The latest truth about cholesterol, lifestyle

With the Ministry of Health and the Academy of Medicine publishing the latest regional guidelines on cholesterol in December 2023, we spend endless hours peering into our phones and searching for the truth about cholesterol through various social media platforms. No longer needed. Why not walk through carefully selected information about cholesterol and extract the essence that relates to our daily lives?

Bad cholesterol is the real bad guy

Almost all adults know that cholesterol is a type of fatty substance that can accumulate in artery walls and cause narrowing of the ductus arteriosus, but is there really such a thing as good cholesterol? The advent of a new class of cholesterol-lowering drugs is allowing doctors to take a closer look at the area of ​​very low levels of low-density lipoprotein cholesterol (LDL-C or “bad” cholesterol), and the central role of LDL-C is now being investigated. Confirmed. due to stroke or heart attack.

Current evidence supports the view that greater absolute reductions in LDL-C are associated with lower risk of heart disease and stroke, meaning that lower LDL-C is better. In contrast to lowering LDL-C, studies of increasing high-density lipoprotein cholesterol (HDL-C) do not correlate with reductions in cardiovascular events. Therefore, it was previously called “good” cholesterol (HDL-C), but it never lived up to its reputation.

no need to fast

If you've never had your cholesterol checked in your life, you should do so before you turn 40. It is common practice to fast for about 12 hours and then take a fasting blood sample the next day, but fortunately recent studies have shown that the difference between fasted and non-fasted samples is not significant in the majority of patients. . Therefore, the next time he visits the doctor's office, he will not have to endure a 12-hour fast in order to have a blood sample tested.

How low does cholesterol have to be?

While the “lower LDL-C is better” paradigm holds true, the potential benefits must be balanced against the cost and effectiveness of the drug. Therefore, determining an individual's LDL-C goal requires understanding their risk of having a stroke, heart attack, or artery blockage. The higher the risk level, the greater the absolute benefit of lowering LDL-C, with LDL-C lowering outweighing the potential risks of long-term treatment.

As always, those at highest risk benefit most from lowering LDL-C. At the top of the risk ranking are people with a history of stroke, heart attack, or blocked arteries. People at high risk also include people who have genetically severe high cholesterol (familial hypercholesterolemia) and people who have diabetes with diabetic complications. For people in these high-risk categories, LDL-C levels < 1.8 mmol/l (< 70 mg/dl) are considered. Additionally, if you've had a previous heart attack, aiming to lower your LDL-C to below 1.4 mmol/l (<55 mg/dl) may further reduce your risk. there is.

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At the bottom of the risk ladder are patients with simple diabetes, chronic kidney disease, or simple familial hypercholesterolemia (<40 years) with LDL-C < 2.6 mmol/l (< 100 mg/dl). It is enough to maintain it.

As the risk profile decreases, the absolute benefit becomes lower and therapeutic LDL-C goals are adjusted accordingly. Therefore, people who do not fit into any of the previous risk categories can consider LDL-C < 3.4 mmol/L (< 130 mg/dl). However, for this low-risk group, lifestyle modification is the mainstay of management.

lifestyle modification

Lifestyle interventions include smoking cessation, weight loss (for obese people), and regular exercise. The 2022 Singapore Physical Activity Guidelines, published by the Health Promotion Board and Sport Singapore, state that adults should engage in at least 150 minutes (2 hours 30 minutes) to 300 minutes (5 hours) a week to reap substantial health benefits. hours) of moderate exercise. intensity, or 75 minutes (1 hour 15 minutes) to 150 minutes (2 hours 30 minutes) of vigorous-intensity aerobic exercise per week, or an equivalent combination of moderate-intensity and vigorous-intensity aerobic exercise, 5 to 7 A few days in a week divided into sessions.

Dietary tips to reduce your risk of heart attack and stroke include minimizing your intake of saturated fatty acids (SFA) and trans fatty acids (TFA), as both are associated with elevated LDL-C. It will be. Daily dietary cholesterol should be reduced to less than 300 mg per day. Eating 20 to 30 grams of dietary fiber daily, including fibrous B-glucans such as barley and oats, has been shown to lower LDL-C.

alcohol conundrum

Previous observational studies have reported a J-shaped distribution of outcomes, with heart attack rates lowest among people with low to moderate alcohol intake, and those who do not drink or consume high amounts of alcohol. had a higher incidence of heart attacks. However, this perceived benefit has not been tested in randomized controlled trials. Moreover, this J-shaped effect has not been observed in studies in Chinese and Indian cohorts.

The 2022 World Heart Federation (WHF) policy brief challenged the perception that low to moderate alcohol consumption protects the heart. There is a linear correlation between regular alcohol consumption of at least 100g per week and increased risk of stroke, heart failure, fatal hypertension and fatal aortic aneurysm. In patients with severely elevated triglycerides, alcohol consumption is associated with an increased risk of pancreatic inflammation. The latest regional guidelines recommend that people who are not currently drinking should not start drinking alcohol and do not recommend consuming alcohol for its cardioprotective effects.

In high-risk groups, if lifestyle measures fail to reduce LDL-C levels to desired levels, pharmacotherapy should be considered. In our next article about cholesterol, we'll look at the latest treatments and understand how they can significantly reduce your risk of stroke and heart attack.

This article is part of a monthly series on health and wellbeing produced in partnership with Royal Healthcare.