When we talk about cardiovascular health, the first thing that usually comes to mind is blood fats, specifically the well-known cholesterol. It is important to note that cardiovascular health does not depend solely on cholesterol; however, it does play an important role in it.
Cholesterol is a molecule with multiple functions in the body, such as hormone synthesis, the formation of structures like cell membranes, and the production of vitamin D and bile acids, among others. Humans are not only able to obtain this molecule through the intake of foods of animal origin, but we are also capable of synthesizing it ourselves.
In order to reach its destination and perform its functions in the body, cholesterol is transported in different particles such as chylomicrons, VLDL, IDL, LDL (known as bad cholesterol), and HDL (known as good cholesterol). Almost everyone has heard about the latter two, knowing that the good one should be high and the bad one should be low—but the question is, are they really that good and that bad?
HDL cholesterol (the “good” one) has been known for many years for its protective effect against coronary artery disease. However, recent studies have shown that this protective effect is not so clear-cut due to the subtypes of this molecule and the physiological condition of individuals. In other words, it does not act in the same way in a healthy adult compared to someone with conditions such as established coronary artery disease or chronic kidney disease, in which elevated levels may actually complicate their situation.
LDL cholesterol (the “bad” one) is known for its role in promoting the formation of atherosclerotic plaques, increasing the risk of atherosclerosis and its related complications. This effect has been extensively studied and confirmed in people with excessively high levels of this type of cholesterol. On the other hand, at normal levels, this type of cholesterol is responsible for transporting 60–70% of the cholesterol found in the blood, allowing it to reach its destination and fulfill its function.
Therefore, it is clear that the good cholesterol is not always that good, nor is the bad cholesterol entirely that bad. However, thinking only about these two types of cholesterol as markers of cardiovascular health is a mistake. If we reread the second paragraph of this article, we will remember that other types of cholesterol-carrying particles were mentioned, which, when studied together, are known as remnant cholesterol.
Remnant cholesterol is made up of the cholesterol contained in VLDL, IDL, and chylomicron particles. This type of cholesterol is gaining increasing clinical importance due to the consequences that elevated levels may entail. Several studies indicate that high levels can significantly increase the risk of ischemic coronary disease, myocardial infarction, and raise the risk of all-cause mortality in people with obesity. Moreover, this cholesterol may be associated with cardiovascular events even when LDL cholesterol levels are low!
Researchers based in Copenhagen (Varbo A. et al.) decided to study remnant cholesterol levels and their relationship with the risk of myocardial infarction in 106,216 people—not only those with obesity, but also individuals who were overweight or of normal weight. They showed that this marker increases the risk of myocardial infarction regardless of body weight. In fact, body weight explained only 12% of the variability of this parameter, indicating that it is not the only variable that needs to be monitored.
Therefore, it is clear that good and bad cholesterol are not the only players in cardiovascular risk, and that we need to monitor the levels of all types of cholesterol in order to properly manage our cardiovascular health. What strategies can we use to correctly control the levels of all the different types of cholesterol?
1. Getting to know ourselves better: studying our body in an integrated way through genetic testing and combining this information with markers obtained from blood tests allows us to understand where to start when addressing these types of alterations.
2. Controlling our diet: as mentioned earlier, part of cholesterol intake comes from food. However, fluctuations in cholesterol levels depend less on the amount of cholesterol in foods and more on their fat composition.
3. Engaging in physical exercise: exercise is one of the key factors for increasing HDL cholesterol levels.
4. Using phytosterols: this strategy is only useful if excess cholesterol is due to excessive dietary intake. These molecules help reduce the absorption of cholesterol from food. To determine whether this is the cause, it is recommended to consult a healthcare professional.
5. Increasing our omega-3 intake: thanks to the role this fat plays in regulating the expression of certain proteins that make up HDL cholesterol, it can help increase its levels.
