Cholesterol: Everything You Need to Know

Cholesterol travels in the blood attached to lipoproteins, which are combinations of proteins and fats. The main lipoproteins are LDL (Low-Density Lipoprotein) and HDL (High-Density Lipoprotein). These lipoproteins play a crucial role in cardiovascular health.

Cholesterol is a fatty compound that the body needs for building cells, producing hormones, and synthesizing vitamin D, among other functions. There are two types: dietary cholesterol and cholesterol produced in the liver. In the bloodstream, cholesterol travels bound to lipoproteins, which can be divided into two main types: LDL and HDL cholesterol.

LDL cholesterol is commonly known as "bad cholesterol." When there is too much LDL cholesterol in the blood, it can accumulate in the walls of the arteries and cause plaque formation, leading to the narrowing and hardening of blood vessels. This process is known as atherosclerosis, and it is one of the major risk factors for heart disease and strokes. 

Elevated LDL cholesterol can over time lead to serious problems, such as a heart attack or stroke, if plaque buildup grows large enough to block blood flow. The goal is to keep LDL cholesterol levels as low as possible.

HDL cholesterol is known as "good cholesterol."Unlike LDL, HDL cholesterol helps remove excess cholesterol from the blood vessels and transports it to the liver, where it can be broken down and eliminated from the body. A high level of HDL cholesterol is generally a sign of good heart health, as it reduces the risk of atherosclerosis and other cardiovascular diseases.

Measuring blood cholesterol

The cholesterol level is measured through a blood test, and the result provides information about both total cholesterol and how different types of cholesterol are distributed. The main values measured are:

•  Total cholesterol: The total amount of all types of cholesterol in the blood.

•  LDL cholesterol: The amount of "bad cholesterol" in the blood.

•  HDL cholesterol: The amount of "good cholesterol" in the blood.

•  Triglycerides:  Blood fats that can also affect the risk of cardiovascular diseases.

 If you want to read more about measuring cholesterol levels, please read the article below: 

 Cholesterol Levels: How to Interpret Cholesterol Test Results 

 P-Kol-LDL  

In addition to cholesterol levels, many other factors affect the risk of cardiovascular diseases, such as age, gender, blood pressure, smoking, and the presence of diabetes.Risk calculators, such as FINRISKI and SCORE, help assess an individual's risk of developing cardiovascular diseases. The calculators are based on population studies and provide information on the likelihood of experiencing a serious cardiac event within the next ten years.

The risk calculator provides a clear picture of how much factors such as high LDL cholesterol, elevated blood pressure, or smoking increase the risk, thus helping to make necessary lifestyle or medication changes.

Diet has a significant impact on blood cholesterol levels.Certain fats, particularly saturated fats and trans fats, can raise LDL cholesterol, while healthy fats, such as polyunsaturated and monounsaturated fats, can help improve cholesterol levels. It is beneficial to know which foods to favor and which to avoid in managing cholesterol.

Saturated fats and trans fats are the main culprits behind elevated LDL cholesterol. These fats are abundant in animal products, such as fatty meats, butter, cheese, and whole milk, as well as in processed foods like pastries, cookies, and fast food. It is advisable to limit the intake of these fats to keep blood cholesterol levels in check.

Polyunsaturated and monounsaturated fats, found in sources such as vegetable oils, fish, nuts, and avocados, can help lower LDL cholesterol and raise HDL cholesterol. These healthy fats are recommended as part of a daily diet.

Fiber, especially soluble fiber, is an effective way to lower cholesterol. Soluble fiber binds cholesterol in the intestines and prevents its absorption back into the bloodstream. Foods high in soluble fiber include oats, barley, legumes, fruits, and vegetables.

Sterols and stanols are plant compounds that inhibit the absorption of cholesterol in the intestines, thereby helping to lower blood LDL cholesterol levels. These compounds are naturally found in vegetable oils, nuts, and seeds, but they have also been added to some foods, such as margarines and yogurts.

Since HDL cholesterol helps remove excess cholesterol from the bloodstream, increasing its levels is important for heart health. Maintaining high HDL cholesterol can be achieved through healthy lifestyle choices, such as diet and exercise.

Regular exercise, especially aerobic activities such as walking, running, cycling, and swimming, can increase HDL cholesterol levels. The goal should be at least 150 minutes of moderate exercise per week.

Moderate alcohol consumption can raise HDL cholesterol levels, but alcohol intake should always be limited. The general recommendation is no more than one drink per day for women and two drinks for men. Excessive alcohol consumption can lead to many other health issues.

A cholesterol-lowering diet does not have to be complicated or tasteless.The following recipes will help you prepare delicious and healthy meals that promote cholesterol management.

Oatmeal Apple Porridge

 Ingredients: 

•  1 dl rolled oats

•  2 dl water or plant-based milk

•  1 apple, diced

•  1 tbsp chia seeds

•  A pinch of cinnamon

 Instructions: Bring water or plant-based milk to a boil and add the rolled oats. Simmer for a few minutes. Add apple pieces, chia seeds, and cinnamon. Enjoy as a healthy and fiber-rich breakfast.

