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Which Cholesterol Subtype Is More Dangerous Hdl Or Ldl

Sdldl And Atherosclerotic Cvd Risk

How to Read a Cholesterol Test: LDL, HDL, Lp(a), Apo(e), sdLDL, TG/HDL, ApoA1/ApoB

The increased atherogenicity of sdLDL is linked to the specific biochemical and biophysical properties of these particles. The small size of the particles favours their penetration into the arterial wall where they serve as a source of cholesterol and lipid storage. Longer circulation time increases the probability of atherogenic modifications of sdLDL in the blood plasma. The specific role of sdLDL, the pathogenesis of atherosclerosis, and other diseases was the subject of numerous studies .

The association of sdLDL with peripheral artery disease has also been studied recently. Elevated sdLDL contents were registered in patients with worse early outcome after balloon angioplasty .

Elevated levels of sdLDL were reported in many conditions linked to atherosclerosis, such as dyslipidemia, diabetes, and metabolic syndrome , as well as in a number of other disorders . In MetS, the increased sdLDL levels had an independent predictive value for future cardiovascular events . Noteworthy, the sdLDL-C/LDL-C ratio correlated better with various parameters associated with MetS and was suggested to be a more useful clinical indicator than absolute sdLDL-C and LDL-C levels . Interestingly, sdLDL fraction was significantly increased in chronic kidney disease , and its measurement could be used for CVD risk assessment in patients with CKD .

Amgen Is Working On A Medicine To Silence The Lpa Gene

In collaboration with Arrowhead Pharmaceuticals, Amgen is exploring a new type of therapy called short interfering RNA to treat high Lp. This approach targets and disrupts the messenger RNA that is required to translate the LPA gene into particles of Lp. By silencing the gene, the goal is to achieve a large and durable reduction of Lp. An investigational therapy based on this new drug modality has entered Phase 2 clinical testing.

Any medicine designed to lower Lp levels will require large outcome studies to show that it can actually reduce the risk for heart attacks, strokes, and other serious events. According to one study based on genetic data, a large reduction in Lp may be needed to achieve a meaningful reduction in risk.

Effects Of Statins And Other Therapies On Sdldl

As the accumulating evidence points to the important role of sdLDL in the development of atherosclerosis and CVD, many studies focus on improving the lipid profile. The predominance of sdLDL is associated with the elevated TG and decreased HDL levels . Hence, the goals of the corrective therapy include lowering the proportion of sdLDL-C and/or raising the HDL-C content. Statins are widely used in clinical practice as lipid lowering agents for treatment of dyslipidemia in atherosclerosis and related disorders. Despite the large amount of information available to date, it is not yet clear whether statins are efficient for specific lowering of sdLDL-C. The results of clinical studies are sometimes contradictory in that regard . In some studies, statins failed to decrease the sdLDL proportion because larger LDL fractions were also decreased and the ratio of sdLDL-C versus lbLDL-C was unchanged . Therefore the outcome of the statin treatment should be evaluated by the absolute changes of sdLDL concentrations and not their relative content or size distributions. Lack of standardization in LDL fractionation methods and varying clinical characteristics hinder the objective comparison of the results of clinical studies. More intervention studies are necessary to draw the conclusion on the effect of statin therapy on sdLDL-C proportion and its relationship to CVD risk reduction .

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Who Needs To Get Checked

Everyone should get their cholesterol checked, starting at age 20 and then every 4 to 6 years after that if their risk remains low.

After age 40, your doctor may want to check your levels more often. Typically, people assigned male at birth who are ages 45 to 65, along with people assigned female at birth who are ages 55 to 65, should have their cholesterol checked every 1 to 2 years.

Everyones risk for high cholesterol goes up with age. This is because the older we get, the harder it becomes for our bodies to filter out cholesterol.

A family history of high cholesterol can also increase risk.

