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How Do The Lipoproteins Ldl And Hdl Influence Heart Disease Risk

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How Is The Total Cholesterol Or Blood Cholesterol Test Done

How HDL size and quantity affect heart disease risk | Ronald Krauss

A blood test is a routine test. A phlebotomist is the person whose job it is to draw blood. Blood is usually drawn from the vein in your arm. You will sit down and the phlebotomist will wrap a rubber band around your upper arm so that the vein in your elbow sticks out. Then they will use a needle to puncture the vein and remove blood. The blood is sent to the lab to be examined.

Youve probably been at health fairs where testing is offered. In that case, the person performing the test takes a drop of blood from your finger. The finger stick test uses a small blade to poke a hole in the tip of your finger to get the blood.

The Association Between Cholesterol And Heart Disease

The 20152020 Dietary Guidelines for Americans doesnt include a specific limit, it still strongly recommends eating as little dietary cholesterol as possible. It mentions studies and trials that have produced strong evidence that healthy eating patterns that are low in dietary cholesterol can reduce the risk of heart disease in adults.

An eight-week study published in 2016 stated that elevated LDL is an established risk factor for heart disease and that dietary fatty acids play a significant role in the development of heart disease. The researchers found that making minor dietary changes reduced cholesterol and could potentially reduce future risk of heart disease.

Other Pathways Through Which Trans Fatty Acids May Influence Cardiovascular Health

One of the unsolved questions in this research field is what the exact effect is of trans fatty acids on cardiovascular disease. The risk estimates from the observational studies are much larger than can be explained by the effect on lipoproteins only. This could be due to residual confounding, but there could also be additional adverse effects of trans fatty acids on cardiovascular disease through pathways other than lipoproteins.

Other suggested pathways are systemic inflammation, oxidative stress, endothelial function and insulin resistance or diabetes. Several studies, but not all, suggest that industrial trans fatty acids have unfavorable effects on inflammation. For inflammatory effects of ruminant trans fatty acids and CLA there are not many indications that they have strong effects on inflammatory processes., , , , However, the available number of studies is small and the dosages of ruminant trans fatty acids used in these studies are low.

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What Are Ldl And Hdl

LDL and HDL are two types of lipoproteins. They are a combination of fat and protein. The lipids need to be attached to the proteins so they can move through the blood. LDL and HDL have different purposes:

  • LDL stands for low-density lipoproteins. It is sometimes called the “bad” cholesterol because a high LDL level leads to a buildup of cholesterol in your arteries.
  • HDL stands for high-density lipoproteins. It is sometimes called the “good” cholesterol because it carries cholesterol from other parts of your body back to your liver. Your liver then removes the cholesterol from your body.

What Are Triglycerides And Why Should I Care About Them

What You Should Know About Lipoprotein(a) And Heart Attack ...

Triglycerides are the scientific name for the most common form of fat, found in both the body and foods. Triglycerides attach to lipoprotein particles in the blood. Recent studies indicate that elevated triglycerides are an independent risk factor for coronary heart disease . Some triglyceride-rich lipoproteins may cause plaque build-up in the arteries.

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S To Reducing The Risk Of Cardiovascular Disease

Diet and nutrition can play a significant role in reducing the risk of cardiovascular disease. It is helpful to lower sodium intake, increase consumption of dietary fiber, and limit consumption of saturated fat which promotes plaque formation. In addition, it is important to replace refined starches and added sugar, which can boost triglycerides, with whole grains, fruits, and vegetables. Eating foods rich in omega-3 fatty acids, especially fish, using alcohol in moderation, and opting for low or no-fat dairy products can all help reduce your cardiovascular disease risk. Emphasizing vegetable-based sources of protein, such as beans and legumes, can be beneficial, as well as consuming more soy products. It is also important to maintain a healthy weight, manage cholesterol levels, and avoid smoking or chewing tobacco.

