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Cholesterol: The Good and The Bad

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Cholesterol is a type of fat found in the body. It plays a key role in how the body functions, but can also be harmful if there is too much of it.

There are two types of cholesterol, the “bad” and the “good.”

Low-density lipoprotein (LDL) is the “bad” type of cholesterol. When a patient has high levels of LDL in their blood it often leads to atherosclerosis, which is when the LDL cholesterol builds up along the artery walls. Eventually, this build up becomes a layer of plaque, which hardens the arteries and makes it harder for blood to flow through them. This plaque can break off at times, which can then cause stroke or heart attack.

In contrast to LDL, there is a second form of cholesterol known as high-density lipoprotein (HDL). This is the “good” cholesterol. HDL is known to lower the body’s level of LDL through a process known as reverse cholesterol transport.

“HDL, when it is first formed, it is more like a disk that travels around the body and can pick up cholesterol (LDL),” explained Dr. Jorge Plutzky, director of the Vascular Disease Prevention Program and Preventive Cardiology at Brigham and Women’s Hospital. “It sort of fills up, transforming from a disk into a bigger sphere and then will move the cholesterol (LDL) back to the liver and deposit it there.”

The benefits of HDL are not fully understood yet. HDL could also have anti-inflammatory properties or may limit oxidation that can contribute to how dangerous different lipid proteins are, according to Dr. Plutzky.

Physician Focus Remains on LDL

While HDL is the “good” version of cholesterol, doctors remain focused on LDL. The key to health is to lower levels of LDL, not necessarily raising levels of HDL.

“We’ve now had a few drugs that were very oriented at raising HDL that failed,” explained Dr. Plutzky.

“There’s so much evidence around reducing LDL and bad cholesterol,” he explained. “Our major initial focus is to keep the conversation on LDL…because we know that can make a difference for people.”

He finds that, instead of focusing on raising HDL levels, doctors should be on the watch for low HDL, which can predict if a patient is at risk for higher triglyceride levels.

Once a patient’s LDL levels have been balanced, triglyceride levels are the next thing that physicians should focus on. Triglycerides are a type of fat found in the blood, similar to cholesterol, that are used to store energy in the body. Like cholesterol, they can also increase a patient’s risk of heart disease.

What Can Patients Do?

Many people across North America are struggling with high LDL levels. According to the Center for Disease Control and Prevention, in the US alone, 35 million people are at risk for heart disease because of their cholesterol levels.

So how do patients, especially those with a genetic history of high cholesterol, prevent this issue?

Eating healthy and exercising regularly is the key. Patients should avoid foods that are high in fat or salt, while eating more fruits and vegetables. 

Dr. Plutzky stressed the importance of starting this healthy lifestyle early, instead of waiting until a health issue develops. In the case of families with a genetic history, establishing healthy habits is a great way to set an example for children who might have cholesterol problems as they get older.

“Beginning to ingrain lifestyle habits, such as eating right and being active, is very important, in terms of offsetting future risks,” he advised. “We really encourage people to be active. It doesn’t necessarily have to be exercise; it can be anything. It could be dancing, or sports, or yoga, anything that has you moving. In terms of eating right, it’s really about trying to avoid processed foods and excess simple carbohydrates. You’d want a predominantly plant-based diet with a modest amount of protein. These are great habits to get into [early], opposed to turning 30, 40, or 50 and …trying to reset habits.”

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