Good and bad cholesterol are something we often hear spoken about, but what do they actually mean and how can they impact on our overall health?

Cholesterol is a waxy, fat-like substance which is naturally present in our blood.

Cholesterol is important to have in the body for a number of reasons. Your body needs some cholesterol to make some vital hormones and vitamin D as well as some substances that help you digest your food. Your body is capable of making all the cholesterol it requires for healthy function.

Lifestyle factors such as our diets, level of activity, whether we smoke and family history all play a part in our level of good and bad cholesterol.

Our levels of good and and bad cholesterol also play a part in our risk of heart disease.

LetsGetChecked is joined by Dr. Jeremy Bock to explain everything you need to know when it comes to good and bad cholesterol, including the advice he gives his patients when it comes to lowering the likelihood of cardiovascular issues down the line.

good-and-bad-cholesterol-explained-diagram-of-heart


Contents



Good and Bad Cholesterol: What is the Difference?


There are two main types of cholesterol: high-density lipoprotein (HDL) and low-density lipoprotein (LDL) or good and bad cholesterol.

HDL is known as “good cholesterol”. HDL transports bad cholesterol to your liver to be expelled from the body.

LDL is known as “bad cholesterol”. LDL it takes cholesterol to your arteries, where it may collect in the artery walls.

Too much LDL cholesterol in your arteries may lead to a buildup of plaque known as atherosclerosis. This can increase the risk of blood clots in your arteries. If a blood clot blocks an artery in your heart or brain, you may experience a stroke or heart attack.

good-and-bad-cholesterol-explained-healthy-vs-unhealthy-arteries-

If you would like to learn about good and bad cholesterol via our podcast, check out our latest episode: Matters Of The Heart | Your Guide


What Causes High Cholesterol?


Family history

You can be really unlucky and have a family history of high cholesterol, that is to say, a first-degree relative (parent, sibling, aunt, uncle) may suffer from high cholesterol. It could be the case, in this instance, that no amount of dieting or exercise will bring down your cholesterol levels and you may require some medication.

Obesity

Being overweight or obese is usually defined by having a body mass index (BMI) of 30 or greater. Alternatively, having a waist circumference over 40 inches for men or over 35 inches for women can put you at risk of having high cholesterol levels.

Diet

A diet that includes large quantities of red meat, full-fat dairy products, saturated fats, trans fats, and processed foods usually puts you at a very high risk of having high cholesterol.

Smoking

Cigarette smoke damages the walls of your blood vessels, making them more likely to accumulate fatty deposits. Smoking may also lower your level of HDL or “good,” cholesterol.


How to Treat High Cholesterol?


To treat high cholesterol, it is recommended that patients make some lifestyle modifications.

Lifestyle changes such as exercising and eating a healthy diet are the first line of defence against high cholesterol.

Other necessary lifestyle changes to begin with include:

  • Quitting smoking
  • Eating a healthy diet
  • Exercising regularly, 3 times a week for 20 mins
  • Reducing stress where possible

Monitoring Your Cholesterol


good-and-bad-cholesterol-explained-artery-illustration

You can get a blood lipid panel from your doctor or you can purchase a convenient and accurate home test from LetsGetChecked. The Cholesterol Test requires a finger prick blood sample. It tests for:

  • Triglycerides – a type of fat in the blood
  • HDL – good cholesterol
  • LDL – bad cholesterol
  • HDL % of total Cholesterol

Blood lipid panel testing is important to ensure that underlying issues don’t develop into serious health problems. Many cases of heart disease and heart attack/stroke can be avoided with regular testing.


Cardiologist, Dr. Jeremy Bock Shares His Advice


Dr. Jeremy Bock works at Virginia Hospital Center as an Interventional Cardiologist and an Endovascular Specialist.

good-and-bad-cholesterol-explained-image-of-dr-bock

What Is Heart Disease?

I think when most people think of heart disease, they think of coronary heart disease which is a buildup of plaque in the heart arteries which puts them at risk for death and disability, period.

At least in developed nations, that type of heart disease is the number one cause of death and so, it is an important subject to discuss with patients and with non-patients in the community. We need to be very aggressive in treating certain risk factors for that disease.

How Can You Prevent A Heart Attack?

I think we are seeing the same amount of heart disease but people are living longer with it, so if you look back about 40 years ago, or more, the treatment of a heart attack was to put the patient into a quiet room, put them on pain control and prevent them from developing a life threatening heart rhythm as a result of the heart attack.