What Factors Affect Cholesterol Levels

A variety of factors can affect your cholesterol levels. They include:

  • Diet: Saturated fat, trans fat and cholesterol in the food you eat increase cholesterol levels. Try to reduce the amount of saturated fat, trans fat and cholesterol in your diet. This will help lower your blood cholesterol level. Saturated and trans fat have the most impact on blood cholesterol.
  • Weight: In addition to being a risk factor for heart disease, being overweight can also increase your triglycerides. Losing weight may help lower your triglyceride levels and raise your HDL.
  • Exercise: Regular exercise can lower total cholesterol levels. Exercise has the most effect on lowering triglycerides and raising HDL. You should try to be physically active for 30 minutes on most days of the week.
  • Age and sex: As we get older,cholesterol levels rise. Before menopause, women tend to have lower total cholesterol levels than men of the same age. After menopause, however, womens LDL levels tend to rise and HDL can drop.
  • Heredity: Your genes partly determine how much cholesterol your body makes. High blood cholesterol can run in families.

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What Causes High Cholesterol

Some causes of high cholesterol are beyond your control, such as age, family history and gender. High cholesterol can be hereditary and levels of LDL naturally rise as people get older.

You cant change your age or family history, but there are risk factors in your life that you can change, including:

  • Getting too much saturated fat, trans fat, and cholesterol in your diet
  • Diabetes

If Cholesterol Is Necessary Why Do We Have To Worry About How Much We Have

Cholesterol Metabolism, LDL, HDL and other Lipoproteins, Animation

Having enough cholesterol to meet your needs is important. Having too much cholesterol can cause problems. If your cholesterol levels are high, the condition is called hypercholesterolemia. If your cholesterol levels are low, the condition is called hypocholesterolemia. It is not common to have cholesterol levels that are too low, but it can happen.

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Role Of Oxidation In Atherogenesis

Oxidative stress, especially LDL oxidation has been suggested for almost three decades as the most probable aetiology of atherosclerosis . Markers of LDL oxidation in plasma, particularly circulating oxidized LDL and auto-antibodies against oxidized LDL, could be used to assess the development of atherosclerosis in patients . Circulating oxidized LDL is additive to the global risk score based on age, sex, total and HDL cholesterol, diabetes mellitus, hypertension, and smoking as a useful marker for identifying persons at risk for CAD .

A study has associated circulating oxidized LDL with both subclinical atherosclerosis and inflammatory variables . This conclusion supports the concept that oxidatively modified LDL may play a major role in development of atherosclerosis . It has been proposed that, because of the antigenic properties of oxidized LDL, the anti-oxidized LDL antibody titer could represent a useful index of in vivo LDL oxidation. Autoantibodies against oxidized LDL have been reported to be associated with atherosclerosis, but existing reports are still conflicting. Some studies have reported a positive relationship between autoantibodies against oxidized LDL and CHD whereas another did not . There is a strong cross-reactivity between autoantibodies against oxidized LDL and anticardiolipin antibodies, which have been positively associated with CHD .

Prevalence Of Risk Factors And Familial Lipoprotein Disorders In Premature Chd

We have assessed the prevalence of risk factors in patients with premature CHD. The most prevalent CHD risk factors in these subjects were cigarette smoking, low HDL cholesterol, hypertension, elevated LDL cholesterol, and elevated homocysteine, followed by elevated lipoprotein and finally diabetes . In our view, these are all important independent risk factors. Familial lipoprotein disorders that we have observed in families afflicted with premature CHD include lipoprotein excess, dyslipidemia with high triacylglycerol and low HDL cholesterol, combined hyperlipidemia associated with elevations in both triacylglycerol and LDL cholesterol and low HDL cholesterol, hypoalphalipoproteinemia, and hypercholesterolemia .

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Desirable Blood Lipid Levels:

Less than 200 mg/dL = Desirable200-239 mg/dL = Borderline high240 mg/dL and above = High

LDL cholesterol:

Less than 100 mg/dL = Optimal100-129 mg/dL = Near/above optimal190 mg/dL and above = Very high

HDL cholesterol:

Below 40 mg/dL = Suboptimal 60 mg/dL and above = Optimal


Less than 150 mg/dL = Normal150-199 mg/dL = Borderline high500 mg/dL and above = Very high

What Is A Healthy Blood Cholesterol Level


For people who have plaque in their arteries or who have other factors that put them at risk for cardiovascular disease, doctors recommend an ideal LDL level well below 70 mg/dl. For those without risk factors who have an LDL level at or above 190 mg/dl, the recommendation is to get this level down to below 100 mg/dl. People age 40 to 75 who are living with diabetes and whose LDL is at 70 or above may need medication.

