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Lipid Panel Atherosclerosis

LDL-C

Optimal Result: 0 - 99.1 mg/dL, or 0.00 - 2.57 mmol/L.

Understanding Low-Density Lipoprotein Cholesterol (LDL-C):

Low-density lipoprotein cholesterol (LDL-C) is a critical biomarker in assessing cardiovascular health, commonly known as "bad" cholesterol due to its association with increased risk of heart disease. LDL-C is one of the primary lipoproteins responsible for transporting cholesterol to cells throughout the body. While cholesterol is essential for building cell membranes and producing hormones, excess LDL-C can lead to the formation of plaque in the arteries. This plaque buildup, or atherosclerosis, can restrict blood flow, making arteries less flexible and more prone to blockages. Elevated levels of LDL-C are a significant risk factor for developing coronary artery disease, stroke, and peripheral artery disease. Therefore, maintaining optimal LDL-C levels is crucial for heart health. Health experts recommend regular screening through a lipid profile, which measures LDL-C along with high-density lipoprotein cholesterol (HDL-C), total cholesterol, and triglycerides. A comprehensive understanding of LDL-C and its impact on the body is essential for preventing cardiovascular diseases and promoting overall well-being.

Conditions Associated with Elevated LDL-C Levels:

Elevated LDL-C levels are strongly associated with several cardiovascular conditions, including:

  1. Coronary Artery Disease (CAD): High LDL-C levels contribute to the development of plaque in the coronary arteries, leading to reduced blood flow to the heart muscle.
  2. Peripheral Artery Disease (PAD): Elevated LDL-C can cause plaque buildup in the arteries that supply blood to the limbs.
  3. Stroke: LDL-C can contribute to the narrowing and blockage of arteries in the brain, increasing the risk of ischemic stroke.
  4. Chronic Kidney Disease (CKD): High cholesterol levels are common in CKD and can exacerbate the progression of the disease.

Possible Reasons for Elevation:

Several factors can lead to elevated LDL-C levels, including:

  1. Diet: Consuming foods high in saturated and trans fats can increase LDL-C levels.
  2. Lack of Physical Activity: Sedentary lifestyle contributes to higher LDL-C and lower high-density lipoprotein cholesterol (HDL-C).
  3. Genetics: Familial hypercholesterolemia is a genetic disorder characterized by high LDL-C levels.
  4. Obesity: Excess body weight is linked to higher LDL-C levels and lower HDL-C levels.
  5. Medical Conditions: Conditions such as hypothyroidism, nephrotic syndrome, and liver diseases can increase LDL-C levels.
  6. Medications: Certain medications, like diuretics, beta-blockers, and corticosteroids, can elevate LDL-C levels.

Treatment Considerations:

Managing high LDL-C levels involves a combination of lifestyle changes and, if necessary, medication. Key treatment strategies include:

  1. Dietary Changes: Adopting a heart-healthy diet low in saturated and trans fats, and high in fruits, vegetables, and whole grains.
  2. Physical Activity: Engaging in regular exercise to help lower LDL-C and raise HDL-C levels.
  3. Weight Management: Achieving and maintaining a healthy weight can significantly reduce LDL-C levels.
  4. Medications: Statins are commonly prescribed to lower LDL-C levels. Other medications include bile acid sequestrants, ezetimibe, and PCSK9 inhibitors.
  5. Regular Monitoring: Periodic lipid profile tests to monitor LDL-C levels and adjust treatment as necessary.

Correlated Biomarkers:

Several other biomarkers are often correlated with LDL-C levels and can provide a more comprehensive picture of cardiovascular risk:

  1. High-Density Lipoprotein Cholesterol (HDL-C): Known as "good" cholesterol, higher levels are associated with a lower risk of heart disease.
  2. Triglycerides: Elevated levels of triglycerides can also contribute to atherosclerosis.
  3. Total Cholesterol: This includes LDL-C, HDL-C, and other lipid components.
  4. C-Reactive Protein (CRP): An inflammatory marker that can indicate increased cardiovascular risk when elevated.

Nutrient Associations:

Certain nutrients and dietary components can influence LDL-C levels:

  1. Fiber: Soluble fiber, found in oats, fruits, and vegetables, can help reduce LDL-C levels.
  2. Omega-3 Fatty Acids: Found in fatty fish, flaxseeds, and walnuts, these can help lower LDL-C and triglycerides.
  3. Plant Sterols and Stanols: Naturally occurring in plants, these substances can help block the absorption of cholesterol in the intestines.
  4. Antioxidants: Vitamins C and E, as well as polyphenols found in fruits and vegetables, can protect against LDL-C oxidation.