While its impossible to control aging and family history, there are some behaviors that increase the risk of developing high cholesterol that can be changed

Individuals living with obesity and type 2 diabetes are more at risk for an increase in bad cholesterol and a dip in good cholesterol.

Its important to work with your doctor, who can provide support and resources, to help you adhere to their recommendations on how to lower your risk. Recommendations may include losing excess weight and focusing on finding what works best for you in managing your diabetes.

Other behaviors that may put you at a higher risk include:

  • smoking, which can damage blood vessels and may lower good cholesterol
  • eating a diet high in saturated and trans fat, which includes foods like fatty meats and dairy-based desserts
  • not getting enough physical movement throughout the week
  • drinking an excess of alcohol

They Eat Foods Fortified With Plant Sterols

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Plant sterols and stanol esters reduce blood cholesterol levels by blocking cholesterol absorption in the digestive system. They are natural compounds found in plant cell membranes, so you’ll get them inside you by eating fruits and vegetables. Unfortunately, you don’t get nearly enough to impact cholesterol through eating fruits and vegetables, so food manufacturers have fortified certain foods like orange juice and butter-like spreads with them.6254a4d1642c605c54bf1cab17d50f1e

If you don’t want to take cholesterol-lowering prescription medicines like statins, consider trying a product with plant stanols like Benecol spread. An American Heart Association journal study found that supplementing the diet of participants with a plant stanol ester spread for six months reduced LDL cholesterol and, in particular, the ability of LDL droplets to accumulate on artery walls. For more information on other over-the-counter heart protection, read Best Supplements for High Cholesterol, According to Nutritionists.

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Should You Take A Statin Drug

Statin drugs, which serve to lower cholesterol levels in the body, have unfortunately become a holy grail of preventative cardiovascular care. According to a 2013 CDC report:

In 20072010, cardiovascular agents and cholesterol-lowering drugs were two of the most commonly used classes of prescription drugs among adults aged 1864 and 65 and over.

While statins are effective cholesterol-lowering and anti-inflammatory agents, they are also known to cause numerous negative side effects ranging from muscle pain and weakness, extreme fatigue, headache, nausea and related abdominal issues, to upper respiratory infections, sleep problems, memory and cognitive problems, and even sexual dysfunction. Besides lowering cholesterol so much that the body lacks what it needs to function well, statins also deplete the body of the important antioxidant and vitamin-like substance, coenzyme Q10, which is needed for energy production within every cell in the body, especially in heart cells. Lack of CoQ10 can result in severe heart and immune system dysfunction.

I do not recommend using statins for primary prevention, which should be based on a healthy lifestyle. Prescribing a statin to just anyone with high cholesterol is not a sound medical practice, in my opinion the risks associated with statin use simply outweigh the benefits for the majority of people.

For whom do I believe the benefits of statins outweigh the risks? High-risk patients with documented heart disease:

Cholesterol Chart For Adults

Your doctor may recommend a plan of treatment for high cholesterol that includes lifestyle modifications and potentially medication. This will vary based on factors like other medications you may be taking, your age, sex, and general health.

Here are some medications more commonly prescribed for high cholesterol:

  • Statins.Statins lower the LDL cholesterol levels by slowing the production of cholesterol by the liver.
  • Bile acid sequestrants.Bile acid sequestrants are substances used in digestion. These resins can reduce cholesterol levels in the blood by binding to bile acids and removing them, forcing the body to break down LDL cholesterol to create bile acids instead.
  • Cholesterol absorption inhibitors.Cholesterol absorption inhibitors can block the absorption of cholesterol from the diet, sometimes in conjunction with statins.
  • Bempedoic acid.Bempedoic acid helps to stop an enzyme in the liver, ATP citrate lyase, from making cholesterol. This drug is often combined with statins for increased benefit for those with familial hypercholesterolemia, an inherited condition that can cause early heart disease.
  • PCSK9 inhibitors. Also used frequently with familial hypercholesterolemia, PCSK9 inhibitors, which are injected drugs, help the liver absorb and remove more LDL cholesterol from the blood.

