What are normal cholesterol levels. How does cholesterol travel in the blood. Why is LDL considered the bad cholesterol. Who is most at risk for having high cholesterol. Are there medicines that can help control high cholesterol.

Decoding Cholesterol: The Good, The Bad, and The Essential

Cholesterol, a substance produced by the liver and released into the bloodstream, plays a crucial role in various bodily functions. Despite its negative reputation, cholesterol is essential for survival, contributing to skin maintenance and hormone development. However, when levels become elevated, it can pose significant health risks.

Dr. Anil Purohit, a non-invasive cardiologist at HCA Healthcare’s Grand Strand Medical Center, provides valuable insights into this common condition. He emphasizes that the number of people affected by high cholesterol is likely underestimated, with approximately 100 to 102 million Americans diagnosed. Alarmingly, about 40% of the population remains underdiagnosed and undertreated.

The Journey of Cholesterol in Your Body

Cholesterol travels through the bloodstream in lipid-enveloped particles called lipoproteins. These lipoproteins come in two main types:

• Low-density lipoproteins (LDL)
• High-density lipoproteins (HDL)

These lipoproteins transport cholesterol to various organs and body areas where it’s needed for essential functions.

Cholesterol Levels: What’s Normal and What’s Not?

Understanding cholesterol levels is crucial for maintaining good health. Dr. Purohit provides a breakdown of what’s considered normal, borderline, and high:

Total Cholesterol

• Good: Less than 170 mg/dL
• Borderline: 170-199 mg/dL
• High: 200 mg/dL or higher

HDL (High-Density Lipoprotein) Cholesterol

• Good: 45 mg/dL or higher
• Borderline: 40-45 mg/dL
• Low: Less than 40 mg/dL

LDL (Low-Density Lipoprotein) Cholesterol

• Optimal: Less than 110 mg/dL (may be lower for those with heart disease risk factors)
• Borderline: 110-129 mg/dL
• High: 130 mg/dL or higher

It’s important to note that these guidelines have evolved over time. Currently, cholesterol goals are often tailored based on individual risk factors such as obesity, diabetes, high blood pressure, and age.

The Villain of the Cholesterol Story: LDL

LDL cholesterol, often referred to as “bad” cholesterol, has earned its negative reputation for good reason. According to the Centers for Disease Control and Prevention, an estimated 73 million American adults have high levels of LDL cholesterol.

LDL cholesterol is problematic because it tends to deposit cholesterol in the lining of arteries. This buildup initiates a process called atherosclerosis, where plaque forms on artery walls. When this occurs in the heart’s blood vessels, it’s known as coronary artery disease.

Does High Cholesterol Always Lead to Heart Disease?

While high cholesterol significantly increases the risk of heart disease, it doesn’t guarantee its development. However, it’s crucial to manage cholesterol levels to minimize this risk.

Risk Factors for High Cholesterol: More Than Just Diet

Understanding the risk factors for high cholesterol can help individuals take proactive steps towards prevention and management. While diet plays a role, it’s not the only factor to consider.

Genetic Predisposition

According to Dr. Purohit, genetics is the most significant determinant of cholesterol levels. Some individuals may have a genetic predisposition to produce more cholesterol or process it less efficiently.

Lifestyle Factors

Several lifestyle choices can contribute to elevated cholesterol levels:

• Sedentary lifestyle: Lack of regular physical activity can lower HDL (good) cholesterol levels.
• Poor dietary choices: Consuming foods high in saturated and trans fats can increase LDL cholesterol.
• Tobacco use: Smoking can lower HDL cholesterol and increase LDL cholesterol.

Medical Conditions

Certain health conditions can impact cholesterol levels:

• Diabetes: This condition can affect fat distribution and increase LDL cholesterol.
• Obesity: Excess weight can lower HDL cholesterol and raise LDL cholesterol.
• Hypothyroidism: An underactive thyroid can lead to increased LDL cholesterol.

Managing High Cholesterol: Medications and Their Effectiveness

For individuals diagnosed with high cholesterol, medication can be an effective management tool. Statins are the most commonly prescribed class of drugs for lowering cholesterol levels.

Types of Statins

Dr. Purohit explains that statin prescriptions are typically based on individual patient profiles. Some common options include:

• High-intensity statins (e.g., Crestor, Lipitor): Can reduce LDL cholesterol by up to 50% at the highest tolerable dose.
• Moderate-intensity statins: Can lower LDL cholesterol by 30-35%.
• Low-intensity statins: Can decrease LDL cholesterol by about 20%.

Timeframe for Effectiveness

The time it takes for cholesterol-lowering medications to show results can vary. Generally, patients may see improvements in their cholesterol levels within a few weeks to a few months after starting treatment. However, the full effect of statins is typically observed after about 4-6 weeks of consistent use.

