Cholesterol Guidelines For Reducing Stroke Risk
Current guidelines set similar cholesterol goals for reducing the risk of stroke and the risk of coronary heart disease. These guidelines generally recommend that people without existing heart disease who do not smoke and have no other heart disease risk factors should maintain a total cholesterol level of less than 240 mg/dL, with LDL below 130 mg/dL and HDL above 40 mg/dL.
People with cardiovascular risk factors are advised to aim for even better cholesterol levels to better protect against heart disease and stroke. These individuals should maintain a total cholesterol level below 200 mg/dL, with LDL below 100 mg/dL, and HDL above 60 mg/dL.
Conventional Markers Are Not Accurate Predictors Of Cardiovascular Risk
The second factor to consider is that conventional lipid markers, which are the ones that we typically have tested for if you go to your doctor for routine blood work, so Im talking about total cholesterol, LDL cholesterol, and HDL cholesterol, are not accurate predictors of cardiovascular risk. The most recent research has shown that these markers, total and LDL cholesterol, are not strongly associated with heart disease. The ratio of total-to-HDL cholesterol as well as non-HDL cholesterol, which is similar, are better predictors than total cholesterol or LDL cholesterol, but they are nowhere near as predictive as some of the newer markers like LDL particle number, which in turn itself isnt as predictive as lipoprotein, or Lp. These markers, they tell us something different than the standard lipid markers.
With lipoprotein, we know this is a different type of lipoprotein. Im not going to go into a lot of detail here because its, I guess, pretty geeky, but its known as one of the most atherogenic lipoproteins that have been identified and its the single most significant lipid risk marker for heart disease. Of all of the things we could measure in terms of lipid markers, lipoprotein, or Lp, is the most predictive for future risk of heart disease.
Learn The Warning Signs Of Serious Complications And Have A Plan
High blood cholesterol can lead to serious cardiovascular complications, such as heart attack or stroke. If you think that you are or someone else is having the following symptoms, Every minute matters.
Heart attack
Heart attack symptoms include mild or severe chest pain or discomfort in the center of the chest or upper abdomen that lasts for more than a few minutes or goes away and comes back. This discomfort can feel like pressure, squeezing, fullness, heartburn, or indigestion. There also may be pain down the left arm or in the neck. Although both men and women can experience these symptoms, women are more likely to have other, less typical symptoms, such as shortness of breath, nausea, vomiting, unusual tiredness, and pain in the back, shoulders, or jaw. Read more about the signs and symptoms of a heart attack.
Stroke
If you think someone may be having a stroke, act F.A.S.T. and perform the following simple test.
FFace: Ask the person to smile. Does one side of the face droop?
AArms: Ask the person to raise both arms. Does one arm drift downward?
SSpeech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
TTime: If you observe any of these signs, . Early treatment is essential.
Read more about the signs and symptoms of a stroke.
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When Ldl Cholesterol Is Meaningless
If you arent familiar with blood work, I have a slightly unique lipid profile thats different from many others with high LDL:
- My triglycerides are low
- My HDL Cholesterol is high
- I am relatively lean and athletic
- My HbA1c is in a very healthy range
Effectively, all known numbers are very good except for the one that doctors can easily treat. Am I really at risk for heart disease or early death? High LDL might a slight risk factor for some at-risk individuals , but what happens when you compare it to the strength of the other risk factors?
So lets see what the major research studies have to say when you actually tease out this demographic, especially when theyre not on drugs:
When Should My Cholesterol Levels Be Tested
Your GP may recommend that you have your blood cholesterol levels tested if you:
- have been diagnosed with coronary heart disease, stroke or mini stroke , or peripheral arterial disease
- have a family history of early cardiovascular disease
- have a close family member who has a cholesterol-related condition
- are overweight
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What Levels Are Normal And When Are They Too High
|
“Its normal for cholesterol levels to rise slightly as you get older and women tend to have higher HDL than men. In the UK, the average total cholesterol level is 5.7mmol/l.” – Dr Zenon Andreou |
“Its normal for cholesterol levels to rise slightly as you get older and women tend to have higher HDL than men. In the UK, the average total cholesterol level is 5.7mmol/l.”
