Stroke, Heart Attack, Atherosclerosis and DVT

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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Cardiovascular risk of stroke and heart attack is one of the chief health concerns of the U.S. population, and a majority of people are now looking to some form of Complementary Medicine and integrated medical approach to decrease risk of occurrence, or recurrence, and avoid some of the side effects of the many pharmaceutical medicines prescribed to help achieve these goals. It is always good to discuss cardiovascular issues with a cardiologist, especially if standard tests reveal significant risk, or if you fall into a high risk demographic. On the other hand, the latest findings in Complementary and Integrative Medicine (CIM) present an array of health issues that the standard cardiologist may not have sufficient expertise with which to guide the patient, and instead may be relying on information given to him by the pharmaceutical industry, which does not have a vested interest in successful Complementary Medicine. Many patients could achieve significant benefit from safe and effective Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM). A cocktail of pharmaceuticals with a long list of adverse side effects is not necessary for most patients. This is where a Complementary Medicine physician, such as a knowledgeable Licensed Acupuncturist and herbalist, can help make sense of the wide array of health research on reducing cardiovascular risk, and tailor a program specific to the individual patient. As you will see from this article, there are a wide variety of herbs, nutrient therapies, dietary changes, and techniques that are proven helpful in prevention of cardiovascular risk. Integrative medical care is the best approach when trying to prevent or reverse cardiovascular problems, and may be the key to a safe effective treatment protocol for any of the related pathologies, such as atherosclerosis, hypertension, high cholesterol, etc. Unfortunately, we are still far away from the time that standard medicine and medical doctors are going to provide anything more than lip service in this goal. To achieve true integrative medical approaches, the patients themselves must take a proactive role and take charge of their healthcare.

Unlike standard care in cardiovascular medicine, Complementary and Integrative Medicine (CIM) offers the patient the goal of restoring the health of the system, not just blocking the highest risk factors, insuring better long-term outcomes

Just below iatrogenic deaths, death from heart attack and stroke is the second most common statistical cause of death in the United States, at 768,755 per year in 2005, and 750,976 in 2008, and nearly 2 million strokes and heart attacks occurring yearly in the U.S.A. as of 2012. There has not been sufficient progress on decreasing incidence and mortality, although new techniques to quickly restore blood flow in the hospital Emergency Room have helped dramatically. Demographically, the highest rates of heart disease and stroke, and mortality, occur in the South and Midwest, with between 356 and 1457 deaths per 100,000 population yearly for heart disease, and 78 to 624 per 100,000 for stroke in 2010-12 (U.S. CDC). How do we actually determine if we are at high risk of cardiovascular health problems? Atherosclerosis usually develops slowly, and there are no symptoms until the artery becomes highly atherosclerotic, or small emboli break off and cause such problems as chest pain or neurological episodes. Chest pain is not the only symptom of mild heart attacks, though. Recent research by the National Institutes of Health has found that women suffer different symptoms before heart attacks than men, with 70 percent reporting severe fatigue, 48 percent reporting sleep disturbances, and about half reporting anxiety, indigestion and shortness of breath. These symptoms correlated with reports of symptoms experienced during the heart attacks as well for about half of the women studied, along with profuse cold sweat and dizziness. One does not have to experience a severe chest pain to suspect a heart attack. Of course, these symptoms do not always indicate that a heart attack is going to occur, or is occurring, either. These common health problems could be a sign that cardiovascular stress is increasing, and attention to the whole cardiovascular health picture that is started early may be important to prevent future cardiovascular problems. A majority of us will experience cardiovascular disease, and a great many of us will eventually experience a stroke or heart attack. Keeping these strokes and heart attacks mild in scope, and preventing them, requires a proactive, intelligent, informed holistic approach and regimen.

