Cholesterol is a waxy, fat-like substance that can be found in all parts of the body. It does not mix with blood, and it has to be carried in the bloodstream through packages called lipoproteins. There are 2 important types of lipoproteins that affect the risk for heart disease: HDL (high-density lipoprotein) and LDL (low-density lipoprotein).

HDL is what we called good cholesterol while LDL is bad cholesterol. HDL carries cholesterol in the blood, and back to the liver for it to be removed from the body. LDL deposits cholesterol and is responsible for its build-up and blockage in the arteries.

For years, good cholesterol (HDL) has been considered as being able to counteract bad cholesterol (LDL), or even prevent heart disease. Nonetheless, its goodness has been questioned by some scientists.

Two recent studies, one announced in March 2004, and one published one week earlier, found that ultra-low levels of LDL can protect heart patients from heart attacks and deaths. This in turn suggested that HDL matters little.

Despite that some heart experts are not ready to change their treatment advice; others have concluded that HDL should play at most a minor role in deciding whether to prescribe cholesterol-lowering drugs, reported the New York Times on March 15, 2004.

Some cholesterol researchers feel that the theory that the more HDL, the better, may be too simplistic. Having a high HDL is generally a good thing, but it does not mean that it is so powerful that it creates a total immunity to heart disease. According to them, there are people who have high levels of HDL but the HDL does not function properly. This explains why people with high level of HDL can still end up with heart disease.

Some experts think that treatment for high LDL should not be withheld just because a person's HDL level is high. As one of the cardiologist said, if you have a high LDL level, you should be concerned about it, independently of your HDL because you are at risk.

Others, who have different views on how to weigh HDL in treatment decisions, will still look at the overall risk including a patient's HDL levels. Their reason is that by excluding HDL levels from the equation, patients who are otherwise at low risk for heart disease would gain little by taking LDL-lowering drugs, which can cost about US$100 per month (as at 2004).

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