Cholesterol and the heart
THEODORA A. KAROTSAKIS, Cardiologist Specialist
Cholesterol belongs to the class of chemical compounds known as lipids or fats. It is a substance so necessary for humans that our body produces 2/3 of it and only 1/3 is absorbed from the food we eat. Thus, the pathologically high level of cholesterol comes from uncontrolled production by the body, which is greatly enhanced by poor nutrition. Cholesterol is insoluble in water. In order to circulate and reach from the liver where it is mainly produced to the place of consumption (cell) it needs a soluble vehicle (apoprotein b) which, together with it, becomes LDL cholesterol. To return to the liver for neutralization or excretion with bile, the analogous form is HDL cholesterol. If the level of LDL is high, or the level of HDL is low, then it begins to collect on the wall of the arteries, forming atheromatous plaques. These plaques gradually enlarge, narrowing the arteries and even worse if they suffer micro-injuries, a clot is created which can block the artery. When these occur in the arteries of the heart and brain they can cause angina pectoris, myocardial infarction or stroke.
Latest data
What is certain is that with proper treatment, the chance of having a heart attack drops by 20% – 30% for every 10% drop in cholesterol. Latest data on the incidence of elevated cholesterol is that every decade of elevated cholesterol increases the risk of heart disease by 4%. The latest study, published in a peer-reviewed medical journal, showed that those with high cholesterol for 11-20 years had an average 16.5% risk of heart disease, while those with high cholesterol for 1-10 years had a lower risk (8.1%) danger. Those who never had high cholesterol had a 4.4% risk.
Prices – target
In the majority of cases the object of treatment is to reduce the “bad” LDL cholesterol. However, the extent of the reduction is not the same for everyone, it simply depends on the size of the heart risk. This is determined by the presence of coronary artery disease, heredity and the presence of other predisposing factors for coronary artery disease (hypertension, smoking, diabetes mellitus, obesity). So today if there is a history of coronary heart disease, achieving an LDL value <70 mg/dl is ideal for maximum protection. But if there are only predisposing factors without disease then the need for treatment is lower and the target value for LDL is from 100-160 mg/dl depending on the number of factors.
Treatment
The means we have to control hypercholesterolemia are drugs and the adoption of non-aggravating eating habits. Let’s start with the eating habits that are also less expensive:
• Reduced consumption of animal fat (red meats, cheeses, especially yellow)
• Avoiding a high-calorie diet and saturated fats (fried oil, margarines) because they increase LDL.
• Avoiding vegetable polyunsaturated oils because they reduce HDL. Pure monounsaturated olive oil does not reduce it.
• Little consumption of meat and a frequent diet of pulses, fish, poultry, fruits and vegetables.
• Increase physical activity, stop smoking and reduce body weight to increase HDL.
As far as pharmaceuticals are concerned, we have the following categories.
Statins: reduce LDL production and are the most effective means of lowering LDL cholesterol. Its action seems to be achieved not only by the hypolipidemic property but also by a strong anti-inflammatory action on the atheromatous plaque that prevents its ruptures leading to heart attack. Side effects are gastrointestinal disturbances, burden on liver function and myopathies – myalgias. All reversible with their interruption
Ezetimibe: Reduces cholesterol absorption from the gut and is given with a statin when we can’t reach the LDL target. Nicotinic acid: It is an effective drug that simultaneously reduces LDL and triglycerides, while increasing HDL. Unfortunately, the annoying side effects (flushing and itching) limit its use.
Fibrates: They belong to the older generation and today we exploit their action mainly in severe hypertriglyceridemia.
Resins: prevent dietary cholesterol from being absorbed thus reducing LDL. They are less effective drugs and with more side effects.
Bottom line: Cholesterol is a silent killer, treating hypercholesterolemia reduces the chance of a heart attack or stroke. Medication is necessary, but it must be accompanied by a change in our eating habits, an increase in physical activity, loss of excess weight and cessation of smoking.