Atherosclerosis | Cholesterol, LDL, HDL, Triglycerides

Atherosclerosis & Cholesterol. Are LDL, HDL and triglycerides good measures of atherosclerosis risk? A look at atherosclerosis, cholesterol and tips to dodge a heart attack.

how to dodge a heart attack? let's look at atherosclerosis aka plaque and best lab tests to prevent it

LDL? LDL-cholesterol? people call them both LDL. HDL? VLDL? IDL…

cholesterol is carried in our bloodstream by lipoproteins. lipoproteins are the buses and cholesterol is the passenger

some get stuck in the artery wall. if there’s a lot of lipoproteins in the blood, over the years this forms plaque aka atherosclerosis

plaque can block blood flow and cause angina (chest pain when the heart muscle doesnt get enough blood). plaque can also break and clot causing a heart attack

lipoproteins: LDL (low dens lipoprotein). VLDL or very low density lipoprotein

LDL and VLDL are the same family. there’s other families of lipoproteins but these are the main ones that cause atherosclerosis

this family of lipoproteins includes LDLs, VLDLs etc. they all carry apoB.

we can measure these lipoproteins by measuring apoB

lipoproteins cause atherosclerosis but blood work measures LDL-cholesterol (cholesterol in LDL) and triglycerides. they estimate risk of atherosclerosis

European atherosclerosis society: LDL-cholesterol is a satisfactory surrogate for LDL particle number. so high LDL-cholesterol is a red flag. and same for triglycerides

online: focus on LDL-cholesterol, ignoring triglycerides vs focus on triglycerides & ignoring LDL-cholesterol

both markers of lipoproteins that cause atherosclerosis. risk of atherosclerosis determined by apoB particles regardless of lipids… benefit of lipid-lowering (so, lowering cholesterol or triglycerides) proportional to reduction in apoB regardless of the change in LDL-Cholesterol or triglycerides

if LDL-cholesterol is high, number of LDL lipoproteins is often high. high LDL-cholesterol is a red flag and indicates high apoB

cholesterol/triglycerides reflect lipoproteins. exceptions: lipoproteins rule, not LDL-cholesterol or triglycerides

normal number of lipoproteins, normal apoB + high LDL-cholesterol/triglycerides=normal risk

high lipoproteins, high apoB + normal cholesterol/triglycerides= high risk of atherosclerosis

LDL-c/triglycerides are like the check engine light. checking engine directly = apoB

HDL-cholesterol aka ‘good cholesterol’?

people with high HDL-cholesterol tend to have less heart disease
causal relationship? raise HDL-cholesterol specifically

analysis: raising HDL-cholesterol did not lower atherosclerosis risk. raising HDL-cholesterol offers no CV protection

“the effects on cardiovascular disease of foods or nutrients cannot be judged from changes in HDL cholesterol”

HDL-cholesterol: correlates. doesn’t cause benefit. same for ratios using hdl-cholesterol

raising my HDL-cholesterol does nothing for risk

high HDL-cholesterol = distraction

key concepts to dodge atherosclerosis and a heart attack:

1) high apoB buses, apoB lipoprots = risk of atherosclerosis
2) We can measure apo B lipoproteins by measuring apoB
3) LDL-cholesterol and triglycerides are useful but not perfect
4) careful with HDL-cholest

improving our lipids including apoB: diet. more detail on lipids in your blood work

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References:
https://academic.oup.com/eurheartj/ar...
https://jamanetwork.com/journals/jama...
https://jamanetwork.com/journals/jama...
HDL-cholesterol:https://www.ncbi.nlm.nih.gov/pmc/arti...
https://www.ahajournals.org/doi/pdf/1...

Disclaimer: The contents of this video are for informational purposes only and are not intended to be medical advice, diagnosis, or treatment, nor to replace medical care. The information presented herein is accurate and conforms to the available scientific evidence to the best of the author's knowledge as of the time of posting. Always seek the advice of your physician or other qualified health provider with any questions regarding any medical condition. Never disregard professional medical advice or delay seeking it because of information contained in Nutrition Made Simple!.

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