Lifestyle Modifications: A Holistic Approach to Cholesterol Management

While medications can be effective in managing high cholesterol, lifestyle modifications play a crucial role in overall cardiovascular health. Implementing these changes can complement medical treatment and, in some cases, may be sufficient to manage mild cases of high cholesterol.

Dietary Changes

A heart-healthy diet can significantly impact cholesterol levels. Consider the following dietary modifications:

• Increase fiber intake: Soluble fiber can help lower LDL cholesterol. Good sources include oats, beans, lentils, and fruits.
• Choose healthy fats: Replace saturated and trans fats with unsaturated fats found in olive oil, avocados, and nuts.
• Limit dietary cholesterol: While dietary cholesterol has less impact than previously thought, it’s still advisable to limit intake of high-cholesterol foods.
• Incorporate plant sterols: These compounds, found naturally in plants or added to certain foods, can help block cholesterol absorption.

Regular Physical Activity

Exercise can help improve cholesterol levels by:

• Increasing HDL cholesterol
• Reducing LDL cholesterol
• Promoting weight loss, which can further improve lipid profiles

Aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week.

Weight Management

Maintaining a healthy weight can have a positive impact on cholesterol levels. Even a modest weight loss of 5-10% can lead to significant improvements in lipid profiles.

Regular Monitoring: The Key to Effective Cholesterol Management

Regular cholesterol screenings are essential for monitoring the effectiveness of treatment and making necessary adjustments. The frequency of these screenings may vary based on individual risk factors and treatment plans.

Recommended Screening Intervals

• For adults with no risk factors: Every 4-6 years
• For adults with risk factors or on cholesterol-lowering medication: More frequent testing as advised by healthcare provider
• For children and adolescents: At least once between ages 9-11 and again between ages 17-21

Understanding Your Test Results

When reviewing cholesterol test results, it’s important to consider all components of the lipid profile, including:

• Total cholesterol
• LDL cholesterol
• HDL cholesterol
• Triglycerides

Your healthcare provider can help interpret these results in the context of your overall health and risk factors.

The Future of Cholesterol Management: Emerging Treatments and Research

While statins remain the gold standard for cholesterol management, ongoing research is exploring new treatment options and approaches. Some promising areas include:

PCSK9 Inhibitors

These injectable medications can dramatically lower LDL cholesterol levels, particularly in patients who don’t respond well to statins or have genetic forms of high cholesterol.

Bempedoic Acid

This oral medication works in the liver to block cholesterol production. It may be particularly useful for patients who can’t tolerate statins due to side effects.

Gene Therapy

Researchers are exploring ways to modify genes involved in cholesterol metabolism, potentially offering long-term solutions for managing cholesterol levels.

Personalized Medicine

Advancements in genetic testing and biomarker analysis may allow for more tailored treatment approaches based on individual patient characteristics.

As research progresses, it’s likely that cholesterol management strategies will become increasingly sophisticated and personalized, offering hope for improved outcomes in cardiovascular health.

Cholesterol and Overall Cardiovascular Health: A Broader Perspective

While managing cholesterol levels is crucial, it’s important to view it as part of a broader approach to cardiovascular health. Other factors that contribute to heart disease risk include:

• High blood pressure
• Smoking
• Diabetes
• Family history of heart disease
• Age and gender

A comprehensive approach to heart health should address all these factors in addition to cholesterol management.

The Role of Inflammation

Recent research has highlighted the role of inflammation in cardiovascular disease. While the relationship between cholesterol and inflammation is complex, managing inflammation through lifestyle changes and, in some cases, medication may be an important component of heart disease prevention.

Integrating Cholesterol Management into Overall Wellness

Effective cholesterol management isn’t just about numbers; it’s about adopting a heart-healthy lifestyle that promotes overall wellbeing. This might include:

• Stress management techniques
• Adequate sleep
• Social connections and support
• Mental health care

By taking a holistic approach to health, individuals can not only manage their cholesterol levels but also improve their quality of life and reduce their risk of various chronic diseases.

Empowering Patients: The Importance of Education and Engagement

Knowledge is power when it comes to managing cholesterol and overall heart health. Patient education and engagement are crucial components of successful cholesterol management.

Understanding Your Numbers

Encourage patients to familiarize themselves with their cholesterol numbers and what they mean. This knowledge can motivate them to take an active role in their health management.

Shared Decision Making

Involve patients in treatment decisions. Discuss the pros and cons of different management strategies, including lifestyle changes and medications, to develop a plan that aligns with the patient’s values and preferences.

Leveraging Technology

Various apps and digital tools can help patients track their cholesterol levels, medication adherence, and lifestyle habits. These tools can provide valuable insights and motivation for ongoing management.

Support Groups and Resources

Connect patients with support groups or educational resources related to cholesterol management and heart health. Peer support can be invaluable in maintaining long-term lifestyle changes.

By empowering patients with knowledge and tools, healthcare providers can foster a collaborative approach to cholesterol management, leading to better outcomes and improved overall health.

