Understanding Cholesterol: A Simplified Guide to Your Heart Health

In episode two of this blog series, we dive deep into the complexities of cholesterol, a crucial

element that impacts heart health. While lipidology—the study of fats and lipids—is a highly

specialized field, the key takeaways shared here are accessible for anyone wanting to improve their understanding of cholesterol and its role in cardiovascular health.

Cholesterol is often misunderstood, and much of what we know about it even confuses doctors themselves. Here, we’ll break it down in a way that not only clears up some confusion but also provides practical steps for managing cholesterol levels in a healthy, sustainable way.

What Is Cholesterol, Really?

Cholesterol is essential for your body’s proper functioning. Without it, you wouldn’t survive.

Your body uses cholesterol to build cell membranes, produce certain hormones, and make bile, which helps digest fat. But here's the catch: While cholesterol is necessary, an imbalance can lead to serious health issues, particularly cardiovascular disease.

You get cholesterol in two main ways:

1. Your body produces it naturally, with most made in the liver and brain.

2. You consume it from animal products like meat, eggs, and dairy. (Plants, by the way, don’t contain cholesterol.)

However, cholesterol on its own can’t travel through your bloodstream. It needs a “vehicle” to

move around, which is where lipoproteins come into play.

Lipoproteins: The "Chauffeurs" of Cholesterol

Lipoproteins are like little sacs that carry cholesterol and other fats (like triglycerides) in your

blood. There are two main types of lipoproteins that most cholesterol panels measure:

• HDL (High-Density Lipoprotein): Often referred to as "good"; cholesterol, HDL helps remove cholesterol from your cells and transport it back to your liver for disposal.

• LDL (Low-Density Lipoprotein): Known as "bad"; cholesterol, LDL can deposit cholesterol into the walls of your arteries, leading to plaque buildup—a major cause of heart disease.

Please note: When LDL or HDL is reported on a cholesterol panel, it’s not reporting particle

number. Instead, it’s reporting how much cholesterol is in those particles. This is a crucial point because knowing the number of particles can reveal a lot about your heart health.

The Role of Apolipoprotein B (Apo B) in Heart Disease

One critical detail that often gets overlooked is the protein called apolipoprotein B (Apo B),

which sits on the outside of every LDL particle. Apo B is responsible for LDL particles crossing into the walls of your arteries and getting stuck there. This process sets the stage for plaque formation, leading to cardiovascular disease.

So why is this important? Well, if you have more LDL particles, you have more copies of Apo

B, and that increases your risk of developing cardiovascular issues. That’s why doctors look at not just LDL cholesterol levels but also the number of particles and Apo B levels.

For instance, if you have an LDL cholesterol (LDL-C) level of 100 mg/dL, you could have a few

large particles with a lot of cholesterol, or many smaller particles with less cholesterol. It’s the latter scenario—more particles—that poses a higher risk, even if your LDL number seems

"normal."

The Real-World Example: How Apo B Affects Your Health

Here’s a real-life example: A 65-year-old patient presented with an LDL level of 110 mg/dL. At

first glance, his number seemed pretty good. But when his Apo B levels were checked, they were high. This meant that while his cholesterol concentration wasn’t alarmingly high, he had a high number of LDL particles, each carrying less cholesterol. In other words, there were plenty of chances for those particles to get stuck in his arteries.

For this patient, the treatment wasn’t just about lowering his LDL-C number, but also focusing

on reducing the number of LDL particles and lowering his Apo B level. This helps decrease his risk of heart disease.

The Hidden Danger: Lipoprotein (a)

While most people are familiar with LDL and HDL, there are other lipoproteins you should be

aware of, such as lipoprotein (a), often abbreviated as Lp(a). Lp(a) has become a hot topic in

recent research because it's been linked to a higher risk of heart disease, stroke, and other cardiovascular problems like aortic valve stenosis.

What makes Lp(a) particularly dangerous is that it tends to form unstable plaque in your

arteries—plaque that is more likely to rupture, causing heart attack. Unfortunately, Lp(a) levels are largely determined by genetics and can’t be controlled by diet or standard cholesterol medications. That’s why if you have a strong family history of early-onset heart disease, it’s critical to check your Lp(a) levels.

Can You Control Cholesterol Without Medications?

Yes, it’s possible to manage your cholesterol levels through lifestyle changes, especially when it comes to LDL-C. The most effective strategy is reducing your intake of saturated fat. Since saturated fat comes from animal sources, cutting back on red meat, fatty dairy products, and processed meats can significantly lower your LDL.

Here’s what you can do:

• Focus on plant-based foods as fruits, vegetables, whole grains, and legumes.

• Eat lean proteins like chicken or fish instead of fatty cuts of meat.

• Choose low-fat dairy or eliminate dairy altogether.

• Exercise regularly, which can help raise your HDL (good) cholesterol levels.

For those with low HDL, exercise remains the best approach to raise it. Other options include

supplements like fish oil. Niacin—once commonly used to boost HDL—has fallen out of favor

due to its side effects and lack of proven benefit in preventing heart disease.

When Medications Are Necessary

Despite the benefits of diet and exercise, genetic conditions like familial hypercholesterolemia(FH) may require medical treatment. FH causes extremely high LDL-C (and ApoB) levels due to genetic mutations that prevent the liver from clearing LDL cholesterol properly. In such cases, medications like statins and PCSK9 inhibitors are crucial for reducing LDL-C levels and preventing cardiovascular events.

The Truth About Cholesterol and Heart Disease

It’s common to hear misconceptions about cholesterol, with some arguing that it’s not the cause of heart disease. However, the evidence linking LDL-C (and other ApoB lipoproteins like lipopriein a) to heart disease is overwhelming. Numerous randomized control trials have shown that reducing LDL cholesterol through medications significantly lowers the risk of

cardiovascular events.

In fact, individuals with familial hypercholesterolemia—who have extremely high LDL-C levels

from birth—experience premature heart disease starting in youth , but the risk is significantly

reduced when their LDL-C levels are lowered with treatment.

Conclusion: Take Control of Your Heart Health

Understanding cholesterol isn’t as complicated as it might seem. By focusing on the numbers that matter and taking proactive steps through diet, exercise, and medication when necessary, you can lower your risk of heart disease.

If you’ve only had a standard cholesterol test, consider asking your doctor to check additional markers like Apo B and Lp(a). Understanding these numbers could be the key to unlocking better heart health and a longer life.

Remember: Knowledge is power, and taking control of your cholesterol is one of the most

important steps you can take for your health. If you want to learn more about ways to reduce

your heart disease risk while improving your health and performance, reach out to me at Premier Cardiovascular Health and Performance.