There are two main types of lipoprotein:
- High-density good lipoprotein this type carries cholesterol away from the cells and back to the liver to be broken down or passed away as a waste product.
- Low-density bad lipoprotein takes cholesterol to the cells where its needed. If there is more LDL than needed, it can build up in the artery walls.
What Causes Elevated Ldl Particle Number
To read more about heart disease and cholesterol, check out this eBook on the DietHeart Myth.
In the last article in this series, I explained that LDL particle number is a much more accurate predictor of cardiovascular disease risk than either LDL or total cholesterol. In this article, Im going to briefly outline the five primary causes of elevated LDL-P.
Conventional medicine is primarily focused on suppressing symptoms. If your blood pressure is high, you take a medication to lower it. If your blood sugar is high, you take a medication to lower it. If your cholesterol is high, you take a medication to lower it. In most cases there is rarely any investigation into why these markers are high in the first place, with the possible exception of some basic counseling on diet and exercise.
On the other hand, Functional Medicinewhich is what I practicefocuses on treating the underlying cause of health problems instead of just suppressing symptoms. If your blood sugar, blood pressure or cholesterol are high, the first question a Functional Medicine practitioner will ask is why? If we can identify the root cause of the heart health problem, and address it at that level, medication is often unnecessary.
To use a simple analogy, if you have weeds in your garden, what happens if you just cut the weeds from the top? They grow right backand sometimes faster than before! If you really want to get rid of them once and for all, you have to pull them up by their roots.
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Diet And Lifestyle Changes
A doctor will look at your overall risk of cardiovascular disease and make recommendations to reduce high blood cholesterol as well as managing other risk factors such as high blood pressure, smoking and being overweight.
Reducing high blood cholesterol levels typically involves decreasing the total cholesterol level by decreasing LDL-cholesterol and triglycerides, while maintaining or increasing HDL-cholesterol levels.
- LDL-cholesterol levels are best decreased by eating less saturated fat
- Triglyceride levels are best reduced by eating less sugar-containing foods, limiting alcohol intake, and reducing the intake of total fat
- HDL-cholesterol levels are best increased by exercise, substituting saturated fats with polyunsaturated or monounsaturated fat , and maintaining a healthy weight.
Heart-healthy dietary changes are summarised in our Heart disease diet page.
Other lifestyle changes should include:
- Exercising regularly
- Maintaining a healthy body weight
- Limiting alcohol intake
Heart-healthy exercise suggestions are summarised in our Heart disease exercise page.
Study Tracking 103000+ Subjects: Ldl Not The Problem
In 2015, a monstrous study that tracked 103,646 50-75 year old subjects for 8 years was published.
When dividing only by LDL-C, with the low group 140 and the high group > 140, 13% of the low LDL individuals got ischemic heart disease, while 14% of high LDL got it.
Thats simply not significant. Are we sure this is the bogeyman weve made it out to be? What more is happening here?
Far more powerful: Triglycerides / HDL ratio
High LDL has nothing compared to higher triglycerides paired with lower HDL, a general marker for insulin resistance. Annotations courtesy Ivor Cummins.
In this study, HDL was once again more powerful. But even stronger than that, the best odds are if you have a Low Triglycerides to HDL ratio, which yielded 9.2%. Compare that to the higher trig/HDL group which had 18.5% disease incidence twice as many individuals. That is significant. LDL is not.
Whats so special about this ratio vs. LDL alone? We discuss that a bit more below, but the quick rundown is that a high Trig/HDL ratio represents insulin resistance, the true problem with our collective metabolic crisis.
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High Ldl Low Trigs And High Hdl Find A Single Study
Heres a simple fact:
There is not asingle study on non-drugged individuals showing that the combination of high LDL, low triglycerides, and high HDL ever leads to more heart disease.