There is no way of stopping the heart attack, which means in 2019, we go in and remove the blockage from the arteries so we can resupply the blood vessel with blood.

Not so long ago, we didn’t have that option so people would die of heart attacks or would end up severely disabled because they lost so much heart tissue as a result of the heart attack that the heart was no longer an effective pump so I think that we still see a lot of that today but we have very good treatments so we can prevent second events and people are living longer with better qualities of life even though they have this type of heart disease.

What Are Some Of The Common Risk Factors For A Heart Attack?

I tell patients that the development of heart disease rests on the accumulation of multiple risk factors. Some of these risk factors are modifiable and they include smoking, being overweight, not exercising and a poor diet. Then there are the non-modifiable risk factors and these are things that you are stuck with. Examples include age, sex and family genetics.

If multiple family members had heart events before the age of 50, then your likelihood of developing similar events is much higher. This is something that we can’t escape, but it gives us a reason to be more aggressive with the things that we can change.

Are Men Or Women More Likely To Have A Heart Attack?

Statistically, males have more cardiovascular events than females and part of it is the genetics of being male.

Other factors are that men typically mistreat their bodies more, men are more prone to hard-living.

However, the has been a lot more attention recently on women and heart disease, as heart disease is rising faster in women than men so women may actually catch up soon. That is why there has been that focus on “Go Red For Women”, there rates of cardiovascular disease has been on the rise.

I think body habitus is important but it is just one of many risk factors that contribute to disease, I think that women have parts that men don’t have that have a lot of fat in them, for instance, breasts.

Women are more likely to be a higher fat percentage but there is a protective effect of hormones that only women have such as estrogen so that may explain part of the theory.

What Are The Two Greatest Risk Factors For Heart Disease?

Smoking and diabetes.

If you’re smoking and you have diabetes, you’re a walking time bomb. Diabetics develop a very specific form of lipid problems where good cholesterol is too low and bad cholesterol is too high.

We call it dyslipidemia, everything in the body is connected. A lot of this stuff spills over into other organ systems, I think with one risk factor comes another. You don’t see a lot of people who are smoking one half or a full box of smokes a day also running 2-3 miles each day.

All of these risk factors seem to run together in groups.

What Is The Difference Between Good And Bad Cholesterol?

The lipid system in the body is very complex but essentially when we talk about cholesterol, we talk about molecules that can be carried towards the arteries and they are carried by a molecule called low density lipoprotein, also known as LDL or bad cholesterol. So this molecule brings cholesterol and triglycerides to the artery, they are deposited in the artery.

Our white blood cells come along and eat that cholesterol and that leads to an inflammatory cascade so you develop this lipid pool within the blood vessel wall which is also inflamed and swollen and angry, and if one of those blood clots should rupture, you are having a heart attack.

The opposite to low density lipoprotein, which is known as high density lipoprotein is a molecule which does the opposite. It transports cholesterol and triglycerides out of the blood vessel wall and returns them to the liver so they can be broken down and eliminated. HDL or high density lipoprotein, so ideally, you want to keep bad cholesterol low and the good cholesterol high.

Can You Raise HDL Cholesterol Artificially?

Our current thinking is that artificially raising your HDL using medications is not really helpful in terms of a risk reduction, however, lifestyle and diet, that effect on HDL is beneficial, there are a number of foods that you typically hear about, such as avocado, flaxseed, some fatty fish that contribute to higher HDL, also exercise, controlling your blood sugar, especially for diabetics can have a beneficial impact on your HDL.

What Is The Most Common Treatment Used For Those Who Are At High Risk For A Heart Attack?

The most common class of medication being used is the statin use of medicines and they are used to prevent mature cholesterol from being formed in the liver. Those have been found to be very very beneficial, not only because they lower LDL or bad cholesterol but also because they also have a potent anti-inflammatory effect that would lead to the destabilization of the heart arteries. This process depends on 1. The type of lipid being there and 2. The level of inflammation that makes the plaque angry.

Someone’s risk is really a spectrum, it’s not a grey area in terms of what is high risk, we as cardiologists because we like to fit patients into categories because it allows us to come up with guidelines and methods to implement preventative care, we can use a risk assessment tool where we plug in patient data and we can come up statistically with what a patient’s risk is.

How Can A Patient Learn More About Their Risk?

The most common class of medication being used is the statin use of medicines and they are used to prevent mature cholesterol from being formed in the liver. Those have been found to be very very beneficial, not only because they lower LDL or bad cholesterol but also because they also have a potent anti-inflammatory effect that would lead to the destabilization of the heart arteries. This process depends on 1. The type of lipid being there and 2. The level of inflammation that makes the plaque angry.

