain damage and death unless a normal heartbeat can be restored within five minutes of its onset. Of the 1 million Americans who suffer heart attacks annually, approximately 400,000 of them die suddenly and unexpectedly from ventricular fibrillation before the victims can reach any medical assistance. For these people, the first sign of coronary heart disease is sudden, unexpected death. Read More......

Heart Attack

Coronary atherosclerosis is the hardening and narrowing of the arteries that supply blood to the heart muscle. Coronary atherosclerosis is the major cause of heart attacks. Heart attacks are the major cause of sudden unexpected death among otherwise healthy adults in the prime of their lives. Heart attacks are also a significant cause of heart failure (due to weakened heart muscle) in this country.

Heart failure considerably decreases a person's longevity and quality of life. In dollar terms, coronary heart disease is costly. The total cost of coronary artery bypass surgery, coronary angioplasty and stenting, medications, and hospitalizations exceeds 50 billion dollars annually. Coronary atherosclerosis, and hence heart attacks, are preventable. A person can significantly lower his or her risk of heart attack by lowering high blood pressure, controlling diabetes, stopping cigarette smoking, losing excess weight, exercising regularly, and lowering the levels of bad “LDL” cholesterol and increasing the level of the good “HDL” cholesterol in the blood. In recent years, other risk factors for coronary atherosclerosis have been identified. These include a high serum homocysteine level and certain subtypes of LDL cholesterol. The following is a comprehensive review of the causes of atherosclerosis and heart attacks, and the means for their treatment and prevention. What is atherosclerosis?

Atherosclerosis is a gradual process whereby hard cholesterol substances (plaques) are deposited in the walls of the arteries. Cholesterol plaques cause hardening of the artery walls and narrowing of the inner channel (lumen) of the artery. Arteries carry blood that is enriched with oxygen and nutrients to the vital organs such as the brain, heart, kidneys, and liver. Arteries also transport blood to other tissues such as the fingers, toes, nerves, bones, skin, and muscles. Healthy arteries can deliver an ample supply of blood to the organs and tissues. In contrast, arteries that are narrowed by atherosclerosis have difficulty delivering blood to the parts of the body they supply. For example, atherosclerosis of the arteries in the legs causes poor circulation in the lower extremities. Poor circulation in the lower extremities can lead to pain while walking or exercising, deficient wound healing, and/or leg ulcers. Atherosclerosis can also cause the complete blockage of an artery from a blood clot. This complete blockage interrupts oxygen supply and results in tissue injury or death. Thus, the blockage of an artery that furnishes blood to the brain can lead to a stroke (death of brain tissue). Likewise, the blockage of the arteries to the heart can result in a heart attack (death of heart muscle), also called myocardial infarction (MI). What are coronary heart diseases (CHD)?

Coronary atherosclerosis refers to the hardening and narrowing of the coronary arteries. The coronary arteries supply the blood that carries oxygen and nutrients to the heart muscle. When coronary arteries are narrowed or blocked by atherosclerosis, they cannot deliver an adequate amount of blood to the heart muscle. Disease caused by the lack of blood supply to heart muscle is called coronary heart disease (CHD). Coronary heart diseases include heart attacks, sudden unexpected death, chest pain (angina), abnormal heart rhythms, and heart failure due to weakening of the heart muscle. Read More......

Is lowering LDL cholesterol enough?

Unfortunately, the prevention and treatment of atherosclerosis are more complicated than just lowering LDL cholesterol levels. LDL cholesterol reduction is only half of the battle against atherosclerosis. Individuals who have normal or only mildly elevated LDL cholesterol levels can still develop atherosclerosis and heart attacks even in the absence of other risk factors such as cigarette smoking, high blood pressure, and diabetes mellitus. Additionally, successfully lowering elevated LDL cholesterol levels cannot always prevent atherosclerosis and heart attacks. In many clinical trials to lower LDL cholesterol, there were patients who adhered to their assigned diets, faithfully took their cholesterol-lowering medications, and successfully lowered their LDL cholesterol to target levels, yet still suffered progressive atherosclerosis and heart attacks. It is clear that while lowering LDL cholesterol below NCEP target levels is an important step, there are other factors involved. What is lipoprotein (a), (Lp(a)) cholesterol?