Medications can also be used to treat contributing factors to cholesterol like triglycerides. These may be used in addition to some of the medications above.

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Hdl Vs Ldl Cholesterol

There are two main types of cholesterol: high-density lipoprotein and low-density lipoprotein . Lipoproteins are made of fat and proteins. Cholesterol moves through your body while inside lipoproteins.

HDL is known as good cholesterol because it transports cholesterol to your liver to be released from your body. HDL helps rid your body of excess cholesterol so its less likely to end up in your arteries.

LDL is called bad cholesterol because it takes cholesterol to your arteries, where it can collect in your artery walls. Too much cholesterol in your arteries may lead to a buildup of plaque known as atherosclerosis. This can increase the risk of blood clots in your arteries.

If a blood clot breaks away and blocks an artery in your heart or brain, you may have a stroke or heart attack.

Plaque buildup may also reduce blood flow and oxygen to major organs. Oxygen deprivation to your organs or arteries may lead to kidney disease or peripheral arterial disease, in addition to a heart attack or stroke.

nearly 12 percent of people in the United States have high cholesterol. You may not even know it because high cholesterol doesnt cause noticeable symptoms.

The only way to find out if your cholesterol is high is through a blood test that measures cholesterol in milligrams per deciliter of blood . When you get your cholesterol numbers checked, youll receive results for:

  • overeating fatty foods
  • increased smoking

Alternative Sinatra Solutions To Support Healthy Cholesterol Levels

Understanding Cholesterol Levels | LDL (Bad) vs HDL (Good) Cholesterol

If you have very high cholesterol or want to prevent it, be sure to:

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Lp Levels Of 50 Mg/dl Or Higher Carry Added Risks

Data shown are from the Copenhagen City Heart Study with up to 16 years of follow-up . Data adjusted for age, sex, total cholesterol contribution), lipid-lowering therapy, triglycerides, and other cardiovascular risk factors. Percentage calculations based on adjusted hazard ratios for Lp levels of 5-29 mg/dL , 130 76 mg/dL , 77-117 mg/dL , and > 117 mg/dL . Nanomole per liter conversion of original data is approximate. Source: Kamstrup PR, et al. JAMA. 2009 301:2331-2339. CI is 95% confidence interval.

Most people have Lp levels in the range of under 5 to 29 milligrams per deciliter , which roughly equals under 13 to 73 nanomoles per liter . There is evidence that the risk of heart disease may start to rise at 30 mg/dl , and it rises more steeply at levels of 50 mg/dL and higher. An estimated one in seven people are at or above this threshold. There are racial and ethnic variations in Lp levels, with Black individuals more likely to have elevated Lp than Whites, Hispanic, or Asian individuals. More research and improved testing methods are needed to better understand the influence of race and ethnicity on Lp, quantify the risks of elevated Lp in different types of patients, and determine which types of patients would benefit most from Lp-lowering therapies.

Lp Is An Independent Risk Factor

Previously, many cardiologists believed Lp was only a risk in patients with other risk factors, such as high LDL. Now we know that Lp is an independent risk factor that has been linked to heart disease in younger adults and otherwise healthy people with no other known cardiovascular risks. Tennis legend Arthur Ashe, who had his first heart attack at 36, was reported to have high Lp, as was Bob Harper, a celebrity fitness trainer who nearly died of a massive heart attack at age 52. Sandra Tremulis, founder of the Lipoprotein Foundation, was diagnosed with a 95% blockage in one of her coronary arteries at age 39.

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Inflammation The Real Risk Factor Emerges

Keeping cholesterol levels down is not the key to heart disease prevention: keeping inflammation at bay is. A healing mechanism, inflammation is actually a natural and necessary response that the body initiates after injury. The inflammatory process begins in response to common assaults like free radical stress, environmental toxins, food allergies, sugar, and other catalysts. The greater the assault of inflammatory stimuli, the more inflammation generated in the body. When inflammation becomes a silent, chronic condition, the pendulum moves from healing to destruction.