An alarming statistic that points to the need for early prevention, and may also indicate a failing of standard pharmacological therapy, is the high incidence of recurrence of stroke and heart attack within three years of a serious event. The Northwestern University Feinberg School of Medicine reported in 2009 that when following over 32,000 patients with atherothrombosis, patients who reached a symptomatic state with vascular disease had a 14.4 percent average rate of recurrence one year after having a heart attack or stroke, and a 18.4 percent average rate of recurrence within 3 years of that first stroke or heart attack. Patients with atherosclerosis in multiple sites had a 40.5 percent average rate of recurrence within 3 years, despite being on standard pharmaceutical drugs. Data from the REACH Registry (Reduction of Atherothrombosis for Continued Health), also showed that almost all strokes were preceded by mild transitory ischemic attacks (TIAs), often mild enough to go unreported. Ischemia is a term meaning local decrease in blood oxygen and nutrients to tissues, and a transitory ischemic attack, or TIA, is usually short, with the lack of blood flow to parts of the brain often creating a period of confusion and poor judgement due to the mild injury to the brain tissue. Recognizing the mild TIA and instituting measures to improve vascular health is the key to prevention of a serious stroke, which can be devastating and debilitating. The mild temporary confusion occurring with TIAs often contributes to the lack of alarm and recognition of the seriousness of these events. Data on the recurrence of stroke and heart attack can be accessed by clicking here: http://www.feinberg.northwestern.edu/news/2009E-August/alberts-paper.html

An article in the June 23, 2015 New York Time Science Times entitled Rethinking Cardiac Care showed just how stubborn standard medicine can be when presented with actual scientific evidence that questions their beliefs. The most common treatment of angina and heart attack since the early 1990s is the surgical implant called a stent for arteries blocked by atherosclerosis, but a 2006 COURAGE Study showed that using the stent did not show benefit over standard drug therapy, with low-dose aspirin, cholesterol lowering statins, and medication for hypertension, with a large number of patients randomly assigned to this therapy with or without the stent. Incidence of cardiac pain were temporarily decreased after a stent surgery, but for many, other symptoms persisted, such as shortness of breath, and the pain episodes, or angina returned. Studies in 2011 have also shown that the area of the heart attack most often occurred not where the stent was applied, or would have been applied, at the point of narrowing or blockage of the artery, but at parts of the artery where the atherosclerotic plaque had ruptured, indicating that the inflammation and calcification of the artery were much more important concerns than the plaque itself. In this article, Dr. David J. Maron, the director of preventive cardiology at Stanford University Medical School, in Palo Alto, California, U.S.A. stated that while we still operate as though we know that the stents are best for the patient, "it is kind of amazing that we don't have the evidence". Finally, the cardinal sin of admitting that almost all manual therapies in standard medicine are not held to "evidence-based" randomized, placebo controlled human clinical trials is being committed. In response to adverse symptoms after stenting, blood thinning drugs are prescribed, with common side effects of shortness of breath, chest tightness, and fatigue as well, diminishing quality of life and contributing to anxiety and insomnia. Much research has now shown that problematic differences in the rate of metabolism of "blood-thinning" anticoagulent drugs between types of patients presents a hazard, as does the wide array of other pharmaceuticals, and even some foods to a small extent, that alter this rate of metabolism, or catabolism of the "blood-thinning" drug. A section of this article provides this information. Blood-thinning anticoagulants are necessary in many cases, but should not be considered a long-term panacea for prevention of stroke for most patients, and should not routinely be used to decrease adverse health effects of therapies such as stents in the long term. These tasks can be helped by integrating Complementary Medicine and achieving healthier routines of diet and lifestyle.

The majority of cardiologists in the United States ignored the findings of the 2006 COURAGE Study, and recent follow-up study showed that over 75 percent of cardiologists still recommend the stent over medication and improved health with diet, exercise and Complementary and Integrative Medicine (CIM). For the small percentage of patients who were informed of the COURAGE Study and the choice, almost all of these patients chose to try the medication and lifestyle changes, and avoid the stent in the followup study. Of course, the insertion of the stent was much more profitable, with each insertion now costing up to $17,000. A new study by the National Heart, Lung and Blood Institute of the U.S. NIH is enrolling 8000 patients over 4 years from 2016 to 2020 and avoiding any chance of screening the patients beforehand with an angiogram, seeing if the COURAGE Study was indeed accurate. Whether cardiologists will participate fully is in question, though, as the first months of the study showed almost no participation by many of the institutions at nearly 3000 participating medical centers. Dr. Maron was quoted: "Cardiologists think this is a very important study intellectually, but when it comes to their own patients, some cardiologists balk, even though they know we don't have the answer". On the other hand, improving cardiovascular health to prevent heart attacks with Complementary and Integrative Medicine (CIM) and Traditional Chinese Medicine (TCM) has been discouraged because we reportedly had no real proof that it worked. The evidence now supports CIM/TCM and yet does not support the stent, but we still see almost no change in treatment protocol.