Lipoprotein (a) (Lp(a)) is an LDL cholesterol particle that is attached to a special protein called apo(a). In large part, a person's level of Lp(a) in the blood is genetically inherited. Elevated levels of Lp(a) (higher than 20 mg/dl to 30 mg/dl) in the blood are linked to a greater likelihood of atherosclerosis and heart attacks in both men and women. The risk is even more significant if the Lp(a) cholesterol elevation is accompanied by high LDL/HDL ratios. Certain diseases are associated with elevated Lp(a) levels. Patients on chronic kidney dialysis and those with nephrotic syndromes (kidney diseases that cause leakage of blood proteins into the urine) tend to have high levels of Lp(a). There are many theories as to how Lp(a) causes atherosclerosis although exactly how Lp(a) accumulates cholesterol plaques on the artery walls has not been well defined. Clinical trials conclusively proving that lowering Lp(a) reduces atherosclerosis and the risk of heart attacks have not been conducted. Currently, there is no international standard for determining Lp(a) cholesterol levels and commercial sources of Lp(a) testing may not have the same accuracy as research laboratories. Therefore, specifically measuring and treating elevated Lp(a) cholesterol levels are not widely performed in this country. How can Lp(a) cholesterol levels be reduced?

Most lipid-lowering medications such as statins, Lopid, and cholestyramine have a limited effect in lowering Lp(a) cholesterol levels. Estrogen has been shown to lower Lp(a) cholesterol levels by approximately 20% in women with elevated Lp(a) cholesterol. Estrogen can also increase HDL cholesterol levels when given to postmenopausal women. Additionally, nicotinic acid (Niacin or Niaspan) in high doses has been found to be effective in lowering Lp(a) cholesterol levels by approximately 30%. Read More......

Why is HDL the good cholesterol?

HDL is the good cholesterol because it protects the arteries from the atherosclerosis process. HDL cholesterol extracts cholesterol particles from the artery walls and transports them to the liver to be disposed through the bile. It also interferes with the accumulation of LDL cholesterol particles in the artery walls.

The risk of atherosclerosis and heart attacks in both men and is strongly related to HDL cholesterol levels. Low levels of HDL cholesterol are linked to a higher risk, whereas high HDL cholesterol levels are associated with a lower risk.

Very low and very high HDL cholesterol levels can run in families. Families with low HDL cholesterol levels have a higher incidence of heart attacks than the general population, while families with high HDL cholesterol levels tend to live longer with a lower frequency of heart attacks.

Like LDL cholesterol, life style factors and other conditions influence HDL cholesterol levels. HDL cholesterol levels are lower in persons who smoke cigarettes, eat a lot of sweets, are overweight and inactive, and in patients with type II diabetes mellitus.

HDL cholesterol is higher in people who are lean, exercise regularly, and do not smoke cigarettes. Estrogen increases a person's HDL cholesterol, which explains why women generally have higher HDL levels than men do.

For individuals with low HDL cholesterol levels, a high total or LDL cholesterol blood level further increases the incidence of atherosclerosis and heart attacks. Therefore, the combination of high levels of total and LDL cholesterol with low levels of HDL cholesterol is undesirable whereas the combination of low levels of total and LDL cholesterol and high levels of HDL cholesterol is favorable.

What are LDL/HDL and total/HDL ratios?

The total cholesterol to HDL cholesterol ratio (total chol/HDL) is a number that is helpful in estimating the risk of developing atherosclerosis. The number is obtained by dividing total cholesterol by HDL cholesterol. (High ratios indicate a higher risk of heart attacks, whereas low ratios indicate a lower risk).

