Blood Lipid Levels: Impact on Cardiovascular Disease
By Nick Gold
Impact of Lipids on Cardiovascular Health
Maintaining a safe level of blood lipids help to lower the risk of developing a dangerous cardiovascular disease at some point during adulthood.
Cardiovascular diseases tend to kill millions of people worldwide and they are preventable if individuals maintain optimal health throughout their lives. A cardiovascular disease implies that something is wrong with the heart or the blood vessels.
Some good examples of cardiovascular diseases include coronary artery disease, myocardial infarction, angina, hypertension, and atherosclerosis.
This article summarizes the impact of blood lipids on cardiovascular health and what you can do to lower the risk of developing cardiovascular disease at some point in the future.
The concept of ideal cardiovascular health
The American Heart Association (AHA) has defined the ideal cardiovascular health using 7 parameters which can be monitored independently. AHA has also created a specific list of behaviors and habits people can put into practice to have a healthier lifestyle and lower their risk of developing cardiovascular diseases.
For example, having the untreated total cholesterol level below 200 mg/dL, having a blood pressure of less than 120/80 mm Hg and a glucose concentration of less than 100 mg/dL can help you prevent most heart-related problems. Unfortunately, less than 5% of people take these parameters into account and maintain optimal health throughout adulthood.
The goal of AHA is to help physicians educate their patients and assist them in making better decisions when it comes to influencing the lipids in their blood. This involves making lifestyle changes such as engaging in regular exercise, reducing the intake of saturated fats and avoiding smoking.
Blood lipids and atherosclerosis
It has been discovered that low-density lipoproteins (LDL cholesterol, aka bad cholesterol) play a vital role in the development and progression of atherosclerosis.
Atherosclerosis is one of the most dangerous cardiovascular diseases out there. It is characterized by a narrowing of the blood vessels as a result of plaque buildup. Plaque is a waxy substance which develops inside blood vessels and arteries. This substance makes the blood vessels narrower and the speed of circulating blood will increase.
Atherosclerosis develops over a period of decades and it progresses as a result of an unhealthy lifestyle. When too much plaque builds up in certain vessels, this can cause a rupture which might lead to stroke or a heart attack.
How does atherosclerosis develop?
Studies show that nearly 90% of all the LDL particles travel around the body through plasma. Some of these LDL particles get trapped in the walls of veins and arteries and they start to create a buildup.
It has been discovered that the progression of atherosclerosis is directly related to the absolute plasma LDL levels in the body. As LDL particles circulate through veins and arteries, more of them become trapped by the plaque buildup and cause lager blockages.
The atherosclerotic plaque burden can be determined by 2 factors - the amount of exposure to LDL particles and the concentration of low-density lipoproteins and other particles similar to them. It is possible to quantify this burden by multiplying a person’s age by the LDL concentration in the bloodstream. Of course, this gives only an estimate as only complex laboratory investigations can offer a more accurate reading of blood lipids.
When the individual is young, the risk of a major cardiovascular event is small as plaque buildup is still in its infancy. However, poor lifestyle choices combined with advanced age can lead to a major deposit of plaque on blood veins and arteries. This can lead to something called thrombus which can block a blood vessel entirely.
When this happens, several health conditions can appear such as unstable angina, myocardial infarction (heart attack) or even death.
To better understand this concept, let’s look at a real-life example. The incidence of myocardial infarction among people who are 40 years old is about 1% in the United States. That means that one in 100 people might have a heart attack when they reach 40.
If we consider that the mean level of LDL-C (which is a form of cholesterol) for these people is 125 mg/dL then this means that the total plaque burden can amount to 40 years x 125 mg/dL = 5,000 mg-years. This is the point when atherosclerotic plaque buildup can significantly increase the risk of developing myocardial infarction or heart attack.
How to Prevent Atherosclerosis
Keeping blood lipids at normal level throughout life is one of the best ways to prevent cardiovascular diseases. This means that fewer LDL particles are trapped in the walls of veins and arteries and the exposure to bad cholesterol is limited.