Patient Understanding of the Mechanisms of Stroke and Heart Attack Helps with More Proactive Strategy and Better Choices

Understanding what atherothrombosis is, and how to prevent it, is the task of all patients interested in preventing cardiovascular disease and death. Inflammatory calcification of the blood vessel walls and fibrin accumulation due to advanced glycation endproducts lies at the heart of the disease, and restoration of healthy vascular epithelium is obviously important. The contribution of lipid cholesterol is now proven to be less important than the factors that cause rupture of the arterial plaque, or thromboses.

The term athero-, from the Greek word athere, or porridge, refers to the appearance of the inside of arteries affected by the accumulation of atheroma, or deposits of fats, calcium, and fibrins on the inside of the blood vessels, or epithelium. A thrombus is a clot, or coagulated mass of blood cells, resulting from inappropriate hemostastic (stopping of bleeding) processes, which occur in chronically injured blood vessels due to inflammatory processes, trauma, or mechanical stress. Normally, the thrombus, or scab, should form to protect the artery or vein, but then dissolve once the blood vessel regains health. If the atherothrombosis grows, and is not broken down and the vessel repaired, decreased blood flow will result. We may not immediately feel this decreased blood flow, but the subsequent circulatory problems will contribute to poor tissue nourishment, failure to properly regulate inflammatory processes and tissue repair in the body, and various physiological dysfunctions, as well as chronic pain. If the atherothrombosis is not broken down and the vessel repaired, a piece of it can break off eventually, and this blood clot is called an embolus, the chief cause of strokes, heart attacks, and peripheral circulatory disorders. An embolism is an obstruction or occlusion (narrowing) of a blood vessel by an embolus. This embolus may be composed not only of a part of a thrombus that breaks off, but also of a mass of bacterial bodies, or other microbes, when chronic inflammation and biotic imbalance are not maintained. Since the atherothrombosis is composed of lipids, or fats, along with calcium deposits and fibrins (proteins formed by the action of thrombin), scientists originally thought that the lipids, or fats, were responsible for the accumulation of the atherothrombosis. We now know that other mechanisms are chiefly responsible for the chronic perpetuation of these atherothromboses, and atherosclerosis, on the inner linings of our blood vessels.

To effectively reverse the accumulation of atherothrombi and atherosclerosis, or the hardening and narrowing of blood vessels, we need to do more than just block lipid formation and eat a less fatty diet. This strategy has led the population to believe that taking statin drugs alone will prevent their stroke and heart attack, but a thoughtful patient will realize that only a restoration of health of the blood vessels, a better system of tissue repair, and a decrease in the chronic inflammation and mechanical stress put on the blood vessels, will truly restore this cardiovascular system to a healthy state. As scientific research goes forward, much has been learned about safe and effective means to complete this task. Both reduction of atherothrombosis and restoration of the health of the blood vessels is possible with Complementary and Integrative Medicine (CIM). Ignoring the problem and depending on statin drugs and baby aspirin alone is a ticket for failure, and the price of failure may be devastating.

Since a thrombus is a scab-like formation on the inside of a blood vessel that forms to protect a damaged or weakened spot on the arterial wall, helping your body to repair these unhealthy areas of the arterial walls is most important in this protective homeostatic process. When chronic inflammation, calcification and accumulation of advanced glycation endproducts inhibits the normal arterial repair, atherothrombosis occurs, as well as atherosclerosis, or the narrowing and hardening of the blood vessels. By ignoring the healthy restoration of the blood vessels and simply depending on blockage of cholesterol formation and a slight inhibition of the blood pressure, we have ignored the most important aspect of cardiovascular health and reduction of risk. Standard medicine has offered nothing to achieve this goal of healthy arterial vascular restoration, while Complementary Medicine continues to add tools that are supported by sound research to achieve this goal. Since the formation of the thrombus is in essence a healthy and protective mechanism, but the inability of the body to repair the arterial wall and dissolve the thrombus leads to increase risk of stroke and heart attack, as well as atherosclerosis, simply blocking the homeostatic mechanism of thrombus formation is not a sensible approach.