High total cholesterol and low HDL cholesterol increases the ratio and is undesirable. Conversely, high HDL cholesterol and low total cholesterol lowers the ratio and is desirable. An average ratio would be about 4.5. Ideally, one should strive for ratios of 2 or 3 (less than 4).

What are the treatment guidelines for low HDL cholesterol?

In clinical trials involving lowering LDL cholesterol, scientists also studied the effect of HDL cholesterol on atherosclerosis and heart attack rates. They found that even small increases in HDL cholesterol could reduce the frequency of heart attacks. For each 1 mg/dl increase in HDL cholesterol, there is a 2 to 4% reduction in the risk of coronary heart disease. Although there are no formal NCEP (please see discussion above) target treatment levels of HDL cholesterol, an HDL level of <40>

How can levels of HDL cholesterol be raised?

The first step in increasing HDL cholesterol levels (and decreasing LDL/HDL ratios) is therapeutic life style changes. When these modifications are insufficient, medications are used. In prescribing medications or medication combinations, doctors have to take into account medication side effects as well as the presence or absence of other abnormalities in cholesterol profiles.

Regular aerobic exercise, loss of excess weight (fat), and cessation of smoking cigarettes will increase HDL cholesterol levels. Regular alcohol consumption (such as one drink a day) will also raise HDL cholesterol. Because of other adverse health consequences of excessive alcohol consumption, alcohol is not recommended as a standard treatment for low HDL cholesterol.

Medications that are effective in increasing HDL cholesterol include nicotinic acid (niacin), gemfibrozil (Lopid), estrogen, and to a much lesser extent, the statin drugs (discussed below). A newer medicine, fenofibrate (Tricor) has shown much promise in selectively increasing HDL levels and reducing serum triglycerides. Read More......

Tips

1. Use liquid plant oils for cooking and baking. Olive, canola, and other plant-based oils are rich in heart-healthy unsaturated fats. Try dressing up a salad or spring vegetables with a delicious, olive oil-based vinaigrette, such as this recipe for fresh mint vinaigrette.

2. Ditch the trans fat. In the supermarket, read the label to find foods that are trans free. In restaurants, steer clear of fried foods, biscuits, and other baked goods, unless you know that the restaurant has eliminated trans fat. Read more about how to spot trans fats—and how to avoid them.

3. Switch from butter to soft tub margarine. Choose a product that has zero grams of trans fat, and scan the ingredient list to make sure it does not contain partially hydrogenated oils.

4. Eat at least one good source of omega-3 fats each day. Fatty fish, walnuts, and canola oil all provide omega-3 fatty acids. Read more about omega-3 fatty acids and why they are so important to good health.

5. Go lean on meat and milk. Beef, pork, lamb, and dairy products are high in saturated fat. Choose low-fat milk, and savor full-fat cheeses in small amounts; also, choose lean cuts of meat.

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Choose healthy fats, limit saturated fat, and avoid trans fat.

The total amount of fat you eat, whether high or low, isn't really linked with disease. What really matters is the type of fat you eat.

The "bad" fats—saturated and trans fats—increase the risk for certain diseases. The "good" fats—monounsaturated and polyunsaturated fats—lower disease risk. The key to a healthy diet is to substitute good fats for bad fats—and to avoid trans fats.

Although it is still important to limit the amount of cholesterol you eat, especially if you have diabetes, dietary cholesterol isn't nearly the villain it's been portrayed to be. Cholesterol in the bloodstream is what's most important. And the biggest influence on blood cholesterol level is the mix of fats in your diet—not the amount of cholesterol you eat from food.

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How Controlling Cholesterol ?

Of all the natural supplements available to help lower cholesterol, red rice yeast extracts are by far the most effective. Red rice yeast (Monascus purpureus) has a long history of use in China as a natural food coloring and healthful ingredient. It is a source of naturally occurring statins, and because it delivers a mix of those compounds rather than a single molecule, it is much less likely to cause the side effects that sometimes occur with the pharmaceutical versions.