Preventing atherosclerosis lead experts to suggest 2 types of approach - primordial prevention and primary prevention. Primordial prevention focuses on minimizing blood lipid levels throughout childhood and adolescence when most of the mean cholesterol levels are inherited from parents.
Primary prevention focuses on lifestyle and diet changes, which can reduce the number of lipids in the bloodstream and prevent plaque buildup. Specialists suggest that an optimal level of blood lipids would be 80 mg/dl for LDL - C and less than 200 mg/dl for total plasma cholesterol levels.
Achieving these levels and maintaining them throughout adulthood can significantly lower the risk of developing myocardial infarction, even for people who are well over their 40s. It's also important to note that some people can retain more LDL particles than others, so there are no "one-size fits all" when it comes to plaque buildup and preventing it.
The importance of timing when it comes to lowering cholesterol levels
As mentioned earlier, atherosclerosis tends to develop over time and it is strongly influenced by a poor diet and a sedentary lifestyle.
Young adults in their twenties might not experience plaque buildup or any symptoms associated with it, but this doesn’t mean that atherosclerosis might not affect them. That’s why any strategy to lower cholesterol levels should be implemented as early as possible and not wait until plaque has already developed a substantial thickness in arteries and veins.
In other words, it’s easier to reduce the LDL-C levels from 120 to 80 mg/dl when a person is in his 20s and prevent major cardiovascular events such as stroke or heart attacks in comparison with a person who is 50 years old. Remember that the total plaque burden is cumulative, so the senior might have a great amount of plaque developed in his circulatory system, which needs to be approached carefully.
Plaque building in veins and arteries is not something that can be stopped altogether. It slowly develops starting from childhood and invasive procedures can detect signs of atherosclerosis beginning in early adulthood. However, it might take decades until plaque develops at a massive rate and starts causing problems.
With that being said, something can be done to slow down the process of developing plaque. For example, engaging in physical exercises regularly, quitting smoking and eating lots of vegetables can significantly reduce the risk of developing cardiovascular diseases.
Some people naturally have low cholesterol levels
There are numerous genetic variants which indicate that some people are less predisposed to developing plaque than others.
This is similar to being involved in cholesterol-reducing therapy throughout the entire life. These individuals have a slower rate of progression when it comes to plaque buildup, and they are less predisposed to cardiovascular diseases.
However, this doesn’t mean that people with naturally low cholesterol levels shouldn’t worry about plaque buildup at all. They should also engage in preventative measures to slow down the progression of atherosclerosis, even if they already have a lower risk in comparison with other people.
How physicians can help when it comes to lowering cholesterol levels
It is commonly accepted that exercise can lower the levels of LDL-C and decreasing the risk of developing cardiovascular disease. This is true, but specialists discovered that diet could have a larger impact when it comes to cholesterol levels.
For example, reducing the intake of saturated fats has been linked with lower levels of LDL-C in the plasma. As a result, a smaller concentration of LDL particles limits the development and progression of atherosclerosis. If this is maintained for decades, the individual in question might never experience a heart attack or a stroke.
However, studies show that replacing saturated fats with carbohydrates can lower LDL-C levels in the plasma but increase triglyceride levels. Having high triglyceride levels is a risk factor for heart problems, so it’s not a viable option.
Further studies offer a better approach - replacing saturated fats with unsaturated fats and protein. This doesn't only lower the LDL-C levels, but also keeps the triglyceride levels at a minimum and prevents a whole suite of cardiovascular problems.
On top of that, researchers have found out that a diet rich in fibers can also help in reducing LDL-C levels and lowering the risk for heart disease. People should consume nuts, plant-based protein, plant phytosterols, and polyunsaturated fats to achieve these benefits.
By following such a healthy diet for years, patients can help to reduce the plaque buildup acquired in childhood or adolescence and enjoy a healthier and longer life. For some people who are not able to maintain optimal blood lipid levels through diet alone, doctors also recommend taking statin drugs.