Cholesterol numbers are in! Here’s what you should know.

U.S. President Donald Trump recently underwent his first physical exam since taking office and was declared in excellent overall health by the White House physician. Despite a clean bill of health, it also was noted that the President has a history of elevated cholesterol numbers, prompting HCA Healthcare Today to dig further into the common condition.

Anil Purohit, MD, a non-invasive cardiologist at HCA Healthcare’s Grand Strand Medical Center, sheds some light on what it means to have elevated cholesterol levels and the number of Americans affected.

“Many feel that the number of people affected by high cholesterol is underestimated. It’s anywhere between 100 to 102 million Americans who are diagnosed with this condition,” said Dr. Purohit, who focuses on preventative cardiology at Grand Strand Heart and Vascular Care. “Unfortunately about 40 percent of the population are underdiagnosed and undertreated with prescribed medications. ”

We asked Dr. Purohit a few more questions about cholesterol – the “good” and “bad” – and advice on ways to help reduce high levels below.

What is cholesterol?

It is a substance produced by the liver and released into the bloodstream. It is not all bad; it’s actually used for a wide variety of bodily functions. It’s responsible for maintaining the skin and developing hormones, for instance, so you need cholesterol in order to survive and for your body to keep building.

How does cholesterol travel in the blood?

It’s stored inside an envelope of lipids (fat) and is transported in particles called lipoproteins – low- density lipoproteins (LDL) and high-density lipoproteins (HDL). So, the cholesterol is transported through the blood to different organs and areas of the body that we need to build like skin and hormones.

What are normal cholesterol levels?

We say that a total cholesterol less than 170 is good. Anything between 170 and 199 is considered borderline and anything more than 200 is considered high. The total cholesterol is the HDL, LDL and a fraction of your triglycerides – another type of fat found in your blood.

Separately, a good HDL level should be as high as it can be – about 45 or greater; a low level would be anywhere less than 40 and borderline is between 40 and 45.

The LDL, which is considered the “bad” cholesterol, should be less than 110, however, that number varies depending on risk factors. If you have risk factors for heart disease, typically, we want to have that number less than 70.

Borderline LDL levels range between 110 and 129 and anything greater than 130 is considered high.

Those are the tried and true guidelines that we have been using. The guidelines have shifted over the years. Now, we target our cholesterol goals based on a patient’s risk factors: obesity, diabetes, high blood pressure, and age.

Why is LDL considered the “bad” cholesterol?

An estimated 73 million American adults have high levels of low-density lipoprotein, or “bad,” cholesterol, according to the Centers for Disease Control and Prevention. LDL deposits the cholesterol in the lining of the arteries, which are the blood vessels that connect different areas of the body. Our bodies are basically like a set of pipes that lead from one area to the other, all connecting through blood vessels. Due to the make-up of the LDL cholesterol, it has the propensity to develop build-up on the wall of the artery and starts a process called atherosclerosis, or plaque, most likely from cholesterol LDL deposits. The plaque can develop anywhere in the body. If it develops in the heart, it’s known as coronary artery disease.

Does having high cholesterol mean you’ll develop heart disease?

No, it doesn’t. Having high cholesterol certainly puts you at a much higher risk for heart disease, but it doesn’t necessarily mean that you’ll develop it, no.

Who’s most at risk for having high cholesterol?

The biggest determinant is your genetics. The others include:

• sedentary lifestyle;
• dietary choices – foods that have high saturated fat content are high in cholesterol;
• tobacco use/smoking – causes LDL to be released into the blood stream; and
• diabetes, which tends to cause fat distribution and LDL to increase.

Are there medicines that can help control the condition?

Yes, there are a class of medications called statins that are most commonly prescribed. We typically prescribe the class of statin based on each individual patient profile. There is the moderate to high intensity statin medications called Crestor or Lipitor. At the highest tolerable dose, they can reduce the cholesterol levels as much as 50 percent.  In moderate low doses, they can reduce bad cholesterol as much as 30-35 percent, while the lower potency doses can lower the cholesterol as much as 20 percent.

How long does it take for the prescribed medicines to work?

Many patients think their cholesterol results will automatically improve in a few months, but usually it takes anywhere between 6 months and 1 year to see some kind of effect. In my practice, if I haven’t seen anything in about 8 months, we may need to change the dose of your medications. So, it will take time; it’s not something that you’ll notice overnight.

What are other ways people can reduce their levels?

• Regular aerobic exercise, 30-45 minutes, four times a week, at least at a moderate pace,
• Eating more fruits and vegetables; it will increase your good cholesterol (HDL) while reducing your bad;
• Tobacco cessation, no smoking – we know that smoking causes the good HDL to decrease;
• Good healthy eating habits that include low saturated fats and;
• Managing some of the other co-existing risk factors that can sometimes drive high cholesterol like diabetes.

