New research shows that a particular subclass of low-density lipoproteins (LDL) is a much better predictor of potential heart attacks than the mere presence of LDL.
LDL levels below 70 were tied to an increased risk of hemorrhagic stroke.
Several studies have shown that apoB may be a better predictor of cardiovascular disease risk than LDL-C.
Those with a family history of early heart disease not only need to get tested for the usual risk factors of high cholesterol, high blood pressure, diabetes and smoking but also must make sure they know if their Lp(a) is high and get their children tested as well.
No, this is not the new “must know” texting lingo; it’s the response I get from many of my patients who struggle with hyperlipidemia. Dealing with an abnormally high concentration of fats or lipids in the blood can be frightening and perplexing — just what do those numbers mean and why do they matter? Well, let’s start with the basics
Lipoproteins are important biochemical substances whose main purpose is to carry lipids from one tissue to another. VLDL is produced by liver cells and is an important carrier of triglycerides (TGs) and to a lesser extent cholesterol. Once in the circulation, VLDL is broken down in capillary beds by an enzyme called lipoprotein lipase, releasing lipids, mainly TGs, for energy utilization by cells or storage in adipose tissue.
LDL and VLDL are both "lipoprotein packages" in your blood. Both are considered "bad" types of cholesterol. They differ in what each package carries.
LDL cholesterol carries mostly cholesterol, some protein, and minimal triglycerides throughout your circulation. LDL should be less than 130 mg/dl, and ideally less than 100 mg/dl.
VLDL cholesterol contains minimal protein and mainly transports triglycerides. VLDL should be less than 40 mg/dL.
At the end of the study, the researchers found that the avocado diet led to significant reductions in LDL cholesterol, compared with the other two diets.
Conventional wisdom tells us LDL cholesterol is bad and HDL cholesterol is good. A huge improvement from the days of "all cholesterol is bad," but still a far cry from adequate. Chances are, your doctor has failed to mention that there are two types of LDL cholesterol particles, and only one is detrimental to our health.
For half a century, a high level of total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C) has been considered to be the major cause of atherosclerosis and cardiovascular disease (CVD), and statin treatment has been widely promoted for cardiovascular prevention. However, there is an increasing understanding that the mechanisms are more complicated and that statin treatment, in particular when used as primary prevention, is of doubtful benefit.
Having high LDL cholesterol places a person at a higher risk of developing heart disease if it is left untreated. But there are certain steps one can take to reduce or prevent high LDL levels. Of course, there are many cholesterol medications that can help lower LDL levels by varying degrees however, making therapeutic lifestyle changes can be a more active way of achieving and maintaining an improved LDL number.
Changing HDL and LDL levels does not always alter heart disease or stroke risk.
A person’s cholesterol levels before the age of 45 can predict their lifetime risk of developing cardiovascular disease. The finding has prompted debate about whether younger people should be recommended preventative measures, such as taking statins.
The result comes from an analysis of medical data on nearly 400,000 people of European ancestry from across Europe, Australia and North America. The study found that when blood concentrations of non-HDL cholesterol – often known as “bad cholesterol” – are higher than 145 milligrams per 100 millilitres before the age 45, a person’s relative risk of developing heart disease at some point in their life nearly doubles.
For concentrations between 100 and 145 milligrams before 45, the relative lifetime risk increases by 10 to 20 per cent.
Cardiovascular disease is more complicated than just one risk factor. The people in this study had established disease, and it may be that reducing LDL, even to very low levels, cannot turn back time. At least in this study, it did not.
Triglyceride and remnant cholesterol levels, but not LDL nor HDL cholesterol levels, were associated with major adverse cardiovascular events (MACE), according to an observational analysis of the PREDIMED primary prevention diet trial.
Attached to each LDL particle is a single molecule of a protein called apolipoprotein B100 (ApoB). And by determining how much ApoB is in the blood we can “count” exactly how many LDL particles are present.
Determining LDL in this way is better than measuring the cholesterol stored inside, because ApoB has been shown to be a superior predictor of cardiovascular disease than measuring both LDL cholesterol and non-HDL cholesterol.
This cholesterol may be somewhat under the radar, but in reality it's a just-as-bad cholesterol hiding in plain sight. Produced by the liver, VLDL is composed of various lipoproteins and fat, just like LDL and HDL. But Mayo Clinic experts note that what sets VLDL apart is the degree to which it's composed of a type of fat known as triglycerides.
Cholesterol is complicated. While just reading the word conjures images of people eating fast food or clutching their hearts, cholesterol isn't inherently bad. When your levels are under control, it's actually a necessary and helpful part of your internal chemistry. That's true even for so-called "bad" cholesterol, or the type associated with low-density lipoprotein (LDL) particles, says Michael Blazing, an associate professor of medicine at Duke. "LDL is nothing more than a truck that carries cholesterol around so that any cells that need it can get it," he says.