image by: The Heart Truth

HWN Suggests

Straight from the heart

Researchers continue to dig deeper into the biology of ceramides, but they are also eyeing the lipids as potentially valuable biomarkers to gauge a patient’s heart disease risk. The traditional factors for assessing this risk include age, sex, whether the patient smokes or has diabetes, and lab measurements of lipids such as LDL cholesterol. However, these indicators don’t flag everyone who is in danger. In fact, about 15% of people who suffer heart attacks have no standard risk factors at all. Ceramides may fill the gap.

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  Lipids and Cardiovascular Disease: Putting It All Together

Since the early studies of Anichkov, the accumulation of cholesterol within the subendothelial space of the arterial wall and within lesions on the lumen-facing surface of arteries have been hallmarks of cholesterol and atherosclerotic cardiovascular disease (ASCVD).

 A cholesterol test you've never heard of is now recommended to prevent heart disease

New guidelines for managing cholesterol call for more aggressive prevention and earlier treatment, including a recommendation that all adults be tested once for lipoprotein(a), a genetic risk marker for heart disease.

 Blood Lipids and Cardiovascular Risk: Everything You Need to Know

My goal with this blog post is to bring clarity into this landscape not by just adding another voice, but by taking you by the hand and reviewing all of the different pieces of evidence, and all of the various claims on both sides of the argument. My goal is that by the end of the blog post, you will have much more clarity on the science of this important topic of how blood lipids are related to cardiovascular disease, how important lipids such as LDL-cholesterol are relative to other risk factors, which lab tests to have done, and how to interpret them.

 History in medicine: the story of cholesterol, lipids and cardiology

For almost a century, evidence has been overwhelming that lipids and diet are related and have a negative impact on CVD. It is also clear that lipids, and especially LDL, play a crucial role in atherosclerosis. However, groups of “non-believers” decelerated developments and clinical progress, sometimes for decades. Importantly, we should never forget that patients are individuals and LDL is not the holy grail. As early as 1959, diet, mental stress, obesity, a sedentary lifestyle and smoking were mentioned as risk factors besides lipids. Here as well, there are still “non-believers”. However, as Sir William Osler said: “The good physician treats the disease; the great physician treats the patient who has the disease”.

 Statin drugs are an Internet villain. Do they deserve it?

Cholesterol-lowering medicines are some of the most commonly prescribed, effective drugs. But to influencers on TikTok, they're the enemy.

 The truth about cholesterol: 12 things you need to know – from eggs to weight to statins

It doesn’t help when myths are flying about online, such as eggs being unhealthy because they contain cholesterol. Or when some fringe scientists and proponents of low-carb and high-fat diets dramatically downplay cholesterol’s significance in heart disease – arguing that sugar is a bigger risk to our health, despite all the evidence to the contrary. Nor does it help us laypeople that there are so many different ways to present – and therefore interpret – cholesterol levels.

 This lesser-known cholesterol can quadruple your heart-attack risk

Lp(a) is primarily influenced by genetics, where variations in the aptly named LPA gene influence levels. Quantities are set in early childhood and tend not to vary much after.

 What is lipoprotein(a) cholesterol, or Lp(a)? And can you lower yours?

Most people know about “good” and “bad” cholesterol. But few realise there is another type called lipoprotein(a). It can raise the risk of heart attacks and strokes, even in people who do everything right. This lesser-known cholesterol particle, often written as Lp(a), is gaining increasing attention from researchers and drug companies. Lp(a) isn’t included in routine cholesterol tests and there’s currently little we can do about it. That may now be changing.

Articles of Interest

The Blood Tests That Can Flag Your Hidden Heart Disease Risk

Two blood tests you probably haven’t heard of might predict your risk of heart disease better than standard tests do. The first measures a protein called apolipoprotein B, or apoB for short, that contributes to artery-blocking plaque. The other test, for lipoprotein(a), measures a type of bad cholesterol.

The little-known diet that can slash your risk of heart disease

A secret weapon that can lower cholesterol has been flying under the radar for more than 20 years. It’s called the portfolio diet—and it has been gaining followers, thanks to rising interest in plant-based eating and mounting evidence regarding its health benefits. Developed in the early 2000s by David Jenkins, a professor of nutritional sciences at the University of Toronto, and his colleagues, the portfolio diet emphasizes nuts and seeds, plant proteins, fruits and vegetables, and heart-healthy oils.

This little-known type of fat may actually protect your heart

A new mouse study suggests that "beige" fat surrounding blood vessels can send calming signals to the arteries—revealing an unexpected biological link between fat tissue and heart health.

A Systematic Review of Lipid-Focused Cardiovascular Disease Research: Trends and Opportunities

Lipids are important modifiers of protein function, particularly as parts of lipoproteins, which transport lipophilic substances and mediate cellular uptake of circulating lipids. As such, lipids are of particular interest as blood biological markers for cardiovascular disease (CVD) as well as for conditions linked to CVD such as atherosclerosis, diabetes mellitus, obesity and dietary states. Notably, lipid research is particularly well developed in the context of CVD because of the relevance and multiple causes and risk factors of CVD

ACC/American Heart Association Issue Updated Guideline for Managing Lipids, Cholesterol

Healthy lifestyle habits, earlier treatment to lower long-term exposure to plaque-causing lipids, new cholesterol target goals, selective use of coronary calcium scoring, lipoprotein(a) and apolipoprotein B testing, new treatments, and guidance for managing lipids in specific populations among key focus areas.