Dr. Anil Purohit is a board-certified cardiologist Grand Strand Medical Center and the practice of Grand Strand Heart & Vascular Care, affiliates of HCA Healthcare’s South Atlantic Division.

What is the normal range?

Non-high-density lipoprotein (HDL) cholesterol is a way of measuring “bad” cholesterol in the body. A healthy range for adults aged 20 years and over is less than 130 milligrams per deciliter, according to the National Institutes of Health.

People need cholesterol for specific functions in the body, including building cells and making certain hormones and vitamins. However, excess cholesterol in the blood, especially “bad” cholesterol, or low-density lipoprotein (LDL) cholesterol, is detrimental to the body. It increases the risk of heart disease and other health issues.

Lipid profiles or lipid panels are blood tests that can measure a person’s cholesterol levels. They help doctors predict someone’s risk of cardiovascular diseases such as stroke and heart disease.

One important measure of “bad” cholesterol levels in the blood test result is non-HDL cholesterol.

This article discusses non-HDL cholesterol, what it includes, and its typical range. It also explores other indicators that cholesterol tests involve and the levels that health experts consider healthy.

Doctors commonly measure non-HDL cholesterol levels in a lipid panel, also known as a cholesterol test.

It covers all the “bad” types of cholesterol in the body by subtracting HDL, or “good” cholesterol, from a person’s total cholesterol.

Many experts consider non-HDL a superior predictor of heart disease risk than LDL and cholesterol ratios because it encompasses LDL, very low-density lipoproteins (VLDL), and triglyceride-rich lipoproteins.

The typical range of non-HDL cholesterol varies with age. Anyone aged 19 and younger should have under 120 milligrams per deciliter (mg/dl). Meanwhile, it should be under 130 mg/dl for anyone aged 20 years or older.

The higher the non-HDL cholesterol, the higher the risk of heart disease.

Learn more about high non-HDL cholesterol levels.

Not all lipid panel tests include the non-HDL cholesterol measurement. A doctor may request a lipid panel with non-HDL cholesterol if a person has a condition that puts them at a higher risk of heart disease.

People can calculate their non-HDL cholesterol by using their test results and following the equation: total cholesterol – HDL = non-HDL.

For example, if a person has a total cholesterol of 240 mg/dl and an HDL of 40, their non-HDL is 200 mg/dl.

Learn more about cholesterol ratios and why they are important.

Cholesterol tests usually report the following numbers and ratios:

• Total cholesterol (TC): This measures the total amount of cholesterol in the body, including HDL and LDL.
• HDL level: Health experts call HDL “good” cholesterol that helps clear fats from the bloodstream. The higher the level of HDL, the lower the person’s risk of heart disease. Learn more about HDL levels here.
• LDL level: Health experts call LDL “bad” cholesterol. It is the main cause of cholesterol buildup that blocks artery walls and causes atherosclerosis. Learn more about LDL here.
• VLDL level: VLDL mainly carries triglycerides away from the bloodstream into the body’s tissues. VLDL contributes to plaque buildup in the arteries. Learn more about VLDL here.
• Triglycerides: Triglycerides are a type of fat in the blood that stores unused calories. Learn more about high triglycerides here.
• TC:HDL ratio: This ratio compares HDL in comparison with total cholesterol. Health experts consider scores above 5 as high.
• LDL-HDL ratio: Doctors commonly use this ratio to determine a person’s risk of heart disease. An individual can calculate this by dividing LDL by HDL. Health experts consider scores under 5 as healthy.
• Triglyceride-HDL ratio: Another ratio that can help indicate a person’s risk of developing coronary artery disease. People can calculate this by dividing their triglyceride number by their HDL result.

The table below shows the expected healthy cholesterol level based on age and gender according to the National Institutes of Health (NIH).

However, a doctor may have different cholesterol target goals for individuals with an existing or high risk of heart disease.

Meanwhile, the desirable total cholesterol to HDL ratio is 5:1, but the ideal ratio is 3.5 to 1. A 2019 study shows that doctors can use the TC:HDL ratio to identify people at risk of early acute myocardial infarction, also known as a heart attack.

Learn more about healthy cholesterol levels here.

High cholesterol level does not cause symptoms. A person can only determine if they have high cholesterol if they take a lipid profile test.

Experts recommend individuals undergo regular screening to keep their cholesterol levels in check. They state that:

• individuals aged 9–11 should undergo screening every 5 years
• males aged 45–65 and females aged 55–65 should undergo screening every 1–2 years
• people older than 65 years should undergo annual screening

They may also ask individuals at risk of heart disease to have their levels checked more often. These include those with:

• heart disease
• high cholesterol
• diabetes
• high blood pressure
• obesity

A person whose cholesterol results fall outside typical ranges should talk with their doctor. Aside from lifestyle changes, healthcare professionals may recommend regular screening to monitor their cholesterol levels and determine the need for medications.

