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Lipids are the name for fats found in the blood and body tissues. Your body needs some lipids to build cells, but too much of certain types can be dangerous. The two main types we often talk about are cholesterol and triglycerides. They can have a major impact on heart health because they can cause plaque to form in the arteries.
Cholesterol is a waxy substance made by the liver and found in some food. When we take in more cholesterol than the body can use, it can stick to the walls of the arteries. This makes the arteries narrower, decreasing blood flow to the heart, brain, and other organs (atherosclerosis).
Over time, plaque buildup can lead to life-threatening heart attacks or strokes. Heart disease accounts for 1 in every 5 deaths among U.S. adults. Nearly 86 million adults have cholesterol levels considered “high,” measured above 200 mg/dL. Yet almost half of U.S. adults who could benefit from cholesterol medication aren’t currently taking any.
That’s partly because high cholesterol is usually “silent.” Just like high blood pressure, there aren’t usually noticeable symptoms; most people feel perfectly fine while cholesterol particles are building up in their arteries.
Today we have more specialized tests to better quantify the amount of cholesterol and plaque, and more treatment options to help reduce it, than ever before. Working together, we can help patients prevent a heart attack by keeping lipid levels “lower for longer.”
Beyond LDL: The new frontier of blood markers.
You may have heard of low-density lipoprotein (LDL), which is often called “bad” cholesterol. The test we’ve traditionally used to check LDL, called a lipid panel, doesn’t always show the full picture.
To get a better sense of the risk to your heart health, we consider advanced markers such as:
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Apolipoprotein B (ApoB): This protein plays an important role in plaque buildup.
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Lipoprotein(a) (Lp(a)): This LDL-like particle is inherited in your genes and is a major factor in atherosclerosis, leading to plaque formation. Your Lp(a) level stays relatively stable throughout adult life, so checking once is sufficient.
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VLDL and remnants: Other types of fat contribute to the total buildup of plaque in your body.
Your doctor can check for these advanced biomarkers with specialized blood tests. The results can help us get a more detailed understanding of your individual risk of forming plaques.
Related: Read “Why the Lp(a) Molecule Is Big News for Heart Disease.”
How do genetics influence cholesterol?
Genetics play a huge role in your heart health. Even a low-fat diet could still predispose you to high cholesterol if it is in your genes.
One inherited condition I see often is familial hypercholesterolemia (FH). The receptors on your liver normally act like tiny vacuums to remove fat from the blood. In FH, these receptors don’t work correctly, causing fat to stay in the bloodstream much longer than it should.
I get suspicious of a genetic cause for high cholesterol when I see:
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LDL levels over 190mg/dL in adults
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A strong family history of heart attacks at a young age
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Lipid numbers that stay high despite a very healthy diet
Even if genetics are behind your high cholesterol, there are effective treatments that can help improve your heart health and reduce your risk.
Statins and the next generation of medicines.
A class of drugs called statins (Lipitor, Crestor, and others) are the gold standard for treating high cholesterol. Their powerful benefits include blocking lipid production in the liver, reducing inflammation, and helping blood vessels dilate. Many studies have shown that the limited side effects of these medications are mild and similar to the muscle aches that are part of daily life.
When a patient needs a non-statin medication, a remarkable new toolkit of options is helping us provide patients with more help. These include:
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Ezetimibe: A pill that blocks your digestive system from absorbing cholesterol from food
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PCSK9 inhibitors: These injections are given every few weeks to keep the liver’s “vacuums” active longer so your body can clear out more cholesterol
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Inclisiran: This twice-yearly injectable medication helps lower cholesterol by silencing gene expression that stops the liver from producing PCSK9, keeping liver receptors active
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Bempidoic acid: A pill that blocks cholesterol production in the liver at an earlier step than statins
Medications can make a big difference in helping control lipids, and making healthy nutrition choices can help many people, too.
Related: Read “New Medications to Treat Common Heart-Related Conditions.”
Food choices that can lower cholesterol.
By focusing on foods that lower fat absorption and avoiding those that can clog the system, you can help reduce your risk even if you’re taking medications.
I recommend patients with high cholesterol limit or avoid:
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Trans fats: These are foods with artificially hydrogenated oils, which stay solid at room temperature. Common sources of trans fats include fried fast foods, margarine, packaged snacks, and commercial baked goods.
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Saturated fats: Dietary fats commonly found in animal products and some oils. Examples include butter, cheese, red meat, and coconut or palm oil.
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Hidden dairy fats: Some food manufacturers use dairy products to improve texture, taste, and shelf life. These sneaky sources of fats include baked goods, processed meats, snacks, creamy sauces, and salad dressings.
On the other hand, there are lots of foods you can embrace that have real health benefits. The Mediterranean diet is a great option for cardiovascular health. The best foods to fight cholesterol include:
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High-fiber choices: Vegetables, chia seeds, and flax seeds can help keep cholesterol in the gut so it isn’t absorbed
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Healthy proteins: Fish is one of the best choices for heart health
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Plant-based options: While a vegan diet isn’t for everyone, moving toward more plant-based meals can have a big impact on your heart
Related: Read “Is Your Diet SAD? See How Going Mediterranean Supports Heart Health.”
Advanced tools to monitor lipids.
We use other tests to find out if your lipid levels are causing damage. One of the most helpful tests we use is called a coronary artery calcium (CAC) score. This quick, non-invasive CT scan measures the amount of plaque in your heart’s arteries.
Your primary care physician can order this 10-minute test. It produces a score ranging from 0 (no detectable plaque, very low risk of heart attack) to 400 or higher (extensive plaque, higher risk).
Speak with a cardiologist if:
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Your CAC score is 100 or higher
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You have a surprisingly large amount of plaque for your age
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You’re unable to reach your LDL targets using standard treatments
With more tools than ever to get lipids under control, I’m optimistic that we can identify a treatment plan that can help most patients.
Taking control of your cardiac lipids today is a gift to your future self. Starting prevention measures now can help stop silent plaque from building up and give you the best chance at excellent heart health for years to come.