Not a single one!
This is actually a public challenge made by Feldman , who is willing to pay $1000 to anyone who finds such a study. He posted that challenge quite a while ago, and a year in, nobody has found any such data.
Meet the Lean Mass Hyper-Responders
Dave has a term for individuals similar to myself, who have high LDL but also high HDL and low triglycerides when going low-carb: Lean Mass Hyper-Responders. Were a whole new phenotype of individual, and what were seeing is that the conventional rules dont apply to individuals like us when on the keto diet.
Looks like a fit bunch of folks to me
Most of these LMHR individuals exhibit the following traits:
While my LDL is actually slightly too low to fit Daves true LMHR definition, I fit every other scenario. Interesting, no?
Dave Feldman and Cholesterol Code on a Mission
Along with his team at Cholesterol Code, a scientist named Dave Feldman is flipping the lipid hypothesis on its head.
And given the fourth point above, LDL may just be protective, not harmful. Godspeed, Dave.
Normal Range Of Hba1c Found Among Men : 4
Ideal values of HbA1c depending on age :
| Age | |
|---|---|
| > 100 years | 5.598 |
If you want your blood test report to be interpreted by HbA1c specialist, then you can upload your report. Our HbA1c expert will provide you with the most accurate interpretation of your blood test results and treatment within 12 hours. Upload blood test report now
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Further Information And Support
For assessment and treatment of high cholesterol levels see a doctor. For ideas about how to lower high cholesterol levels a doctor or dietitian can assist.
Our Heart disease diet and Heart disease exercise pages provide practical ideas and ways to get started with healthier lifestyles in general, including cholesterol reduction.
What Should My Cholesterol Levels Be
Blood cholesterol is measured in units called millimoles per litre of blood, often shortened to mmol/L.
As a general guide, total cholesterol levels should be:
- 5mmol/L or less for healthy adults
- 4mmol/L or less for those at high risk
As a general guide, LDL levels should be:
- 3mmol/L or less for healthy adults
- 2mmol/L or less for those at high risk
An ideal level of HDL is above 1mmol/L. A lower level of HDL can increase your risk of heart disease.
Your ratio of total cholesterol to HDL may also be calculated. This is your total cholesterol level divided by your HDL level. Generally, this ratio should be below four, as a higher ratio increases your risk of heart disease.
Cholesterol is only one risk factor. The level at which specific treatment is required will depend on whether other risk factors, such as smoking and high blood pressure, are also present.
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My Ldl Cholesterol Is High But Im Not Worried Heres Why
Note: This is part one of a three-part series on cholesterol, heart disease risk, and the start of my personal journey towards health optimization via food and dietary strategy.
On March 8, 2019, I made a post on social media explaining that after a dietary change, I was feeling better than Id felt in 10 years, and at age 37, was ready to begin a public journey to find the most optimal diet.
Part of this journey is to show my blood work, so I took advantage of my annual free physical.
Attached are the results:
Testing For High Cholesterol
A simple blood test to assess cholesterol levels can be done by your family doctor or at a medical clinic. Your doctor will likely assess other risk factors for cardiovascular disease at the same time. A sample of blood is taken from a vein and is sent to a laboratory for testing. Cholesterol tests may be done using a finger prick of blood, however this is not as accurate as testing blood from a vein.
Blood cholesterol tests can be “fasting” or “non-fasting”. Fasting tests require the person not to have eaten for a period of time prior to the test being taken and give more accurate results than non-fasting tests.
New Zealand health guidelines for acceptable blood cholesterol levels are:
- LDL-cholesterol less than 2.0 mmol/L
- HDL-cholesterol greater than 1.0 mmol/L
- Triglycerides less than 1.7 mmol/L
- Total cholesterol less than 4.0 mmol/L
- Total cholesterol/HDL ratio less than 4.0.
