The time has come for us to address the real risk factors for heart disease. Cholesterol does not cause heart disease. For some of you this may come as shock, but it is true. Without going into too much detail, two popular hypothesises about cholesterol have now been disproved. First, that eating cholesterol in the diet raises cholesterol levels in the blood (so please enjoy your eggs!). And second, that high cholesterol levels in the blood cause heart disease. In fact, research shows that there is absolutely no relationship between total cholesterol levels and mortality from cardiovascular disease or any other causes.
The Bottom line:
Cholesterol is not bad. It is an essential substance present in the cell membranes of all tissues of all mammals. It is involved in numerous bodily functions from brain health to hormone production and without it we would die.
Instead let us rather address the real risk factors for heart disease;
Inflamamtion is the key contributor to heart disease. Chronic inflammation is responsible for the oxidisation of low-density lipoproteins (LDL) which forms atherosclerotic plaque. Inflammatory cytokines produced at the atherosclerotic site then weaken and loosen the plaque. This causes it to break off and block the blood flow in the artery. These clots are the ultimate cause of heart attacks and strokes.
Inflammation can arise from a number of factors. These include:
- poor diet (too much sugar, chemical-laden foods and damaged fats),
- a sedentary lifestyle,
- stress, autoimmune diseases,
- food allergies, hidden infections (e.g. gum disease)
- toxins (eg smoking).
All of these causal factors need to be considered if there is inflammation in the body. To assess the degree to which your body is inflamed, test for your C-Reactive Protein (CRP) level. You are in a healthy zone if your reading is less than 0.8 mg/dL.
2. LDL Particles (LDL-p):
Just to clarify, LDL is a lipoprotein (fat combined with a protein) that acts as a carrier, transporting cholesterol and other substances through the bloodstream. It is not cholesterol itself nor is it ‘bad’ cholesterol. The total LDL value (LDL-c) is harmless. It is the number of circulating LDL particles (LDL-p) that really matters. Elevated LDL-p is what initiates the development of heart disease. It is therefore essential to know your count, especially because it may be high despite your LDL-c being within the normal range.
LDL-p can be estimated by measuring another marker called ApoB. Each LDL lipoprotein particle has one ApoB protein (Apoprotein B), so the higher the number, the higher the LDL particle number. The normal range for apoB is between 40-125 mg/dL.
3. Triglycerides to HDL cholesterol ratio (TG/HDL):
If your ratio is greater than 4, you have elevated LDL-p which, as discussed above, can accelerate the development of atherosclerotic plaques. Research found that the higher your TG/HDL ratio, the more likely you would be to have a heart attack. Excess insulin is the number one reason trigylceride levels increase. A high TG/HDL is therefore also a good indication of insulin resistance.
4. Insulin resistance:
Insulin resistance is another predisposing factor to heart disease. It occurs when the cells become desensitized to insulin. Glucose cannot enter the cell to produce energy, so instead it is sent to the liver to be converted into fat. This fat is then distributed around the body via the bloodstream. Insulin resistance is the underlying cause of metabolic syndrome. Metabolic syndrome is a collection of risk factors which include; weight gain, high blood sugar levels, high triglycerides, low HDL (good) cholesterol) and high blood pressure. All of these put huge stress on cardiovascular function and dramatically increase your risk of heart disease.
To test for insulin resistance measure your fasting blood sugar (a good reading is less than 90mg/DL) as well as your Hemoglobin A1C (HbA1c). The latter determines the average amount of sugar in your blood over the past 2-3 months and can be used to help diagnose insulin resistance. You’re in the healthy zone if your HbA1c is less than 6% of your total haemoglobin count.
Homocysteine is an amino acid and breakdown product of protein metabolism. High levels may contribute to plaque formation, by damaging arterial walls. High levels may also act on blood platelets and increase the risk of clot formation. An inadequate intake of B vitamins (namely B6, B12, and folate), as well as genetic factors that impair the body’s absorption and use of folic acid, can lead to elevated homocysteine levels. A healthy reading is between 6 and 8 umol/L
Hypertension is another important risk factor to monitor. Often termed ‘the silent killer,’ it can damage your body long before any symptoms appear. The increased pressure of blood flowing through your arteries can lead to atherosclerosis and narrowing of the blood vessels making them more likely to block. Damage to the arteries can also result in aneurysms (bulges) that could potentially rupture causing severe haemorrhage and other life-threatening complications. High blood pressure is defined as a systolic pressure at or above 140 mmHg and/or a diastolic pressure at or above 90 mmHg. However, even if you have a reading of between 120/80 mmHg and 139/89 mmHg it is advisable to modify your lifestyle and monitor your readings closely.
You can more accurately determine your likelihood for developing heart disease using the risk factors mentioned above. Ask your doctor specifically for each test, because not all of them are traditionally screened for.
If you need intervention, speak to your trusted health practitioner. Your practitioner will guide you as to what dietary, supplemental and lifestyle changes need to be made, in order to lower your risk of developing heart disease.