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What Treatments Are Available For High Cholesterol

Treatment may include:

  • Addressing risk factors. Some risk factors that can be changed include lack of exercise and poor eating habits.

  • Cholesterol-lowering medicines. Medicines are used to lower fats in the blood, particularly LDL cholesterol. Statins are a group of medicines that can do this. The two most effective types are atorvastatin and rosuvastatin. Other medicines that lower cholesterol levels are ezetimibe and PCSK9 inhibitors.

The Debate About Dietary Cholesterol: Should Nutrition Recommendations Set A Limit


For over 50 years, restriction of dietary cholesterol has been part of dietary recommendations for heart health. Now the focus of cardiovascular nutrition research is shifting. In considering whether specific limits on cholesterol consumption make sense as part of dietary assessment and education, two questions are relevant: 1) does evidence support dietary cholesterol as harmful to cardiovascular risk as assessed by today’s standards 2) how does setting limits on cholesterol intake fit with today’s efforts to express dietary recommendations within the context of dietary patterns?


The complexity of the relationship between dietary cholesterol and cardiovascular disease has become more apparent because of advances in identifying biomarkers of cardiovascular risk and in understanding that a wide range of dietary factors may influence atherosclerotic disease. Several panels creating dietary recommendations in recent years have concluded that evidence is insufficient to support a recommendation to limit dietary cholesterol.1-3 These panels concluded that limiting saturated fat within the context of a healthful dietary pattern is a more effective approach to reduce atherogenic lipids. Some cardiovascular nutrition guidelines, however, do include a recommendation to limit dietary cholesterol to less than 200 mg per day.4,5

Research Gaps and Emerging Perspectives

Practically Speaking

Table: Cholesterol, Saturated Fat, and Calorie Content of Food Choice Comparisons

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Genetic Variation Affecting Plasma Lipoprotein Concentrations And Therapeutic Response

We have tested diets meeting NCEP Step II diet criteria and US Department of Agriculture food guide pyramid guidelines under isoweight conditions, and have found these diets to be well tolerated and palatable and to result in mean LDL-cholesterol reductions of 1520% however, HDL cholesterol also is reduced by a mean of 15% . These reductions are stable within 4 wk of implementing the program and for up to 24 wk. We have also noted marked variability in LDL-cholesterol-lowering response . We ascribed this to 2 major gene polymorphisms, the most important of which is in the APOE gene .

Prevention And Treatment Of Cardiovascular Diseases

How statins affect LDL and overall health | Ronald Krauss

The contributing factors to development of cardiovascular diseases are numerous as mentioned in the risk factors above. Lowering of plasma cholesterol levels is usually the first line of intervention for prevention and treatment of cardiovascular diseases. Dramatic successes have been recorded with cholesterol-lowering therapy which may suggest that maintenance of low cholesterol levels is sufficient to prevent development of atherosclerosis or reversing an established disease condition . Different approaches have been used for prevention and treatment of this condition, some are enumerated below.

2.9.1. Role of High density lipoprotein-cholesterol

Several studies have reported conflicting reports on the effect of hormonal replacement therapy on plasma LDL-C and Lp levels . In a cohort study conducted by Danik et al. , the effect of hormone replacement therapy on Lp and cardiovascular risk was investigated. It was reported that the relationship of high Lp levels with increased cardiovascular disease is modified by hormonal therapy. These data suggest that the predictive utility of Lp is markedly attenuated among women taking HT and may inform clinicians’ interpretation of Lp values in such patients. It was noteworthy that the effect of hormonal therapy was observed only in women with high LDL cholesterol levels, in agreement with previous studies suggesting an interaction between Lp and LDL cholesterol .

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Medical Guidelines And Recommendations

In 2016, the United States Department of Agriculture Dietary Guidelines Advisory Committee recommended that Americans eat as little dietary cholesterol as possible, because most foods that are rich in cholesterol are also high in saturated fat and thereby may increase the risk of cardiovascular disease. Previously, the Dietary Guidelines for Americans recommended that dietary cholesterol be no more than 300 mg per day. The DGAC dropped this recommendation because evidence showed no appreciable relationship between dietary and serum cholesterol, consistent with the 2013 report by the American Heart Association and the American College of Cardiology. Although there is a link between cholesterol and atherosclerosis, a 2014 review concluded there is insufficient evidence to support the recommendation of high consumption of polyunsaturated fatty acids and low consumption of total saturated fats for cardiovascular health.