Salmon-Avocado Salad

 Ingredients: 

•  150 g grilled salmon

•  1 avocado, sliced

•  100 g baby spinach

•  1 cucumber, sliced

•  1 tbsp olive oil

•  1 tbsp lemon juice

•  Salt and pepper to taste

 Instructions:  Combine all ingredients in a salad bowl and mix. Add olive oil and lemon juice on top. This salad is packed with healthy fats that help manage cholesterol.

Vegetable stew with lentils and bell pepper

 Ingredients: 

•  1 onion, chopped

•  2 cloves of garlic, minced

•  1 red bell pepper, diced

•  1 green bell pepper, diced

•  2 dl red lentils

•  4 dl vegetable broth

•  1 tsp smoked paprika powder

•  1 tbsp olive oil

•  Salt and pepper to taste

 Instructions: Sauté the onion and garlic in olive oil.Add the bell peppers and sauté for a moment. Add the lentils, vegetable broth, and spices. Simmer until the lentils are soft. This high-fiber vegetable stew is an excellent choice for managing cholesterol.

The treatment of elevated cholesterol in healthy individuals primarily focuses on lifestyle changes. These individuals typically do not have other significant risk factors for cardiovascular diseases, so medication is often not required unless cholesterol levels are significantly high.

Improving the diet is the first step in managing elevated cholesterol.This means reducing saturated fats and trans fats, and replacing them with healthy fats, fiber-rich foods, and plant-based products.

By incorporating exercise into your daily routine, you can improve cholesterol levels while also preventing other health issues such as obesity and diabetes.

Smoking lowers the amount of good HDL cholesterol and damages the walls of blood vessels, increasing the risk of atherosclerosis. Quitting smoking improves cholesterol values and significantly reduces the risk of heart disease.

Overweight, and especially abdominal obesity, is often associated with high LDL cholesterol and low HDL cholesterol.Weight management helps improve cholesterol levels and reduces the risk of cardiovascular diseases.

Individuals with elevated cholesterol along with other cardiovascular risk factors, such as high blood pressure, diabetes, or a hereditary tendency, often require more effective treatment options.

For these individuals, medication, such as the use of statins, is often necessary to manage cholesterol levels. Medication is always combined with lifestyle changes to achieve the best treatment outcome.

In high-risk individuals, cholesterol levels and other cardiovascular risk factors are monitored more closely.The goal is to keep LDL cholesterol below 2.5 mmol/l and possibly even lower in patients at very high risk.

Medication is considered when lifestyle changes are not sufficient to lower cholesterol levels adequately. The choice of medication depends on the individual risk profile and other factors affecting health.

Statins are the most commonly used medications for the treatment of elevated cholesterol. They inhibit the liver's cholesterol production, thereby helping to lower LDL cholesterol. Statins may also slightly raise HDL cholesterol and lower blood triglyceride levels.

Fibrates are medications that lower triglyceride levels and may slightly raise HDL cholesterol. They are often used in conjunction with statins if the patient has high triglyceride levels or low HDL cholesterol.

Ezetimibe is a medication that inhibits the absorption of cholesterol in the intestines, which lowers LDL cholesterol levels. It can be effective in combination with statins or as an alternative for patients who cannot tolerate statins.

PCSK9 inhibitors are newer cholesterol-lowering medications that significantly reduce LDL cholesterol levels by inhibiting the action of the PCSK9 protein, which increases the removal of LDL cholesterol from the bloodstream.These medications are generally used in individuals who have a very high risk or who do not achieve adequate treatment response with other medications.

Familial hypercholesterolemia (FH) is a hereditary condition that causes very high levels of LDL cholesterol in the blood. FH patients have a significantly increased risk of developing early cardiovascular diseases.

FH patients may be asymptomatic for a long time, but they often have high cholesterol levels diagnosed at a young age. Family history may include early heart attacks or other cardiovascular events. FH is usually diagnosed through blood tests and genetic testing.

The treatment for FH patients always includes cholesterol-lowering medication, usually in combination with statins and other medications. Additionally, strict lifestyle management is required, including a healthy diet and exercise. For FH patients, cholesterol levels are aimed to be kept as low as possible, with the usual target for LDL cholesterol being below 1.8 mmol/l.

While much is said about high LDL cholesterol, having too low levels of HDL cholesterol is also a health risk. Low HDL cholesterol is often associated with an increased risk of cardiovascular diseases, as HDL's role is to remove excess cholesterol from the blood vessels.

Low HDL cholesterol can be due to hereditary factors, excessive intake of saturated fats, lack of exercise, smoking, or being overweight. Treatment focuses on lifestyle changes, such as a healthy diet, weight management, and increasing physical activity. In some cases, medication, such as niacin, may be necessary to raise HDL cholesterol.

Cholesterol is a key factor in cardiovascular health. It is important to understand how different types of cholesterol affect health and how cholesterol can be managed through diet, exercise, and medication if necessary. With the right actions, the risk of heart disease and strokes can be significantly reduced, allowing for a healthy life.Measuring cholesterol levels and regular monitoring are key to detecting and addressing potential issues in a timely manner.