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The Role Of Cholesterol
Medications used to lower cholesterol levelsâin particular, the class of drugs known as statinsâhave been shown to lower the risk of having a stroke and may reduce the severity of a stroke, if one occurs. By reducing levels of LDL, statins and other cholesterol-lowering drugs help prevent plaque formation, which prevents stroke and heart disease.
In fact, statins have even been shown to reduce stroke risk in patients with normal cholesterol levels.
Statins have several effects:
- Help stabilize existing plaque deposits.
- Help make plaques less fatty and more fibrous, making them more resistant to rupture.
- Reduce inflammation and help prevent clots from forming.
Large research studies have drawn clear ties between the use of statins and reduced stroke risk. One meta-analysis found that statin use reduces stroke risk by 21% and that every 10% reduction in LDL levels resulted in a 15.6% reduction in stroke risk.
Studies of specific statins have shown even more striking results. Several studies have found that while statins offer a general reduction in stroke risk, the greatest benefit is seen in those who have not had a prior stroke. Though statins confer benefits to those who have already had at least one stroke or mini-stroke, the impact is weaker.
What Are The Risks Of A High Ratio
The higher your cholesterol ratio is, the greater your risk of heart disease. A high ratio is usually due to too high LDL and/or VLDL cholesterol, or low HDL cholesterol. Both the body and heart can be affected when cholesterol levels are not at normal levels.
Too much LDL cholesterol in your blood can cause a type of heart disease called atherosclerosis. This is a condition in which the flow of blood to the heart muscle is slowed, and it can even stop blood from getting to the heart altogether, increasing your risk of a heart attack or stroke.
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What Causes High Hdl Cholesterol
There are a number of possible causes for high HDL cholesterol, and some of these can be reversed. If you have high HDL cholesterol, your doctor should consider whats causing it to decide on a course of action.
What you eat and drink
Eating a diet high in saturated fats and drinking too much alcohol can contribute to a higher level of HDL. If you and your doctor discuss making lifestyle changes, you will need to keep these going for an agreed time period, such as three months, before checking your HDL cholesterol levels again to see if the changes are working.
Medication
Some medicines could raise your HDL levels, including:
- the oral contraceptive pill
- oestrogen replacement therapy
- anti convulsants.
Your genes
Your doctor should ask you questions about your family to understand if your high HDL could be inherited.
If members of your family, including your parents, grandparents and siblings, have lived for a long time, this is reassuring. If you have a family history of heart disease or strokes, your doctor may want to refer you to a lipid specialist.
Japanese ancestry
Some people with Japanese ancestry have high HDL levels due to a lack of a protein called CETP. This is inherited in the genes.
Menopause
Research has suggested that the changes in hormones that happen during the menopause can affect the way HDL works in the body, and HDL loses some of its protective effects in some women.
Hypothyroidism
Infections and inflammation
Make Changes In The Kitchen
Use your diet to help lower your LDL cholesterol and raise your HDL cholesterol.
For the biggest impact, choose foods that are low in saturated fats and trans fats, and high in fiber, antioxidants, and omega-3 fatty acids. Whole grains, beans, apples, pears, oatmeal, salmon, walnuts, and olive oil are excellent heart-healthy choices.
Here are some more diet tips to help you lower your cholesterol:
Make meat lean. Cut back on red meats that are high in saturated fat and cholesterol, and choose only lean meats with very little visible fat. Examples of lean beef include London broil, eye of round, and filet mignon. Avoid processed meats like bacon and sausage, which are linked to higher odds of heart disease and diabetes.
Remove skin from poultry. That’s where much of the fat is.
Eat more seafood. It usually has less fat than other meat. The American Heart Association recommends eating two servings of fatty fish each week for heart health. Those fish are good sources of omega-3 fatty acids, which are good for you.
Limit saturated fat. These are found in whole-fat dairy products, mayonnaise, and hydrogenated or partially hydrogenated oils or fats . These products may also contain trans fats, which can raise your cholesterol level.
Add fiber with plant foods. Good sources include grapefruits, apples, beans and other legumes, barley, carrots, cabbage, and oatmeal.
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