Cholesterol readings are generally helpful in providing an overview of a person’s general health. However, many experts find non-HDL cholesterol to be a more reliable measure of someone’s heart disease risk.

A person with high levels of non-HDL cholesterol or undesirable cholesterol levels should talk with their doctors, who can help them reach or maintain healthy cholesterol levels. This may involve making lifestyle changes and, in some cases, prescription medications.

Cholesterol

Cholesterol is a substance necessary for the body to build cell membranes, synthesize bile acids, produce hormones and vitamin D. From a chemical point of view, cholesterol is a fat-like substance – lipid (from the Greek “lipid” – fat).
Cholesterol in the human body is synthesized mainly in the liver. Being a fat-like substance, insoluble in water, it is transported through the blood vessels only as part of complexes with proteins – chylomicrons and lipoproteins. The main carriers of cholesterol in the body are lipoproteins. Lipoproteins (protein-lipid complexes) differ in size, density and lipid content.

By density, lipoproteins are divided into the following classes:

• very low density lipoproteins (VLDL)
• intermediate density lipoproteins (IDL)
• low density lipoproteins (LDL)
• high density lipoproteins (HDL)

The ratio of fats (lipids) and proteins in lipoproteins is different. The minimum amount of protein is found in chylomicrons. The increase in the density of lipoproteins is characterized by an increase in the content of the protein component in them, as shown in the table.

Percentage composition of blood plasma lipoproteins
(G.R. Thompson, 1991)

Lipoproteins differ in their role in the development of atherosclerosis. So, low and very low density lipoproteins are considered atherogenic (contributing to the development of atherosclerosis), and the cholesterol they contain is called “bad” cholesterol. VLDL and LDL transport cholesterol from the liver to the cells and tissues of the body.
High-density lipoproteins (HDL), on the contrary, are considered anti-atherogenic (preventing the development of atherosclerosis), and the cholesterol they contain is called “good” cholesterol. High-density lipoproteins (HDL) are called “atherosclerosis police officers” abroad. The anti-atherogenic effect of HDL is manifested due to their ability to capture cholesterol, remove it from cells, tissues, including arterial walls, and transport it back to the liver.
There are three substrates (or “pools”) in the body where cholesterol is found. These are blood plasma, liver, or rather, liver cells (hepatocytes), and cells of other organs. Cholesterol, located in the liver, is in dynamic equilibrium with plasma cholesterol. Depending on the activity of liver cells, the amount (concentration) of cholesterol in blood plasma can vary significantly.
The content of cholesterol sufficient for the body is maintained by its constant synthesis
in liver cells. Cholesterol produced in the liver cells is called endogenous cholesterol. Cholesterol also enters the body with food. This is the so-called exogenous cholesterol. If there is a lot of exogenous cholesterol delivered to the liver, then with normal metabolism, the synthesis of endogenous cholesterol is limited.
As already noted, cholesterol is a fat-like substance that is insoluble in water; it is transported through the blood vessels only as part of complexes with proteins. These protein-lipid complexes (VLDL, LDL, LDL and HDL) are also formed in the liver and then enter the bloodstream.
In addition to these compounds, another type of fat associated with the risk of atherosclerosis is formed in the liver. These are triglycerides. They are transported to the muscles, accumulate there, and, if necessary, are broken down, becoming a source of energy.

Cholesterol exchange

Free cholesterol undergoes oxidation in the liver and organs that synthesize steroid hormones (adrenals, testes, ovaries, placenta). This is the only process of irreversible removal of cholesterol from membranes and lipoprotein complexes.
Every day, 2-4% of the total amount of cholesterol is spent on the synthesis of steroid hormones. In hepatocytes, 60–80% of cholesterol is oxidized to bile acids, which, as part of bile, are secreted into the lumen of the small intestine and participate in digestion (emulsification of fats).
Together with bile acids, a small amount of free cholesterol enters the small intestine, which is partially removed with feces, and the rest is dissolved and, together with bile acids and phospholipids, is absorbed by the walls of the small intestine. Bile acids provide the decomposition of fats into their constituent parts (emulsification of fats). After this function, 70-80% of the remaining bile acids are absorbed in the final section of the small intestine (ileum) and enter the portal vein system to the liver. It is worth noting here that bile acids have another function: they are the most important stimulant to maintain the normal functioning (motility) of the intestine.
Schematically, the exchange of cholesterol can be represented as follows. The liver loads very-low-density lipoproteins (VLDL) with fat, which then travel through the blood vessels, unloading fat. Partially “unloaded” VLDL become low density lipoproteins (LDL).
Low-density lipoproteins (LDL), the main carriers of cholesterol as they move through the blood vessels, can stick
to the walls of blood vessels, narrowing their internal lumen.
High-density lipoproteins (HDL) release LDL particles with cholesterol adhering to the vessel wall and carry them back to the liver, where LDL particles are again loaded with cholesterol and turn into VLDL, or break down and are excreted from the body.
With the active consumption of fatty foods and disorders of fat metabolism, the liver produces an excess amount of very low density lipoproteins (VLDL) and low density lipoproteins (LDL). In the presence of endothelial damage and the absence of a sufficient amount of high-density lipoprotein (HDL), particles of low-density lipoprotein (LDL) with cholesterol begin to “stick” to the walls of blood vessels. Gradually, vasoconstriction develops, i.e., atherosclerosis, and then all the troubles: angina pectoris, heart attack, stroke and other complications of atherosclerosis.