As you may know, in 2001 the FDA banned the sale of the most popular brand of red yeast rice extract, Cholestin, because one of its components (lovastatin) was already a patented drug when Cholestin came on the market (the product now sold as "Cholestin" in the United States does not contain any red rice yeast). You can still obtain Cholestin that contains red rice yeast extract in some European countries, and other brands of red rice yeast extract are still sold in the U.S. Because supplements are unregulated and the demand for quality ingredients is growing, some products will not actually contain any red rice yeast extract and will be ineffective. If you don't get satisfactory results, you can always switch to a better quality brand or even to a prescribed statin.

The most common side effects of prescribed statin drugs are headache, digestive upset, liver dysfunction, and muscle pain. These last two problems can be serious, but statins are well tolerated by most people, and serious side effects are rare. Red rice yeast supplements can cause the same side effects in sensitive people, but in my experience the incidence is significantly less than with the purified prescription compounds.

I recommend that anyone who takes statins or red rice yeast extract supplements for cholesterol control should also take 90 - 120 mg of coenzyme Q10 every day, since these drugs inhibit the body's natural synthesis of CoQ10, which is needed for formation of ATP, our bodies' energy currency. (That may account for the muscle pain that some people experience.)

No matter what supplement or drug you use for cholesterol control, be sure to get at least 30 minutes a day of aerobic exercise and reduce the amount of saturated fat and trans-fats in your diet. Other beneficial lifestyle changes include drinking green tea, eating one clove of garlic per day (diced or crushed in food), and consuming more soluble fiber (such as oat bran), foods rich in omega-3 fatty acids (good sources include salmon, sardines and walnuts) and plenty of leafy greens and fresh fruits.

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Why Cholesterol Matters

Cholesterol is a type of fat called a lipid. The body uses it for many things, such as making new cells. Your liver makes the cholesterol that your body needs. You also get cholesterol from the foods you eat.

Your body needs some cholesterol. But if you have too much, it starts to build up in your arteries. (Arteries are the blood vessels that carry blood away from the heart.) This is called hardening of the arteries, or atherosclerosis. It is usually a slow process that gets worse as you get older.

To understand what happens, think about how a clog forms in the pipe under a kitchen sink. Like the buildup of grease in the pipe, the buildup of cholesterol narrows your arteries and makes it harder for blood to flow through them. It reduces the amount of blood that gets to your body tissues, including your heart. This can lead to serious problems, including heart attack and stroke.

To find out how you are doing, compare your total cholesterol number to the following:

• Best is less than 200.
• Borderline-high is 200 to 239. Even borderline-high cholesterol makes you more likely to have a heart attack.
• High is 240 or above.

What are the symptoms?
High cholesterol doesn't make you feel sick. But if cholesterol builds up in your arteries, it can block blood flow to your heart or brain and cause a heart attack or stroke.

By the time you find out you have it, it may already be clogging your arteries. So it is very important to start treatment even though you may feel fine.

What are the different kinds of cholesterol?
Cholesterol travels through the blood attached to a protein. This package of cholesterol (a lipid) and protein is called a lipoprotein. Lipoproteins are either high-density or low-density, based on how much protein and fat they have.

• Low-density lipoproteins (LDL) are the “bad” cholesterol. LDL is mostly fat with only a small amount of protein. It can clog your arteries. If you have high cholesterol, your doctor will want you to lower your LDL.
• High-density lipoproteins (HDL) are the “good” cholesterol. HDL is more protein than fat. It helps clear the bad cholesterol from your blood so it does not clog your arteries. A high level of HDL can protect you from a heart attack.
• Triglycerides are another type of fat in the blood that can affect your health. If you have high triglycerides and high LDL, your chances of having a heart attack are higher.