Many patients are turning to healthy alternatives rather than waiting until the cardiovascular problems arise and harsh drug therapy becomes necessary. Both effectiveness and degree of risk are concerns with standard pharmacological therapy. Some of the latest findings on standard cardiovascular treatment are disturbing. The new drug touted to reduce arterial plaque, torcetrapib, created to compete with Complementary Medicine's goal of improving cardiovascular health by raising HDL (high density lipoproteins) has been pulled from the market because large studies on the human population showed that it caused more deaths than it saved. This drug, like the popularly prescribed statins, which lower LDL, works by blocking genetic expression of a key protein in lipid metabolism. Modern research now confirms that the problems with atherosclerosis and cardiovascular degeneration are more complicated than just the levels of cholesterol in your body. Inflammory regulation, accumulation of harmful oxidants, and a host of specific metabolic concerns, especially the accumulation of advanced glycation endproducts (AGEs), are now known to be the cause of the buildup of atherosclerotic plaques that contain cholesterol carried lipoproteins, but are not caused by them. The ability of your body to clean up atherosclerotic plaque is also of prime importance and is overlooked in standard therapy to a large extent. Not just prevention, but also reversal of atherosclerosis is important. Allopathic drugs may not be enough to reverse this complex degeneration of your blood vessels and reverse atherosclerosis. Even if you are happy with standard drug therapy, and the chronic side effects are still mild, Complementary Medicine offers not an alternative, but a partnering, or integrating, with standard medicine to achieve greater health goals.

The prime drug emphasis with atherosclerosis is still the blocking of production of cholesterol and cholesterol carrying lipoproteins with statin drugs. The problem with these allopathic drugs are that, while they do statistically raise HDL and lower LDL, the chemical manipulation involved produces altered proteins and poor quality HDL and LDL. In other words, quantity rather than quality is altered. Since HDL and LDL, lipoproteins mistakenly called cholesterol because these molecules transport cholesterol steroid hormones, are essential to the healthy function of the human body, it is vitally important that the quality and function of these molecules is healthy, as well as the quantities. Misformed or genetically altered lipoproteins (HDL and LDL) cause the serious side effects associated with statin drugs, mainly the accumulation of broken proteins in the tissues that cause much muscle and joint pain and inhibit organ function, especially in the kidney, over time. Other important side effects come from the inhibition of other important chemicals in the body related to cholesterol production, such as CoQ10, or ubuquitone, an important cellular antioxidant, and Vitamin D3 hormone. In addition, serious reassessment of widespread statin drug prescription is occurring in 2012, as studies now reveal the significant risk of inducing diabetes with long-term use in patients with metabolic syndrome, or the pre-diabetic state. As you may see from reading this article, depending on cholesterol lowering drugs and hypotensives alone may not be a smart and effective protocol for decreasing risk of stroke, heart attack and atherosclerosis.

What do we mean when we refer to the quality of cholesterol and lipoproteins? For many years, researchers have been puzzled at the low incidence of cardiovascular disease in targeted populations in Europe, despite the standard high dietary intake of fats. Research in Spain in 2010 (cited below) found that low rates of strokes and heart attacks, and a low incidence of death attributed to cardiovascular disease, occurs in Spain despite a high prevalence of standard cardiovascular risk factors, including a high consumption of unsaturated fatty acid rich foods. The researchers found that the fats generally consumed were still of high quality, with high proportions of healthy essential fatty acids, such as DHA (docosahexaenoic acid), alpha-linolenic acid, and oleic acid. The research showed that high intake of healthy fats had a strong correlation in individuals studied with low rates of cardiovascular disease. These quality fatty acids were found in phospholipids in the body, and were carried in serum phosphatidylcholine (a lecithin metabolite). High quality phospholipids had a strong relationship to decreased incidence of carotid artery atherosclerosis.

More recent research has revealed that phytosterols and stanols, found in the oily hulls of whole grains, legumes, nuts and seeds, as well as certain Chinese herbs, are now proven to significantly lower excess LDL cholesterol, improve cardiovascular epithelial dysfunction (reduce atherosclerosis and arterial defects such as thrombosis and weak arterial walls), and supply important chemicals that were rich in the early human diet, but were removed with modern food processing and the limiting of popular food staples by the food industry. These phytosterols and stanols are now proven to even decrease cancer risks, especially colon, breast and prostate, and exert significant anti-inflammatory benefits. Phytosterols are steroid alcohols that are very similar to cholesterol, and show that the benefits of healthy cholesterol in the metabolism are very important to health maintenance. Such renowned medical institutions as the Cleveland Clinic now recommend that when high cholesterol lipids are found, or increased risk of cardiovascular disease, that the first line of therapy should be adoption of a plant-based diet with whole grains and legumes, fresh nuts and seeds, and limiting of saturated fats, while increasing the variety of unprocessed polyunsaturated and monounsaturated oils. The second step should be consumption of about 2 grams per day of phytosterols and stanols, from foods, supplements, and herbs. Finally, the advice and treatment protocols of Complementary Medicine are becoming mainstream.