Why determine the atherogenic index?

To assess the severity of atherogenic (promoting the development of atherosclerosis) properties of blood plasma and the risk of developing clinical manifestations of atherosclerosis, formulas are used to calculate the atherogenic index (AI) by the ratio of atherogenic and antiatherogenic fractions of lipoproteins. There are many ways to calculate the atherogenic index.
One of the most common in the world is the definition of the atherogenic index, as the ratio of total cholesterol (TC) to HDL cholesterol (TC/HDL cholesterol). It indicates the atherogenicity of the blood lipid spectrum at a level > 5.
In Russia, another ratio is widely used, called the atherogenic index of A. N. Klimov. This is the ratio of the sum of atherogenic low-density lipoprotein cholesterol (LDL-C) and very-low-density lipoprotein cholesterol (VLDL-C) to anti-atherogenic high-density lipoprotein cholesterol (HDL-C).

Atherogenic index (A.N. Klimova) = LDL cholesterol + VLDL cholesterol / HDL cholesterol = total cholesterol – HDL cholesterol / HDL cholesterol

Both formulas are given because they are the same. The fact is that total cholesterol (TC) consists of LDL cholesterol, VLDL cholesterol and HDL cholesterol.

For laboratories in a polyclinic or hospital, for ease of calculating the atherogenic index, it is enough to determine the levels of total cholesterol and HDL cholesterol in the patient’s blood. If the level of HDL cholesterol is subtracted from the level of total cholesterol, then we get the amount of cholesterol of atherogenic lipoproteins – LDL and VLDL.
The normal value of the atherogenic index A.N. Klimov – 3.0–4.0. An atherogenic index value above 4.0 indicates a high risk of atherosclerosis or the possibility of its progression up to the development of serious complications.

High cholesterol is a key risk factor for atherosclerosis

As early as the beginning of the 20th century, the St. Petersburg scientist, the founder of the cholesterol theory of atherosclerosis N. N. Anichkov said: “Without a high level of cholesterol in the blood, there is no atherosclerosis.” Most domestic and foreign researchers agree with this.
Since the beginning of the last century, atherosclerosis has been associated with high levels of cholesterol in the blood, a chemical compound necessary for the life of the human body. First of all, as already noted, it is necessary as a building material for cell membranes. In addition to forming a cell framework, the body uses cholesterol to synthesize many vital substances, such as hormones (corticosteroids, androgens, estrogens, etc.) and vitamins.
Thus, on the one hand, life without cholesterol is impossible, on the other hand, cholesterol is perhaps the main threat to modern man. This contradiction is apparent, since researchers have found that it is not cholesterol itself that is responsible for the occurrence and development of atherosclerosis, but an increased level of a number of its compounds with proteins – VLDL and LDL, combined with a reduced level of HDL.

Unfortunately, people, without noticing it, contribute to the development of atherosclerosis. As noted earlier, even in early childhood, fatty (or lipid) spots can form on the walls of blood vessels. If the level of cholesterol in the blood is normal, then fatty spots disappear over time and atherosclerotic plaques do not form. But in conditions of elevated cholesterol levels, or rather VLDL and LDL cholesterol, a person is at an increased risk of developing a disease that is formidable in its prognosis. And if he also smokes, is overweight and has high blood pressure, then the risk of developing atherosclerosis increases several times. All of these factors can lead to damage to the endothelium (inner lining) of blood vessels, where the process of formation of atherosclerotic plaques begins. Therefore, it is so important to know the ways of prevention and the basics of treatment of the “disease of the century”.
The risk of developing complications of atherosclerosis is especially high in severe congenital disorders of lipid metabolism, which are inherited and which, as a rule, affect all close relatives. Such cases are usually attributed to familial hypercholesterolemia caused by a hereditary defect in low-density lipoprotein receptors. The gene is localized on the 19th chromosome.
There are homozygous and heterozygous familial hypercholesterolemia. With heterozygous hypercholesterolemia, total cholesterol is 2-3 times higher than the normative values, and with homozygous hypercholesterolemia – 4-6 times or more. Both of these conditions are harbingers of the early development of clinical manifestations of atherosclerosis in the form of coronary heart disease and even myocardial infarction.
We treated a seventeen-year-old (!) girl who suffered from a severe form of coronary heart disease. Her parents also had earlier development of atherosclerosis. The father suffered a myocardial infarction at the age of 29, the mother was operated on for coronary heart disease at 35, and at 40 for coronary brain disease.
In the preface to a monograph on the surgical correction of lipid metabolism disorders, published in 1987, Academician A.N. Klimov writes about a girl with homozygous familial hypercholesterolemia, who at the age of 6 suffered a myocardial infarction, having blood plasma cholesterol values ​​10 times exceeding normal.