Someone’s risk is really a spectrum, it’s not a grey area in terms of what is high risk, we as cardiologists because we like to fit patients into categories because it allows us to come up with guidelines and methods to implement preventative care, we can use a risk assessment tool where we plug in patient data and we can come up statistically with what a patient’s risk is.

If your 10 year risk is over 20%, you have a 20% chance of having a heart attack, or a stroke or sudden death in the next 20 years, most of us will put a patient on a statin, regardless of what their cholesterol level is.

There is actually an app that I actually have on my iPhone, The app is called ASCVD PLUS. It’s a tool developed by the American School Of Cardiology and it’s a free download in the Apple app store. It plugs in number such as blood pressure, age, smoking status and your most recent lipid panel and it will spit out a number of what your 10 year risk is.

How Often Should People Be Getting Tested?

It depends, if you have no cardiovascular risks, but you just want to answer the question, every 5 years is reasonable, if you have heart disease and are really trying to aggressively manage each of these risk factors, a lot of times, we will recommend that patients get checked once per year.

Every person over the age of thirty should have a doctor and get basic lab work done with a regular doctor, including a fasted lipid panel, because often times these risk risk factors are silent. Just having high LDL doesn’t make you feel bad but what it does do is slowly accumulate until you do have a problem.

It’s like colon cancer, once you get symptomatic colon cancer, it is usually pretty advanced and that is why we recommend screening colonoscopies.

The same thing with lipids, if people have circulating LDL lipids of 300, you’re not going to feel bad but by the time you get to the age of forty eight, you’re going to have a heart attack, even though that is a very young age for that to happen.

What Do Cholesterol Tests Generally Measure?

Lipid tests need to look for HDL, LDL, triglycerides and total cholesterol. Today, I feel like more people know what there total cholesterol is, than the individual numbers, but I actually don’t look at total cholesterol, I like to look at the different fractions because you can have higher cholesterol because the good cholesterol is high and you may be in a lower risk group.

In regular lipid panel tests, total cholesterol, triglycerides and HDL are all measured and LDL is a total calculated number of these other indexes.

What About When It Comes To Diet, Would You Be More Likely To Recommend Going Plant Based Or Carbohyrdrate Free?

I never recommend extremes but I know that there is now very good evidence that suggests that certain foods, namely carbohydrates, can lead to weight gain, insulin resistance and inflammation which increases the risk of cardiovascular disease.

When it comes to carbs, I think to the degree that most people eat them is a bad thing and I think it’s one of the key factors that come into the development of diabetes and obesity.

I also think that our systems or metabolisms were not meant to be eating a lot of the things that we are eating today. If you look back a couple of thousand years, you’re eating meat and plants.

We have all of this stuff in the grocery stores that is processed and didn't really exist years ago and we are shovelling them into bodies and our metabolism doesn’t know what to do with these things.

I understand the reasoning in why a keto or paleo diet would be healthy. That being said, I have never been a big believer in eliminating entire food groups.

What I recommend to my patients is often that if they decrease their carbohydrate intake by 50% and replace that with lean meats, vegetables and some fruit, not only will they lose weight, and not only will their insulin resistance improve and not only will they have more energy but they will vastly improve their cardiovascular risk.

I think in saying that, the keto diet is hard to do for a lot of people. One of my partners who is a firm believer in this has had some amazing results with some of his patients and it completely changed their life.

Things exist because you need to have them in your diet. There are particular food groups that offer essential nutrients that you really need to have. Moderation is key but I also think that diets that are purely based on calorie restriction are in the long term, destined to fail.

If I told a patient, you’re 50 pounds, 75 pounds overweight, you need to cut down your caloric intake by a third, I just don’t think that is a reasonable thing to expect a patient to be able to accomplish. If something is making you miserable, it’s impossible to stick to it long term which is why I think these Keto or paleo diets are more helpful because often times, patients aren’t hungry so they are shifting their calories into something that is just not as bad for them.

What Would Be Your Main Advice To Patients?

I think everyone should have a screening for their cholesterol level for sure. Just like everyone should have their blood checked periodically, or get a BMI and understand how their body weight and their body habitus compares to what is considered normal and healthy.

These are basic things that counsel patients in how they should be healthier and live a more healthy and happy life.


Thinking about taking a Cholesterol Test? View tests at www.letsgetchecked.com/.


Written by Hannah Kingston | Approved by Medical Director Dominic Rowley