Find more general information about inflammation and disease on this page.

Lp Is An Important But Underappreciated Risk Factor For Heart Disease

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While most people know that low-density lipoprotein -C, or bad cholesterol, can cause heart disease, relatively few people know about the risk posed by lipoprotein, or Lp. Also referred to as LP little a, this type of lipoprotein is comprised of an LDL-like particle with a second protein, called apolipoprotein, or apo, coiled around it. Recent studies indicate that people born with elevated LP may have a two-fold to four-fold increased risk of heart attacks and other serious events compared to people with low Lp levels.

Despite this risk, awareness of Lp is still very low among physicians, especially doctors who dont specialize in heart disease. But even cardiologists may overlook Lp, in part because Lp is not as well-understood as other risk factors and treatment options are still very limited .

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People With Low Ldl May Have High Lp

Since the structure of Lp includes a particle of LDL cholesterol, your Lp level contributes to the level of LDL-C that is measured by blood tests. The cholesterol portion of Lp is referred to as Lp-C. On average, every 10 mg/dL of Lp in the blood increases levels of LDL-C by 3 to 4 mg/dl. If your Lp level is low, its impact on total LDL-C is minimal. But in patients with high or very high Lp, their LP-C can account for much or most of their LDL-C test results.

For example, two people with relatively low LDL-C levels of 70 mg/dL could have very different heart disease risks. One person could have an Lp level of 10 mg/dL, meaning that only about 3 percent of their LDL-C is derived from Lp-C. The other person could have an Lp level of 150 mg/dL, meaning that more than two-thirds of their measured LDL-C is actually Lp-C. Thats why testing for Lp is so important, especially in people who have recurrent heart disease despite LDL-lowering therapy.

Should You Seek Advanced Cholesterol Testing

Special tests measure different types of fat particles in the blood. But whether the results can improve your health remains uncertain.

Earlier this year, a leading women’s magazine featured an article about heart health in your 50s and beyond that included this advice: “During your annual physical, consider asking for a specialized vertical auto profile test, a detailed lipid profile that helps identify plaque buildup in your arteries.” .

The VAP is one example of so-called advanced lipoprotein testing, which is a more detailed version of the usual cholesterol test, which doctors call a standard lipid panel or profile. The company that makes the VAP test claims that it improves doctors’ ability to predict and treat heart disease. The test costs about the same as a standard lipid profile and is reimbursed by most insurance carriers. But for most people, there’s little evidence that information from these tests would alter your doctor’s advice.

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The Real Numbers You Need To Know

Knowing your LDL and HDL count is marginally useful in determining whether youre at risk for a cardiovascular event. You and your doctor are really in the dark unless you know how much of your LDL is of subtype A and/or B. People with more B-type particles are said to have a pattern-B distribution, while those with more A-type particles are said to have a pattern-A distribution.

A total cholesterol number doesnt mean much unless it is greater than 320, at which point a person may have an increased risk of thrombotic stroke . If your total cholesterol is this high, you can bring it down by losing weight, eating more fiber and making other positive lifestyle modifications . If your combined HDL and LDL numbers are below 320, ask your doctor to order you a VAP test and figure out what kind of particles you have.

Additionally, keep in mind that a calculation of your HDL to triglyceride ratio is a far better indicator of risk. Back in 1997, a Harvard study showed that, compared to people with the lowest triglyceride/HDL ratios, those with the highest had sixteen times the risk of developing heart disease! To get your triglyceride to HDL ratio, simply divide your triglyceride number by your total HDL number. For example:

  • If your triglycerides are 150 and your HDL is 50, your ratio is 3
  • If your triglycerides are 100 and your HDL is 50, your ratio is 2

If your ratio is 2, youre probably just fine, no matter what your cholesterol numbers are. A ratio of 5 is problematic.

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