Cholesterol is related to but not the direct cause of arteriosclerosis, heart disease, and strokes. We cannot live without cholesterol, we must have it to make cell membranes, vitamin D, many hormones, and bile salts. Yet it is related to heart disease. In general, the higher the cholesterol the worse the risk for heart disease. But it is not the total that is most important, it is the relationship between types of cholesterol subfractions. There are nine different types of LDL cholesterol and five different types of HDL that provide even further information. In general, it is the ratio of HDL to total cholesterol that should be used in general screens. Lowering LDL has value to a certain point, but beyond a certain point low cholesterol may reduce heart disease but increase all cause mortality. Vytorin is a combination of Zocor and Zetia to lower cholesterol more may reduce mortality from heart disease, but overall survival is not increased, and all cause mortality may be higher.