It may help to think of HDL as the “Healthy” cholesterol and LDL as the “Lousy” cholesterol. Or you could remember that HDL should be High and LDL should be Low.
Experts have come up with the best level for each type of cholesterol. Compare your numbers to these targets:

• LDL should be less than 100. LDL increases your risk of heart problems, so the lower your LDL, the better. A level of 160 or above is high.
• HDL should be more than 40. HDL over 60 helps protect against a heart attack. HDL below 40 increases your risk of heart problems. The higher your HDL, the better. A high HDL number can help offset a high LDL number.
• Triglycerides should be less than 150. A level above 150 may increase your risk for heart problems.

What causes high cholesterol?
Many things can cause high cholesterol, including:

• Diet. Eating too much saturated fat and cholesterol can raise your cholesterol. Saturated fat and cholesterol are in foods that come from animals (such as beef, pork, veal, milk, eggs, butter, and cheese), many packaged foods, stick margarine, vegetable shortening, and snack foods like cookies, crackers, and chips.
• Weight. Being overweight may raise triglycerides and lower “good” HDL.
• Activity level. Not exercising may raise “bad” LDL and lower HDL.
• Overall health. Diseases such as hypothyroidism can raise cholesterol. Smoking may lower HDL.
• Age. Cholesterol starts to rise after age 20. In men, it usually levels off after age 50. In women, it stays fairly low until menopause. After that, cholesterol levels rise to about the same levels as in men.
• Family. Some people inherit a rare disease called a lipid disorder. It can cause very high total cholesterol, very low HDL, and high triglycerides. If you have this problem, you will need to start treatment at a young age.

How is high cholesterol diagnosed?
Doctors use a blood test to check cholesterol.

• A fasting cholesterol test (also called a lipoprotein analysis) is the most complete test. It measures total cholesterol, HDL, LDL, and triglycerides. You cannot have food for 9 to 12 hours before this test.
• A simple cholesterol test can measure total cholesterol and HDL. You can eat before this test. Sometimes doctors do this test first. If it shows you have high cholesterol or low HDL, then you will get a fasting cholesterol test.

How is it treated?
The two main treatments are lifestyle changes and medicines. The goal of treatment is to lower your "bad" LDL cholesterol and reduce your risk of a heart attack. You may also need to raise your "good" HDL cholesterol. A high level of HDL helps reduce your risk of heart problems.

Some lifestyle changes are important for everyone with high cholesterol. Your doctor will probably want you to:

• Follow the Therapeutic Lifestyle Changes (TLC) diet. The goal is to reduce the amount of saturated fat you eat. Eating saturated fat raises your cholesterol. The TLC diet helps you learn to make better food choices by picking lean meats, low-fat or nonfat products, and good fats like olive and canola oils.
• Lose weight, if you need to. Losing just 5 to 10 pounds (2.3 to 4.5 kilograms) can lower your cholesterol and triglycerides. Losing weight can also help lower your blood pressure.
• Be more active. Exercise can raise your “good” HDL and may help you control your weight.
• Quit smoking, if you smoke. Quitting can help raise your HDL and improve your heart health.

Sometimes lifestyle changes are enough on their own. But if you try them for a few months and they don't lower your cholesterol enough, your doctor may prescribe a cholesterol-lowering medicine called a statin. You also may need medicines to lower triglycerides or raise HDL.

You may need to start taking medicine right away if your cholesterol is very high or if you have another problem that increases your chance of having a heart attack. People who have a high risk for heart attack benefit from taking higher doses of statins to lower their LDL cholesterol as much as possible. The more these people can lower their LDL, the less likely they are to have a heart attack.

It is important to take your medicine just the way your doctor tells you to. If you stop taking your medicine, your cholesterol will go back up.

You will need to have your cholesterol checked regularly. Your results can help your doctor know if lifestyle changes have helped or if you need more or different medicines. Read More......