Cholesterol is a vital substance naturally found in our bodies. While it plays an essential role in various bodily functions, an imbalance can lead to significant health issues. Low-Density Lipoprotein (LDL) cholesterol, often referred to as bad cholesterol , can accumulate in the arteries, causing atherosclerosis , which is the leading cause of heart attacks and many strokes as well as mortality and disability. A crucial factor in reducing cardiovascular risk is proper adherence to treatment, even when patients experience no symptoms.
Most cells in our bodies can produce cholesterol when necessary, indicating its importance. “However, the beneficial cholesterol produced must not be confused with the cholesterol levels measured in a standard blood test,” explains Leopoldo Pérez de Isla, a cardiology specialist and section chief at Hospital Clínico San Carlos in Madrid.
The Risks of Atherosclerosis
A standard blood analysis can measure a person’s cholesterol levels and categorize this into two types: High-Density Lipoprotein (HDL) known as good cholesterol , and LDL. “When LDL cholesterol levels in the blood remain elevated over time, it starts to deposit in the arteries, leading to atherosclerosis , which is a primary factor for myocardial infarctions and many strokes, as well as conditions related to the aorta and iliac arteries,” Dr. Pérez de Isla explains.
The Challenge of Asymptomatic Conditions
One of the challenges in tackling hypercholesterolemia is that elevated cholesterol usually does not manifest clear symptoms, making a blood test the only reliable way to identify its levels. It’s even recommended that children undergo cholesterol testing between ages 9 and 11 , especially if they have a family history of high cholesterol or cardiac diseases, notes Dr. Pérez de Isla. Adults should check their levels every 4 to 6 years , and more frequently if they have health issues like diabetes or hypertension. “It’s especially crucial for women to monitortheir cholesterol levels as they enter menopause.”
Controllable Factors: Diet and Exercise
High cholesterol levels are often linked to genetic predispositions, but they can also be positively or negatively influenced by controllable factors, such as diet and physical activity . “A diet high in saturated and trans fats contributes to this issue. In severe cases, such as familial hypercholesterolemia, individuals may experience significantly elevated cholesterol levels from birth,” explains Dr. Pérez de Isla.
Different Profiles Based on Risk Factors
“It’s essential to understand that alongside LDL cholesterol levels , several other risk factors can accelerate the formation of atherosclerosis,” the cardiology specialist emphasizes. Therefore, having a certain level of LDL cholesterol in a patient who has multiple other risk factors, such as obesity, a sedentary lifestyle, smoking, diabetes, or hypertension, poses different risks compared to someone with the same LDL level but fewer risk factors.
An elevated LDL cholesterol level leads to atherosclerosis , which can result in life-threatening and quality-of-life-reducing conditions such as acute myocardial infarction, angina pectoris, stroke, and acute or chronic obstruction of the leg arteries, warns Dr. Pérez de Isla.
Prevention
To prevent and manage high cholesterol, the first crucial step is to adopt a balanced diet rich in fruits , vegetables , fish , and whole grains , while limiting saturated and trans fats. Maintaining a healthy weight and engaging in at least 30 minutes of exercise daily are significant contributors to your overall cardiovascular health. Additionally, avoiding smoking and minimizing alcohol consumption are vital elements for preventing cardiovascular disease.
For those individuals in whom these measures are insufficient, or where a doctor assesses that dietary and lifestyle changes alone won’t suffice, the use of medications to lower cholesterol becomes necessary. “It’s important to manage cholesterol levels not just based on whether they are too high or low, but to consider the presence of other factors that might necessitate or dictate how aggressively to pursue cholesterol reduction,” emphasizes Dr. Pérez de Isla.
Adherence to Therapy is Key
Another critical aspect of cholesterol management is ensuring proper adherence to prescribed therapy. This expert underscores that “it is especially important to remember that treatments should be used exactly as directed by the physician and that drugs to lower lipid levels should generally be taken daily unless the physician indicates otherwise.” Maintaining this regimen has been shown in various studies to reduce the likelihood of cardiovascular problems.
“I Am a Chronic Patient”
Tomás Fajardo, a patient and president of Cardioalianza, recognizes the reality of living with cholesterol-related issues. “One of cholesterol’s problems is that it’s a silent disease without symptoms.” He has experienced two heart attacks, one approximately 23 years ago and another 11 years ago. From experience, he understands, “I am a chronic patient, and I must follow the treatment exactly as prescribed. Even when I feel fine, I need to reduce the risk of another cardiovascular episode.”
However, Fajardo also points out the importance of advocacy for adherence, particularly in secondary prevention, noting that “it’s not uncommon for someone to stop treatment due to muscle pain when alternatives exist, or they might mistakenly believe that a food product that lowers cholesterol could replace medications.” A thorough understanding of their condition and the implications of elevated cholesterol levels is essential for patients.
A Broad Therapeutic Arsenal
Several effective medications are available to control LDL cholesterol levels when necessary. Statins continue to be the first-line treatment for dyslipidemia, demonstrating clear clinical benefits despite potential side effects like muscle pain. New therapies such as ezetimibe , PCSK9 inhibitors (evolocumab and alirocumab), and inclisiran provide additional options for high cardiovascular risk patients, explains Dr. Pérez de Isla.
One recent innovation is bempedoic acid , a new oral treatment that significantly reduces LDL cholesterol levels. A large clinical trial (CLEAR Outcomes) demonstrated that it could lessen vascular events in high-risk patients who cannot tolerate statins without causing muscle discomfort. “In addition to clinical trials, real-world studies like MILOS support the effectiveness of bempedoic acid, showing a notable improvement in LDL cholesterol control when combined with other therapies,” adds the expert. Consequently, bempedoic acid is currently considered a safe and complementary therapeutic option for those who cannot achieve lipid goals with statins or cannot use them.
Overall, managing cholesterol levels remains a multifaceted approach balancing lifestyle changes, medication adherence, and professional guidance to ensure optimal cardiovascular health.