In hereditary hypercholesterolemia, the risk of developing coronary heart disease at a young age is 20 times higher than in people with a normal blood lipid spectrum.
How is lipid metabolism disturbed in hereditary hypercholesterolemia? As a result of gene mutations, the metabolism of low-density lipoproteins, the most atherogenic lipoproteins, is disrupted. This mechanism was discovered in the second half of the 20th century by American scientists Brown and Goldstein, for which they received the Nobel Prize. As they found out, on the surface of most body cells there are special protein molecules called “receptors”. Their task is to take not all lipoproteins from the blood stream, but only low-density lipoproteins (LDL), rich in cholesterol, and send them inside the cell. Freed from cholesterol, the receptors return back to its surface. Since there is a lot of cholesterol inside the cell, its synthesis by the cell itself is inhibited, which means that the number of receptors for low-density lipoproteins located on the membrane decreases. During the day, these receptors capture up to 1 g of cholesterol from blood plasma. Such capture by low-density lipoprotein receptors provides a normal level of cholesterol in the blood, preventing the development of atherosclerosis. The lack of such receptors is at the heart of hereditary familial hypercholesterolemia.
We will not dwell in great detail on the mechanism of the various types of familial hypercholesterolemia, but note that there are 5 types of mutations in which low density lipoprotein receptors do not work.

The frequency of heterozygous familial hypercholesterolemia is 1:500, homozygous familial hypercholesterolemia – 1:1,000,000 inhabitants of our planet, and people who have them will definitely get atherosclerosis, even if they follow a low-cholesterol diet. So that at a young age the most severe clinical manifestations of atherosclerosis (for example, myocardial infarction and others) do not occur, they are doomed to life-long medication that normalizes lipid metabolism.
Thus, the development of atherosclerosis is based on processes associated with impaired fat (lipid) metabolism. They are manifested by a different ratio of lipids and lipoproteins and are called dyslipidemias.
The most common dyslipidemias are caused by impaired synthesis and slowing down of lipid breakdown, a decrease in the activity of membrane transport systems that ensure the transfer of cholesterol and triglycerides from the cell.
Distinguish between primary and secondary dyslipidemia. Primary dyslipidemias are independent violations of the processes of synthesis and disintegration of lipoproteins, associated both with lifestyle features and with genetically determined metabolic defects. Secondary dyslipidemia occurs against the background of various diseases, including hormonal (hypothyroidism, pregnancy), metabolic (diabetes mellitus, obesity, gout), renal (nephrotic syndrome, chronic renal failure), toxic addictions (alcohol).

What cholesterol level is considered normal?

The first step in following the rules for lowering cholesterol is to check its level in the blood. Blood cholesterol analysis is performed in almost all clinics and hospitals free of charge or for a small fee.
A blood test for cholesterol in it usually does not require preliminary preparation, but this study is performed on an empty stomach, 10 hours after the last meal. A small amount of blood is taken, which is examined immediately by the express method or sent to the laboratory. If the study is carried out by the express method, then the answer is issued immediately. If a detailed analysis (lipidogram) is performed, the blood is sent to the laboratory, and the answer may be ready the next day or the day after.

Remember the level of your cholesterol and its components.

The simplest analysis is to determine the level of total cholesterol. Total cholesterol (TC) is made up of low-density lipoprotein (LDL), very-low-density lipoprotein (VLDL) and high-density lipoprotein (HDL) cholesterol:

TC = LDL-C + VLDL-C + HDL-C

Let’s talk about the standards of the blood lipid spectrum. The amount of cholesterol and lipoproteins is measured in millimoles per liter (mmol/l) or milligrams per deciliter (mg/dl). What level of lipid spectrum indicators is considered normal?

The standards are different for healthy people with a low risk of cardiovascular disease, and patients with cardiovascular disease.

