Just a generation ago, when it came to cholesterol, the message was loud and clear: High cholesterol led to heart disease, and it was caused in large part eating too much cholesterol from animal sources like red meat, eggs and butter. So Americans switched from butter to margarine, cut down on eggs, and opted for chicken instead of pork.
Through the years, however, a substantial body of evidence has emerged about cholesterol, and it suggests a far more complicated relationship between this form of fat in the blood and heart disease.
Today, we understand not all cholesterol is created equal. High levels of high-density lipoprotein (HDL, or “good”) cholesterol actually help the body to remove fats from arteries; HDL is actually heart-protective. Meanwhile, low-density lipoprotein (LDL, or “bad”) cholesterol is the culprit behind artery-clogging plaques, which are filled with cholesterol and enlarged tissue. As plaques grow, they can eventually block the flow of blood to the heart, causing a heart attack. Or they might break free, circulating through the body and eventually blocking blood flow to the brain, causing a stroke.
So, if routine blood tests from your annual physical come back showing elevated levels of serum cholesterol, should you consider powerful prescription drugs to lower your levels?
“Lowering your cholesterol can significantly decrease your chance of developing heart disease,” says Mimi Guarneri, MD, medical director and founder of Scripps Center for Integrative Medicine. “Research has repeatedly shown that a one percent decrease in cholesterol level can lead to a two-to-three percent decrease in your risk of heart disease over the course of several years. But that’s not all there is to it. Intervention and treatment options depend on a big picture that assess all of a person’s risk factors.”
Heart disease risk factors include, but are not limited to:
- Having a first-degree relative who suffered a premature heart attack (younger than 55 years for men, or 65 for women)
- Smoking cigarettes
- High blood pressure
- Genetic predisposition
- Other blood and biomarkers like fibrinogen, homeocysteine, and apoproteins A1 and B
Tests can help to identify silent risks, like high levels of LDL, and help guide lifestyle choices that may lower the chance of a heart attack or a stroke.
Some of the newest evidence to emerge about heart disease focuses on the role of inflammation in the formation of damaging arterial plaques. An initial bout of inflammation can cause tissue damage in the arteries; meanwhile, the body’s immune response to that damage creates further inflammation. This vicious cycle can eventually lead to the formation of plaque within the arteries.
“The good, news is the progression of inflammation and atherosclerosis can be slowed or even halted,” says Dr. Guarneri. ”Lifestyle modification like regular exercise, specific dietary supplements and stress management techniques can reduce your overall risk for a heart attack or stroke, even if you do have elevated risk factors.”