Deep Dive: LDL Cholesterol

Plus: Heart-healthy recipes!

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"How we spend our days is, of course, how we spend our lives." – Annie Dillard

Tuesday. I’ve dropped a few hints here and there, but just in case you’ve missed it — I (the writer for the Daily Tonic) recently became a dad. So, with a new level of personal resonance, I share with you the next piece of news. The average U.S. daycare and preschool prices increased by 6% last month, nearly 2x the overall inflation rate. UGH. That type of news will raise anyone’s blood pressure and cholesterol. Speaking of heart health, when was the last time you got your cholesterol checked? Let’s dive in.

Together with Inside Hotels

Hotels We Love: The Newbury Boston

Offering an unparalleled experience in Boston’s iconic Back Bay, The Newbury supplies guests with quiet luxury in spades.

Spacious, elegantly-designed rooms are decked out in custom-designed furnishings, with many offering views of the city’s Public Garden. Bath products from Byredo and in-room Nespresso machines offer elevated comforts, but nothing ever feels particularly ostentatious. Restaurant offerings from Major Food Group (the minds behind Carbone and Sadelle’s) ensure that you won’t have to step outside for a truly memorable meal.

Let’s Talk Cholesterol

If you’ve ever done any research on cholesterol, you’ve probably read about HDL and LDL cholesterol. Low-Density Lipoprotein Cholesterol (LDL-C) refers to the cholesterol that often accompanies low-density lipoprotein. It is sometimes called the “bad” cholesterol due to its association with plaque buildup, which can lead to atherosclerosis and a whole array of heart conditions you want to avoid.

So why is LDL cholesterol so important?

For a fixed level of HDL, the cardiovascular risk can increase three-fold as LDL varies from low to high. Simply put, an elevation of LDL could strongly increase your cardiovascular risk. Notably, risk factors associated with high LDL are even more concerning when other biomarkers like Triglycerides, HbA1c, and hsCRP are also elevated.

LDL is often thought of as the cholesterol that can clog blood vessels. It is termed “bad” because it can transport lipids into artery walls, causing them to harden. This makes sense, given that research from major prevention trials has found a linear relationship between LDL levels and the rate of coronary events.

However, some experts argue that the focus on LDL might not be the most relevant. The total cholesterol to HDL ratio might be a better predictor than LDL alone. In fact, the ratio of triglycerides to HDL might be an even more accurate predictor.

It is also important to note that traditional cholesterol testing methods can sometimes lead to misleading conclusions. A person might have a totally normal total and LDL cholesterol but could still be at high risk of a heart attack due to the type of cholesterol they possess. For this reason, the new cholesterol test recommended by some experts is nuclear magnetic resonance spectroscopy (NMR lipid testing).

People with larger cholesterol particles, even with a higher cholesterol level, might have a lower risk of cardiovascular disease. In contrast, those with small and numerous LDL and HDL cholesterol particles might have an extremely high risk of heart disease, even if their cholesterol level appears "normal." The main cause of these small, risky cholesterol particles is refined carbs and sugar in our diet.

Moreover, some experts highlight that unless LDL-C is exceptionally high, it's not the best predictor of heart attack risk. A majority of LDL particles are large and buoyant, and they are mostly neutral in terms of cardiovascular health. A smaller portion, called small dense LDL, is much more relevant when assessing heart attack risk. Standard cholesterol tests, however, measure both together as one. When LDL-C levels are high, the general advice is to adopt a low-fat diet. However, this can lower only the large buoyant LDL and not address the smaller, riskier LDL (the ones elevated through refined carbs and sugar).

So what are the standard ranges to look for? LDL-C levels are categorized based on risk. For instance, less than 70 mg/dL is the recommended level for those with heart disease or at high risk. The standard range is less than 130 mg/dL for others.

But that doesn’t mean those ranges are optimal. While some experts believe an LDL cholesterol level below 100 mg/dL is ideal, others suggest that anything less than 70 mg/dL is optimal. Still, the emphasis remains on the type and number of LDL particles, not just the overall LDL-C.

The key takeaway? This information does not constitute medical advice. It is the compiled expert opinions from the doctors cited in this article. That said, it's crucial to understand that the absolute values of LDL can be misleading. The types of LDL, including the amount of small dense LDL particles, matter more than the total number. Also, certain ratios can offer further insights into cardiovascular health and risk.

Generally, an LDL level below 100 mg/dL is recommended, but some experts consider anything less than 70 mg/dL optimal. It's also vital to evaluate the LDL level alongside the triglyceride-to-HDL ratio, as it's an insightful biomarker for cardiovascular disease risk and insulin resistance.

Tonic Shots

1. Fish For Heart Health? Yes, Please!

Salmon is a great heart-healthy option packed with protein and a bunch of other nutrients your body needs! Enjoy this honey Sriracha spin on this delicious fish!

2. Cruciferous Vegetables Are Key

Nothing like some cruciferous veggies to keep your heart healthy and strong! This recipe is so simple, and it packs a nutritious punch!

3. Turmeric To Combat Inflammation

Turmeric is a great way to fight inflammation, which can help promote heart health. Give this latte recipe a try, and if it is still scorching by you, make it iced!

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