References:

Grundy, S. M., Stone, N. J., Bailey, A. L., et al. (2018). 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 139(25), e1082-e1143.

National Heart, Lung, and Blood Institute. (2021). High Blood Cholesterol. Retrieved from NHLBI.

Labcorp Test Details. (2024). LDL-C Test. Retrieved from Labcorp.

What does it mean if your LDL-C result is too high?

Talk to your healthcare practitioner about a potential treatment plan. A high level of LDL-C can increase your risk for coronary heart disease. If your LDL-C is high enough, a statin prescription may be desirable. Statins lower your cholesterol by inhibiting the liver enzyme responsible for the production of cholesterol. 

- Reducing your LDL-C will reduce your risk for coronary heart disease. [L]

- Dietary cholesterol consumption has a clear connection to blood cholesterol concentrations [L]

- Multiple studies have linked dietary patterns with incidence of coronary heart disease and found that groups consuming predominantly plant-based foods, versus animal-based, have lower rates of heart disease. [L]

Various studies [L, L, L, L, L, L, L, L] have shown that nutritional and lifestyle interventions have halted and even reversed coronary artery disease (CAD). The interventions included among other things:

- low-fat vegan whole-foods plant-based diet, 
- stopping smoking, 
- stress management training, 
- and moderate exercise

The easiest lifestyle adjustment you can make to lower LDL-C is to eat better and exercise more.

Specifically:

- Eat foods that are low in saturated fat, trans fats, and dietary cholesterol. Here is a general guide to following a whole food plantbased diet. 

- Remove all type of meats from diet [L]

- Remove coconut oil from diet. [L]

- Eat fiber rich food

- Exercise at least 2.5 hours / week

- Lower stress

- Limit alcohol intake

- Quit smoking

In addition to the above there are a few "adjuvants" that can help to lower LDL-C:

- a comparative clinical study [L] has shown that Amla ("Indian Gooseberries") can help lower LDL-C and can offer significant protection against atherosclerosis and coronary artery disease.

- Psyllium can have long-term cholesterol-lowering effects [L]

- Black Cumin powder (Nigella sativa) has a significant impact on plasma lipid concentrations, leading to lower total cholesterol, LDL-C, and TG levels while increased HDL-C is associated [L].

- Niacin. [L, L] 

  • Niacin has been widely used as a pharmacologic agent to regulate abnormalities in plasma lipid and lipoprotein metabolism and in the treatment of atherosclerotic cardiovascular disease. Although the use of niacin in the treatment of dyslipidemia has been reported as early as 1955, only recent studies have yielded an understanding about the cellular and molecular mechanism of action of niacin on lipid and lipoprotein metabolism. In brief, the beneficial effect of niacin to reduce triglycerides and apolipoprotein-B containing lipoproteins (e.g., VLDL and LDL) are mainly through: a) decreasing fatty acid mobilization from adipose tissue triglyceride stores, and b) inhibiting hepatocyte diacylglycerol acyltransferase and triglyceride synthesis leading to increased intracellular apo B degradation and subsequent decreased secretion of VLDL and LDL particles. The mechanism of action of niacin to raise HDL is by decreasing the fractional catabolic rate of HDL-apo AI without affecting the synthetic rates. Additionally, niacin selectively increases the plasma levels of Lp-AI (HDL subfraction without apo AII), a cardioprotective subfraction of HDL in patients with low HDL. Using human hepatocytes (Hep G2 cells) as an in vitro model system, recent studies indicate that niacin selectively inhibits the uptake/removal of HDL-apo AI (but not HDL-cholesterol ester) by hepatocytes, thereby increasing the capacity of retained HDL-apo AI to augment cholesterol efflux through reverse cholesterol transport pathway. [L] 

Disclaimer: Please consult your doctor before starting any treatment plan.

Note to vegans: If you are already following a plantbased diet, keep in mind that not all vegan foods are necessary beneficial for your health. This might include juices/sweetened beverages, refined grains, potatoes/fries, sweets. [L, L]

What does it mean if your LDL-C result is too low?

Low levels of low-density lipoprotein cholesterol—“bad” cholesterol—mean a lower risk of developing heart disease. As mentioned, this is because when there is excess LDL-C in the blood, it contributes to the buildup of plaque in the arteries, which can result in heart attack or stroke if a clot tries to pass through.  

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