Small doses of 10mg or 20mg of atorvastatin or ezetimibe can help certain individuals achieve ideal levels of LDL-C in their blood and prevent major cardiovascular events such as myocardial infarction or strokes.
Assessing blood lipids throughout life is vital for achieving ideal health
Measuring blood lipids regularly is paramount for people of all ages, even children.
Experts recommend taking a blood lipid test once every 3 years to assess the levels of triglycerides, LDL-C and other lipoproteins in the body. Parents might also want to test the lipids levels at birth, when the child is 2 years old, 10 years old, 14 years old and finally, when he reaches 18 years of age.
This helps to monitor the inherited plaque burden and see if the adolescent has high cholesterol levels. Based on these results, physicians can recommend lifestyle changes and dietary adjustments to reduce the levels of LDL-C in the blood. These preventative measures help the individual avoid major cardiovascular events when he is 40 years old or older.
If the young patient is constantly assessed and his/her blood lipids are optimal, the doctor might recommend continuing with the prescribed diet. The patient should return for a blood test once every 3 years to see if the lipids are below the optimal threshold.
In some cases when the blood lipids level increased, the doctor might recommend lipid-lowering therapy. Noninvasive imaging might be used in high-risk individuals to determine the amount of plaque buildup in the blood veins and arteries.
If plaque is discovered, the patient can be reassessed to determine if he or she is a good candidate for lipid-lowering therapy. In most cases, patients with high-risk factors such as a family history of cardiac events will benefit from this type of therapy to slow down the rapid progression of atherosclerosis.
If plaque is not discovered in the bloodstream, then the patient doesn’t need lipid-lowering therapy.
The role of educational institutions in achieving optimal blood lipid levels
It is true that healthcare resources are finite and people should do their best to take care of their health and avoid being a burden on the healthcare industry. Irresponsible behavior, which involves eating a lot of junk food, smoking cigarettes and drinking excessive amounts of alcohol, can put a serious strain on healthcare providers.
One way to alleviate this problem and achieve optimal blood lipid levels is by educating people about cardiovascular diseases from an early age.
This can be done if educational institutions such as schools and colleges put an emphasis on blood lipid levels and how to prevent atherosclerosis. Lessons should be taught on how to reduce LDL-C levels, how to engage in regular exercise and what foods are healthier for the heart and circulatory system.
On top of that, numerous people, especially teenagers, smoke cigarettes regularly. This bad habit can significantly contribute to the levels of lipids in the blood, not to mention that cigarettes can cause a host of cancers. Schools, high-schools and colleges should make a priority to help adolescents quit smoking and remain cigarette-free for the rest of their lives.
By adopting such preventative measures, not only that a large portion of the US population will be healthier, but healthcare costs will also be reduced. The saved money can be redirected to finding cures for cancers or developing new drugs and medicines for diseases that have recently appeared.
The educational system might also need to emphasize proper nutrition and offering healthy meals to children and adolescents in primary schools and high schools. Junk foods such as pizza and burgers should be replaced with healthier varieties such as salads, lean protein and nutritious snacks, which include Greek yogurt and nuts.
Putting an accent on healthier meals help in reducing the amount of plaque buildup throughout the early stages of life. As a result, these young adults are less predisposed to develop cardiovascular diseases later on in life. Furthermore, they will become health-conscious parents who will also educate their children on how to become better and healthier individuals!
This article has established that LDL particles are directly responsible for developing atherosclerosis, which can lead to major cardiovascular events. The LDL concentration in the blood combined with the exposure to such particles create the overall risk of heart disease and it can be quantified using both invasive and noninvasive medical procedures.
A healthy diet low in saturated fats and rich in fibers and protein can help to reduce the LDL-C levels in the bloodstream. Couple this healthy diet with a regular exercise regimen and individuals can significantly reduce the atherosclerosis progression throughout their lifetimes.