LDL the “bad” Cholesterol

Cardiovascular disease is the number one disease that kills Americans with an estimated 500,000 people who die annually. There are well known risk factors that include hypertension (high blood pressure), diabetes mellitus (sugar diabetes), cigarette smoking obesity and genetics. High cholesterol is a risk factor for heart disease that can be lowered in part by our lifestyle choices. Cholesterol is a term that includes a group of fats or lipoproteins. They have different names that you may recognize from your lab results sheet.  Triglycerides, HDL, total cholesterol and apolipoproteins are some examples that are found on the lab report from your doctor’s office..

The National Cholesterol Education Program (NCEP) has reported that the LDL or the bad cholesterol is the primary target for reduction. That means all things being equal reducing the LDL cholesterol to within an acceptable range is the number one focus of most physicians for cholesterol management.

What’s so bad about the “bad” cholesterol?? Let’s review the proposed mechanism of a heart attack. It is felt that a heart attack results after a cholesterol (fat) buildup on the inside wall of the blood vessels breaks off and travels along the blood vessel until it lodges or gets stuck and can’t move anymore. If the place where the piece of fat gets stuck is in the blood vessels that go to the heart, that’s a heart attack. Think about it, the fat is blocking the flow of blood, because it’s stuck. All the blood that is behind the blockage can’t really go anywhere.

It’s like a really bad car accident, all the traffic (blood in this case) builds up behind the scene of the accident. There you are sitting waiting for the accident to be cleared so that the traffic can pick up and you can continue on your way. In this scenario when you’re sitting in traffic, you’re the blood that can’t move. The accident is the fat that gets stuck and can’t move. The road you’re waiting on is the blood vessel.

What we know is that the LDL cholesterol is the cholesterol most likely to be the kind that builds up in your blood vessel. It’s therefore the most likely to break off and travel along the blood vessel and cause damage. That’s why doctors are so focused on trying to lower the LDL or “bad” cholesterol. The thinking is that if we lower the LDL we can reduce your chances of having a heart attack or a stroke. The higher your risk of heart disease, the lower your LDL should be. You need to discuss your specific risks with your doctor.

The most common risk factors associated with elevated LDL are  being overweight, physical inactivity, increased dietary consumption of saturated and trans fats, cigarette smoking, diabetes, hypertension, age (men >45 yrs, women >55 yrs) and a family history of heart disease. Most of the risk factors on the list can be affected by a change in lifestyle. Simply exercising 30 minutes a day or eating less saturated or trans fat can improve your risk of having a heart attack or a stroke.

Table 1        LDL Cholesterol Goals for Three Risk Levels

Risk Level LDL-C Goal

CHD and CHD Risk Equivalent                 <100 mg/dL

Multiple (2+) Risk Factors                         <130 mg/dL*

0–1 Risk Factor                                         <160 mg/dL

* LDL-C goal for multiple-risk-factor persons with 10-year risk >20 percent = <100 mg/dl

From the ATP III Final Report of the National Cholesterol Education Program

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