So, the standards of the blood lipid spectrum for healthy people:

Total cholesterol (TC) < 5.0 mmol/L (< 190 mg/dL)
LDL cholesterol (LDL-C) < 3.0 mmol/L (< 115 mg/dL)
HDL cholesterol (HDL cholesterol) > 1.0 mmol/l (> 40 mg/dl) in men
HDL cholesterol (HDL cholesterol) > 1.2 mmol/L (> 45 mg/dL) in women
Triglycerides (TG) < 1.7 mmol/L (< 150 mg/dL)

Norms of the blood lipid spectrum for patients with coronary heart disease and patients with diabetes:

Total cholesterol (TC) < 4.5 mmol/L (< 175 mg/dL)
LDL cholesterol (LDL-C) < 1.8 mmol/L (< 70 mg/dL)
HDL cholesterol (HDL cholesterol) > 1. 0 mmol/l (> 40 mg/dl) in men
HDL cholesterol (HDL-C) > 1.2 mmol/L (> 45 mg/dL) in women
Triglycerides (TG) < 1.7 mmol/L (< 150 mg/dL)

If a patient has hypercholesterolemia, it is customary to determine its severity. There are 3 degrees of hypercholesterolemia:
• mild hypercholesterolemia with a total cholesterol (TC) blood level of 5.0 < TC < 6.5 mmol/l (190 < TC < 250 mg/dl)
• moderate hypercholesterolemia at 6.5 < TC < 7.8 mmol/l (250 < TC < 300 mg/dl)
• Severe hypercholesterolemia with a total cholesterol level > 7.8 mmol/l (TOC > 300 mg/dl)

Cholesterol: harmful or beneficial?

According to the study, the prevalence of elevated total cholesterol among HUMANS is 58%. Hypercholesterolemia, as doctors call high cholesterol levels in the blood, increases the risk of atherosclerosis, hypertension, coronary heart disease, heart attacks, and strokes. Today less than a quarter of people know their cholesterol level. The problem is that with a high level of cholesterol in a person for many years there are no clinical manifestations. Exactly until it’s too late.

Cholesterol is chemically a fatty alcohol. It enters the body with food, and is synthesized by the liver, kidneys and intestines in approximately the same amount. Cholesterol is necessary for the body: cell membranes are made of it, it is needed for the synthesis of fat-soluble vitamins and steroid hormones, including sex hormones, it literally patches the damaged walls of the arteries. And at the same time, when there is too much of it, cholesterol is deposited in the walls of blood vessels. This leads to the fact that the lumen of the arteries narrows, and blood clots form in them, which lead to coronary heart disease, heart attacks and strokes.

Protection on the verge

You can measure your cholesterol level during a medical examination or in the laboratory of a polyclinic, having previously received a referral from a therapist. The upper limit of normal cholesterol in the blood is 5.2 mmol / l. If the indicator is normal, then the person is protected from atherosclerosis. A re-analysis should be taken after a year and a half. If the cholesterol level is in the range from 5.3 to 6.5 mmol / l, then such a person is at risk for the development of diseases of the cardiovascular system. He needs a doctor’s consultation and, at a minimum, a correction of diet and lifestyle. With cholesterol in the range from 6.6 to 8 mmol / l, a diagnosis of moderate hypercholesterolemia is made, and above 8 mmol / l – already expressed. This level of cholesterol in the blood is considered catastrophic. Here, without consulting a doctor, additional research and taking special drugs that reduce cholesterol, you can not do.

Another test that all people whose cholesterol level is above 5.2 mmol/l should undergo is to find out their lipid profile. This analysis allows you to evaluate not only the concentration of cholesterol in the blood, but also high, low and very low density lipoproteins – transport proteins that deliver cholesterol from the liver to tissues and vice versa. Atherogenic or involved in the formation of plaques in the arteries are low-density lipoproteins (“bad cholesterol”). Finding out the lipid profile is important, first of all, for the correct treatment tactics.

Run away from a heart attack

In order to bring cholesterol levels back to normal, along with lipid-lowering drugs, a special diet and exercise are required. Physical activity can not only reduce the amount of bad cholesterol in the blood, but also increase the concentration of good.

WHO recommends an hour a day of moderate physical activity for healthy people. For the elderly or people who already have chronic diseases, it will be enough to walk daily at a moderate pace for 40 minutes. This alone is enough to halve the risk of dying from a stroke or heart attack. Of course, no exercises will remove existing atherosclerotic plaques, but they will not allow new ones to form. In addition, physical activity reduces weight, which means that the load on the heart and blood vessels decreases.

Eat like a Greek

Traditionally, if you have high cholesterol, the Mediterranean diet is recommended, that is, you will have to switch to the diet of the Greeks and Italians. Lots of vegetables, fruits, olive oil, fish, nuts, and low saturated animal fats. Olive oil and fish are rich in polyunsaturated fatty acids – Omega 3. Their consumption reduces the concentration of bad cholesterol by 18%. Moreover, according to the American Association for the Study of the Cardiovascular System, regular consumption of fish oil is recommended as a prevention of atherosclerosis. In alternative medicine, green tea, avocados, various berries and juices are also recommended to lower cholesterol levels. Juices, of course, freshly squeezed with pulp.

Treatment with juices is called juice therapy. To date, dozens of studies are being conducted on the effect of juices on blood cholesterol levels. The leaders so far are concentrated pomegranate juice, 40 g of which for 8 or more weeks daily significantly reduced the level of total cholesterol and low density lipoproteins.