Managing LDL Cholesterol: Key Strategies for Heart Health

High levels of LDL cholesterol are a major risk factor for cardiovascular disease. Since September is National Cholesterol Month, Dr. Jerry Reves is here to explore how to manage LDL effectively with diet, exercise and medication.

What is LDL?

LDL is the abbreviation for low-density lipoprotein, one of the many particles in our blood. This lipoprotein is responsible for transporting cholesterol in our bodies. It can be considered a kind of dump truck loaded with cholesterol it picks up at the liver, which it then dumps at various places in the body, especially on the internal walls of arterial blood vessels.

A “lipid profile” blood test measures the amounts of various lipids in the body, including low-and high-density lipoproteins and triglycerides. The amount of LDL is important because it tells us how much cholesterol is being transported in our blood.
The Good and the Bad Cholesterol

Physicians and laypeople have adopted the terms good and bad cholesterol for lipoproteins based on their association with disease. High-density lipoprotein is associated with better cardiovascular health, and elevated LDL is considered a cause of atherosclerosis, the build-up of cholesterol and other deposits in the arterial circulation.

Ultimately the build-up combined with an inflammatory action causes coronary artery disease, cerebrovascular disease, and peripheral artery disease. Coronary artery disease causes ischemic heart disease that leads to acute myocardial infarction (heart attacks). Cerebrovascular disease causes one kind of “brain attack” or stroke. Peripheral artery disease causes ischemia or inadequate oxygen supply in various muscles and organs in the body, principally the legs during exercise which causes pain. All these diseases compromise health and together represent a major cause of death and disability.

Causes of High LDL

It is important to understand that high LDL needs to be lowered. Any value above 100 mg/dL is considered worrisome. For people with a history of coronary artery (heart), cerebrovascular, or peripheral vascular disease the target to try to achieve is below 70 mg/dL. For Americans who are exposed to the typical Western diet and the propensity to be sedentary, achieving this target can be challenging.

Genetic makeup is mainly responsible for one’s lipid profile, but there are many other causes/associations, including age, sex, diet, weight, smoking, and certain diseases (diabetes, kidney, or human immunodeficiency virus [HIV]). LDL levels rise as we age. Women after menopause, smokers, overweight people, and those with diseases such as diabetes have an increase in LDL.

Strategies to Lower LDL

While it’s true that factors we cannot control increase LDL, there are many things we can do to control and lower LDL, the bad cholesterol. You can play a major role in your LDL by paying close attention to the six actions listed below. However, this takes resolve for you and your spouse/partner/friends to make a major commitment.

How to Lower LDL

1. Eat a cardiovascular healthy diet (e.g., Mediterranean Diet)
2. Incorporate regular physical activity (e.g., aerobic exercise)
3. Maintain a healthy body weight
4. Lower life stresses
5. Take prescribed medications (e.g., statins)
6. Do not smoke or vape

LDL Diet

It is very important to follow a diet that is low in the saturated fats found in red meat and many other processed products. Make a habit of reading the label of every single item one considers purchasing in the grocery store, and select only those low in saturated fats. Do not eat foods that have refined sugar, including most desserts, cookies, sodas, etc. Eat high-fiber vegetables, fruits, and nuts. Eat fish with high omega-3 fatty acids. Avoid deep- fried foods, and use extra virgin olive oil in preparing meals. The widely publicized and relatively easy-to-follow Mediterranean Diet (Google or Access Davis C, et. al., “Definition of the Mediterranean Diet; a Literature Review,” Nutrients. 2015; vol. 9, pp. 139-53). This diet is fundamentally a philosophy that rejects much of what the average American consumes but includes readily available foodstuffs that are fresh and easily prepared.

Lower LDL Through Exercise

We have written many times in this space about the necessity of having an exercise routine for 30 minutes a day, at least five days a week, that produces an aerobic workout from walking to far more intense sessions. This is an essential strategy to marry with a healthy diet if one hopes to reduce the LDL.

Your physician orders your lipid profile blood test and if the results show an elevated LDL, you and your physician map out a method to lower the LDL. Often this will involve the addition of medication if your diet and exercise cannot reduce the LDL to the desired level.

Many different classes of antihyperlipidemic drugs are effective and safe in reducing LDL. The most commonly employed antihyperlipidemic is one of the several “statin” compounds. These drugs work in the liver and reduce the amount of cholesterol that the liver produces. In addition to lowering LDL, this reduces the buildup of atherosclerotic plaques that cause heart and brain attacks. The statins also reduce inflammation, reduce platelet adhesiveness, and stabilize the fatty plaques – all actions that reduce the number of heart and brain attacks that can cause death and disability. Many other drugs can be added or used as substitutes for statins if the side effects of statins preclude their use.

The Bottom Line

In America, the incidence of heart attack and stroke has been reduced in part because of the concerted efforts of patients and physicians to lower elevated bad cholesterol. However, because of the aging population cardiovascular disease remains the number one cause of death. Each of us can do our part to reduce our risk by measuring our LDL and then adopting the lifestyle/medical approaches to lowering an elevated LDL.