On Friday morning, April 16, 2004, Mohamed Hadibèche, then a 44-year-old truck driver, felt a mild pain in his chest. It was gone within minutes. The following morning, the pain returned – again, subsiding soon after. So when the pain returned the next afternoon, he assumed he could ignore it. But this time it rapidly grew more intense. “I felt I had a stake deep in my chest,” recalls Mohamed. His wife, Houria, insisted on getting him to hospital.
Mohamed couldn’t have known it that Sunday, but inside the walls of the ­arteries leading to his heart, ­cholesterol had been building up. Over time, this cholesterol had hardened into a substance called plaque, creating a condition called atherosclerosis. These plaques narrowed the space through which his blood flowed.
When plaques rupture, as they sometimes do, blood clots can form, further interfering with the flow of blood. This appears to be what happened to Mohamed. Blocked by hard, calcified cholesterol and clots, oxygen-rich blood could no longer reach his heart. And Mohamed Hadibèche suffered a heart attack.
What is cholesterol, and why do we have it?
Cholesterol is a fat-like substance called a lipid that’s primarily produced by the liver. We couldn’t live without it. “You need it for hormones, DNA, and cell membranes,” says Dr Ian Graham, professor of cardiovascular medicine at Trinity College in Dublin, Ireland. If not for cholesterol, your brain couldn’t function.
Your cholesterol test only measures the first two major lipoproteins. Low Density Lipoprotein (LDL), named for its lower concentration of cholesterol, is commonly labelled “bad” cholesterol because it contributes to plaque. High Density Lipoprotein (HDL) is the so-called “good” cholesterol because it is thought to help remove LDL cholesterol from the arteries. The third major lipoprotein is Very Low Density Lipoprotein (VLDL), a larger particle with a high concentration of triglycerides.
But when that excess goes where it’s least welcome – stuck to the walls of your arteries, as happened to ­Mohamed – it increases the risk of heart problems. If the arteries leading to the brain are involved, it can increase the risk of stroke.
Not all heart problems are related to high cholesterol, but the World Health Organization estimates that cholesterol is responsible for a third of coronary heart disease cases. That’s significant, because cardiovascular disease is the number-one cause of death globally, accounting for more than 17.5 million deaths a year. Meanwhile, high triglycerides, fats that rise when “good” cholesterol levels fall, can double the risk of stroke, says a large 2012 study.