Some supplemental guidelines have recommended doses of phytosterols in the 1.63.0 grams per day range . A recent meta-analysis demonstrating a 12% reduction in LDL-cholesterol at a mean dose of 2.1 grams per day. However, the benefits of a diet supplemented with phytosterols have also been questioned.

Risk for heart disease

> 6.2 High risk

Effects On Cardiovascular Disease

Investigating effects of ruminant trans fatty acids on disease outcomes and comparing these effects with industrial trans fatty acids is challenging because ruminant trans fatty acids are only present in small amounts in the diet. Until the mid 1990s partially hydrogenated vegetable oils containing up to 50% trans fatty acids were widely used in the food industry. In contrast, milk fat naturally contains only some 5% trans fatty acids. As a result, observational studies have lacked the power to pick up an effect of this small amount of ruminant trans fatty acids, if any, amid so many other factors that affect the risk of cardiovascular disease. Many observational studies have investigated the associations between trans fatty acid concentrations in blood or adipose tissue and the risk of cardiovascular disease, but when blood or adipose tissues are studied it is not possible to distinguish which trans fatty acid is coming from which source. Only very few observational studies have investigated separate effects of dietary ruminant trans fatty acids. A meta-analysis of four prospective cohort studies did not show a significant association between intake of ruminant trans fatty acids and coronary heart disease . Intake of total trans fatty acids in these studies ranged from 2.8â10âg/day.

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Dietary Intervention Trial Evidence

Many studies of cholesterol lowering by dietary means have been carried out. In 1946 Morrison initiated a dietary trial consisting of an experimental group of 42 men and 8 women who were survivors of a MI and a control group of 43 men and 7 women. Alternate patients were placed on a low-fat , low-cholesterol diet and were followed for 3 y. Patients in the experimental group were found to have significant reductions in total cholesterol concentrations and less CHD mortality at the 12-y follow-up. Several other relatively small trials were conducted between 1956 and 1965, which similarly concluded that restriction of dietary fat and cholesterol, under controlled conditions, significantly reduces CHD mortality .

Selected dietary intervention trials with coronary heart disease morbidity or mortality or both as endpoints


Dietary Cholesterol Food Sources

What is Non Hdl Cholesterol?

Dietary cholesterol is a main steroid from animal tissues. The main food sources include egg yolk, shrimp, beef, and pork, poultry, as well as cheese and butter. According to NHANES data, the top five food sources of cholesterol in the American population are eggs, and mixed egg dishes, chicken, beef, and beef mixed dishes, burgers, and regular cheese . There are two main sources that contribute to and make up the liver cholesterol pool, namely dietary cholesterol , and de novo cholesterol which is synthesized in the liver or extra-hepatic tissue.

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Full Fat Or Reduced Fat Dairy

Although full fat dairy foods contain saturated fat, it appears this type of fat has a neutral relationship with heart health.

The Heart Foundation recommends unflavoured milk, yoghurt and cheese can be consumed by the general population but for people who need to lower their LDL cholesterol, reduced fat versions should be consumed instead.

Testing Your Lipid Profile

The danger of consuming foods rich in cholesterol and saturated and trans fats cannot be overemphasized. Regular testing can provide the foreknowledge necessary to take action to help prevent any life-threatening events.

Current guidelines recommend testing for anyone over age twenty. If there is a family history of high cholesterol, your healthcare provider may suggest a test sooner than this. Testing calls for a blood sample to be drawn after nine to twelve hours of fasting for an accurate reading.

According to the National Institutes of Health , the following total cholesterol values are used to target treatment:National Heart, Lung, and Blood Institute, National Institutes of Health. High Blood Cholesterol: What You Need to Know. NIH Publication No. 05-3290. . Section 2.01.

  • Desirable. Under 200 milligrams per deciliter
  • Borderline high. 200239 milligrams per deciliter
  • High risk. 240 milligrams per deciliter and up
  • According to the NIH, the following desired values are used to measure an overall lipid profile:

    • LDL. Less than 160 milligrams per deciliter
    • HDL. Greater than 4060 milligrams per deciliter
    • Triacylglycerols. 10150 milligrams per deciliter
    • VLDL. 238 milligrams per deciliter

    Video 4.5.1: Understanding Cholesterol

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