The debate grows concerning the reductions in cardiovascular deaths seen in the late 1960s through the 1980s. Many experts now agree that changes in diet and lifestyle, combined with improved acute care in hospitals and emergency rooms, are primarily responsible for the improvement. In the late 1980s, statin drugs were introduced to block cholesterol production in the liver, and many objections to their approval emerged, with modest benefits and concern over a number of issues of long-term risk. Nevertheless, this strategy, along with overprescription of hypertension medication, emerged as the only tools pushed in standard medicine. Today, reviewing statistics, we see that from 1997 to 2009, incidence of hypertension has increased from less than 200 per 1000 adults to more than 250 per 1000, and rates of heart disease, coronary heart disease, and stroke have stayed the same. Deaths from cardiovascular disease, especially coronary heart disease, continue to fall, but reduction in deaths from stroke and myocardial infarction has been minimal during this span (U.S. CDC data).

In 2013, the University of Oxford, United Kingdom, Nuffield Department of Clinical Medicine, released a long-term comprehensive study of 44,561 men and women enrolled in the European Perspective Investigation into Cancer and Nutrition (EPIC), and found that those with a predominantly vegetarian diet had a 32 percent lower risk of ischemic heart disease than non-vegetarians, adjusting for other risk factors. Vegetarians have lower non-HDL cholesterol, BMI, and systolic blood pressure (Crowe FL et al; Am J Clin Nutrition 2013 Jan 30; PMID: 23364007). These researchers stated that "few previous prospective studies have examined differences in incident ischemic heart disease (IHD) risk between vegetarians and nonvegetarians." This study shows dramatically that improvement in diet and lifestyle, and attention of overall health, has been, and still is, the number one reason for improvement in cardiovascular health. A 32 percent lowered risk of cardiovascular disease is decidedly more dramatic than that achieved by pharmacological treatment. By improving one's health, integrating Complementary Medicine as well as simple dietary and lifestyle routines, the dramatic lowering of cardiovascular risk can be accomplished, with less need for pharmaceutical intervention. By relying completely on statin drugs and a cocktail of high pressure medications that have a poor track record, and ignoring the underlying health of the cardiovascular system, we may be doing a little more harm than good. Continued improvement in cardiovascular statistics demands improved health of the blood vessels and heart tissues, and improved tissue maintenance and immune health, with healthy diet, regular exercise, and even herbs, nutrient medicines and acupuncture.

The June 23, 2015 New York Times article cited above, entitled Rethinking Cardiac Care, also explores recent and ongoing studies of the real benefits to lowering the blood pressure dramatically. The last decade or two has led to a belief that lowering the systolic pressure dramatically will insure less cardiovascular risk, but this is still not proven, and clinical results do not support this tactic. The blood pressure has a high and low point, with the diastolic the pressure at rest, and the systolic representing how hard the heart pumps. Of course the systolic can vary dramatically with exertion and excitement, and naturally increases with aging and stress. Many experts still believe that there are logical reasons for the heart pumping with more force with an aging system, and that lowering the systolic too low could be detrimental to health for many in aging, and many studies show that this systolic pressure raises for most of us when we even enter a doctor's office (white coat hypertension). Finally, a randomized controlled study is being conducted to see if a general systolic pressure of 140 for patients over age 60 may created a better outcome than a general systolic pressure of 120. European guidelines still call for a general systolic pressure of 150 or lower for these patients, but individualize these aging patients according to actual cardiac and stroke risk. Studies have shown that aging patients who generally have a systolic pressure of 120 have fewer strokes and heart attacks, but this could indicate that these patients just took better care of themselves, with daily aerobic exercise, stress reduction and a healthy diet. For patients with a higher systolic pressure, but still below 150, they may need this pressure to supply blood nutrients, and blood pressure lowered by drugs may not actually create the benefits of a blood pressure that is just naturally lower in general. Studies have not been conducted to really prove this one way or another, and artificially lowering blood pressure may not incur any benefits, but will incur many side effects. In 2014, the Sprint Study was started to finally provide some actual evidence, and the sponsors, the National Heart, Lung and Blood Institute of the U.S. NIH now suggest that we try to maintain a general systolic pressure of 150 or below for patients over age 60, as does Europe, but this is still generally ignored in the U.S. with a large overprescription of multiple drugs to lower the systolic blood pressure, no matter what the diastolic pressure is.