Assessing your risk of cardiovascular disease (Lipid Series – Part 2)

There is so much noise online about the tests that matter, the ones that don’t, and which biomarkers to look out for. In this episode, Dr Dayspring clearly outlines the three lipid tests that you should take to best assess your risk of atherosclerotic cardiovascular disease – and importantly, the ones you don’t need.

Confused About the New Cholesterol Guidelines? Here’s What to Know.

The guidelines also recommend that all adults now have levels of Lipoprotein(a), a genetically determined form of cholesterol, tested at least once. Lp(a) increases the risk of heart disease, regardless of your other lipid levels. “It’s an amplifier of whatever your risk is,” said Dr. Ann Marie Navar, an associate professor of cardiology at the U.T. Southwestern Medical Center in Dallas. We reach our adult levels in childhood, and they remain relatively stable over a lifetime, with a few exceptions. There’s another, less widely used test for a different lipoprotein called ApoB. This is perhaps the best measure of cholesterol related risk

Impact of Lipids on Cardiovascular Health...

This review describes the cumulative effect of lipid-carrying lipoproteins on the risk of cardiovascular disease, estimates the magnitude of the clinical benefit that can be achieved by maintaining optimal lipid levels, identifies the most effective timing for implementing strategies designed to achieve optimal lipid levels, and provides a clinical pathway to help people achieve the lipid levels necessary for ideal cardiovascular health.

Lipid Disorders and Cardiovascular Risk: A Comprehensive Analysis of Current Perspectives

The complex origins of CVDs involve a sophisticated interaction between genetic, environmental, and lifestyle variables. Among these factors, dyslipidemia plays a crucial role in the development of CVDs. The extensive impact of CVDs worldwide necessitates a thorough analysis to understand its immense scope fully.

Lipids and lipoproteins in cardiovascular diseases: a classification

Lipids and lipoproteins, their metabolism, and their transport are essential contributing factors of cardiovascular disease (CVD) as they regulate plasma cholesterol concentration, enhancing cholesterol uptake by macrophages, leading to foam cell formation and ultimately resulting in plaque formation and inflammation. However, lipids and lipoproteins have cardioprotective functions as well, such as preventing oxidation of proatherogenic molecules and downregulating inflammatory proteins.

Lipoproteins and lipids in cardiovascular disease: from mechanistic insights to therapeutic targeting

This review comprehensively discusses low- and high-density lipoprotein cholesterol, lipoprotein (a), triglycerides as well as fatty acids and derivatives in the context of cardiovascular disease, providing mechanistic insights into their role in pathological processes impacting on cardiovascular disease.

Omega-6 Fats Linked to Increased Risk of Heart Disease

But in the latest study on fats published in the BMJ, researchers found convincing evidence that not all plant fats are created equal and that linoleic acid, or omega-6 fatty acids, may be associated with a higher risk of early death from any cause, as well as increased risk of heart disease and death from heart-related conditions.

The Associations of Lipid Profiles With Cardiovascular Diseases and Death in a 10-Year Prospective Cohort Study

Lower or higher levels of TC, higher level of ApoAI, and lower level of ApoB were associated with increased risks of CVD, and lower level of TG was associated with increased all-cause death. Maintaining optimal lipid levels would help to prevent CVD and reduce mortality.

The big fat debate on cholesterol and statins

Patients can be confident that having their blood lipids reduced by drugs is a safe and efficacious way of reducing their risk of heart disease. Obesity should be avoided or dealt with – a complex topic in itself. There is no reason to take up specialised diets as they are unproven.

The Effect of Diet on Cardiovascular Disease and Lipid and Lipoprotein Levels

With regards to CVD there are very few well conducted randomized controlled trials and most of the information is derived from observational studies that demonstrate associations. These observational studies have found that fruits, vegetables, beans/legumes, nuts/seeds, whole grains, fish, yogurt, fiber, seafood omega-3 fatty acids, and polyunsaturated fats were associated with a decreased risk of CVD while unprocessed red meats, processed meats, sugar-sweetened beverages, high glycemic load CHO, and trans-fats were associated with an increased risk of CVD.

What causes cardiovascular disease (Lipid Series – Part 1)

We consider risk factors for atherosclerosis, discussing what goes wrong within the lipid transportation system that causes cholesterol to be deposited into the artery wall in a process called atherogenesis. We also address misconceptions about cardiovascular disease and the endothelium that are commonly perpetuated online, genetic influence, dietary cholesterol, and much, much more.

Resources

Lipid Insights

The National Lipid Association Lipid Insights podcast series brings you engaging discussions on the most relevant, timely, and groundbreaking topics in lipidology.