By Robert Bazell Chief science and health correspondent
NBC News
updated 3/16/2004 6:32:49 PM ET 2004-03-16T23:32:49

Thomas Siko never paid much attention to his health, even though he had a strong family history of heart disease, until he almost had a heart attack himself.

“I’m a typical man. If it doesn’t hurt or hurt too much, I don’t get it checked," says Siko.

But after a heart bypass operation he was introduced to cholesterol measurements -- low density lipoprotein (LDL) and high density lipoprotein (HDL).

But what do these terms mean and which measurement is more important?  While patients can certainly be confused about cholesterol, some articles even suggest the medical profession is.

Some leading doctors maintain that there is no confusion.  LDL, or "bad" cholesterol, increases the risk for heart disease, while HDL, or "good" cholesterol, reduces the risk.

Researchers know more about LDL because the wildly profitable drugs known as statins dramatically reduce it. As a result, drug companies have paid for dozens of large-scale studies focusing on LDL.

According to Dr. Steven Nissen of the Cleveland Clinic, “In virtually every clinical trial, the more we lowered LDL, or bad cholesterol, the more we reduced the risk of heart attack, stroke and death.”

But there are no blockbuster drugs available to raise HDL.  Dr. Henry Ginsberg of Columbia University says that’s why HDL is not as well understood as LDL. “If you can raise your HDL, everything we know suggests that’s good, but the bottom line proof is not there yet.”

When Siko’s cholesterol was measured, both his LDL and HDL were in the normal range. But experts emphasize cholesterol is not the whole story. “Very few people have a heart attack because of one single factor,” Dr. Ginsberg adds.

In Siko’s case, family history probably played a key role. And researchers emphasize that smoking, diabetes, lack of exercise and high blood pressure are all critical factors -- even though bad cholesterol gets all the attention.

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