Has our medical community led us to believe that simply taking cholesterol inhibiting statin drugs and hypertension medications with limited benefits would protects us from cardiovascular injury? Has this advice and treatment protocol led millions of Americans to a false reality and contributed to the avoidance of a real preventive medicine protocol? Serious questions are being raised about the standard medical protocol to reduce cardiovascular deaths, accounting for more than 40 percent of all deaths in the United States, and to prevent and treat the myriad ill effects of poor cardiovascular health. While cardiovascular experts in standard medicine still criticize publication of so-called "alternative" remedies and preventive measures, citing the fear that the public will abandon standard protocols, the real question should be whether the manner of promoting standard treatment of cardiovascular risk has deterred the public from adopting healthy complementary measures to improve outcomes and quality of life. The integration of short courses of acupuncture with an individualized protocol of exercise, weight loss and herbal nutrient medicine, to enhance standard treatment will be successful.

The continued emphasis on cholesterol as the chief culprit in cardiovascular disease is outdated, and the continued reference to imbalance of lipoprotein expression and regulation as "high cholesterol" is very misleading. Cholesterol itself is not a lipoprotein, but rather is a steroid hormone carried by lipoproteins. Cholesterol is primarily made in the liver, but is also produced by cells in the lining of the small intestine, as well as individual fat cells in the body. The molecule Acetyl coenzyme A is the building block to cholesterol, as well as the building block of an important neurotransmitter, acetylcholine, the most important neurotransmitter in the autonomic nervous system. Acetyl coenzyme A is derived from healthy fatty acids, many from the diet, and in the production of cholesterol is turned into mevalonic acid. Statin drugs block the production of the enzyme that controls the rate of production of mevalonic acid, thus reducing the endproduct cholesterol steroid hormone. Unfortunately, a number of other important molecules are also blocked downstream from mevalonic acid, including the precursors to the Vitamin D hormone, and the important antioxidant Coenzyme Q10, both of which more recent research has revealed are essential to cardiovascular health. In response to legitimate doubts about the benefits of low cholesterol for everyone, or artificially lowering cholesterol levels rather than restoring the metabolic homeostasis, a new drug has been introduced to severely lower cholesterol lipids. While this new drug, the PCSK9 inhibitor, is approved for only those with very high cholesterol not controlled with statin drugs, or for those patients who cannot tolerate the adverse effects of statins, there is no doubt that it will be prescribed to most patients with cholesterol levels that are considered high.

There are also a variety of reasons why each individual may have a higher level of circulating cholesterol or lipoprotein. Allopathic medicine tries to find a single treatment that works for a majority of paients, but with this approach comes an attitude that tends to treat each patient the same, ignoring individuality in the health profile to a great extent. Increased circulating cholesterol may be a sign of increased need for this hormone in the body, and a growing number of medical doctors and researchers are questioning the need to reduce, or block, cholesterol production, in a great number of patients. With any molecule in the body, there is a tendency to express variants that do not work well in the body. This is why the body may express large amounts of certain valuable molecules. Cholesterol is certainly an important molecule in the body, playing a host of vital roles, such as the daily precursor to other steroid hormones, such as progesterone, estrogen etc. There is now some concern that the number of poor quality cholesterol molecules in the body could be hurting our health, and a host of factors may be causing the difficulties with quality cholesterol production. Certainly, fatty acid imbalance is a factor, but poor liver function, metabolic stress, and the chemical blocking of the pathway of cholesterol production, may all play a part in poor quality cholesterol. Fatty acids are long chain hydrocarbons that are the backbone of triglycerides and phospholipids, whose degradation products form the sterol base of cholesterol. Many fatty acids are essential fatty acids, meaning that it is essential that we obtain them from our food. Building a holistic basis for healthy cholesterol and lipoproteins requires quality natural foods and oils, daily essential fatty acid balance in the diet, good liver function and health, decrease in metabolic stress, and overall hormonal balance.