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How Bad is The Bad Cholesterol

The numbers project a not-so-good picture. People with diabetes are at 3-4 times higher risk of suffering cardiac death and stroke compared to non-diabetics. Their risk of developing morbidity and mortality from coronary heart disease (CHD) is the same as that of a patient with a history of heart attack or established coronary condition.

There are many risk factors that predispose a diabetic patient to develop CHD, including family history, smoking, obesity, sedentary lifestyle, hypertension and hypercholesterolemia. It is imperative that controllable risk factors be addressed to lessen the risk of a diabetic to develop heart disease and/or stroke.

The management of lipid or cholesterol abnormalities is crucial. Hypercholesterolemia, or hyperlipidemia, is a condition wherein there are high levels of lipids in the blood. Cholesterol is a soft, waxy, fat-like substance that is carried through the body in two bundles, or lipoproteins. It is produced by the liver and brain for many important body functions. Total cholesterol is the sum of your blood’s cholesterol content. Triglycerides are another type of fat in the blood. When you eat, your body converts any calories it doesn’t need to use right away into triglycerides, storeit in fat cells and release it later for energy.

What LDL means
Low-density lipoproteins (LDL) is oftentimes called the bad cholesterol because it mixes with other substances and forms fatty deposits or plaques on the walls of your blood vessels. This makes the arteries and veins stiffer and narrower, making it difficult for the blood to flow through. This condition is known as atherosclerosis. Moreover, the plaques can fall off, form clots and block blood flowing to your heart and brain. On the other hand, high-density lipoproteins (HDL) is also known as the good cholesterol because it helps carry away LDL cholesterol, thus keeping arteries open and blood flowing more freely.

The reduction of LDL and triglycerides, and the elevation of HDL are imperative to reduce the risk of development of macrovascular (big vessel) disease complications like CHD and stroke. Lowering the LDL cholesterol has been shown in many significant trials to reduce macrovascular disease and death in patients with type 2 diabetes and remains the primary goal of lipid-lowering treatment. The strong link between high levels of LDL cholesterol and cardiovascular morbidity and mortality among diabetic patients is indisputable. In the landmark trial among type 2 diabetics, the United Kingdom Prospective Diabetes Study (UKPDS), for every 39 mg/dL increase in LDL, there was a 1.6-fold increase in relative risk for development of CHD.

According to a research published in the January 2008 issue of Clinical Diabetes, persons with diabetes actually have a more dangerous form of LDL. The LDL particles are smaller, denser and contain less cholesterol than normal-sized or the fluffy buoyant LDL particles. However, these smaller particles are “exceptionally atherogenic” or artery-clogging. In addition, because diabetes often results from obesity, LDL can interact with the features of metabolic syndrome, which magnifies risk of heart disease.

How to lower LDL
A variety of things can affect cholesterol levels. These are things you can do something about:

  • Diet. Saturated fat and cholesterol in the food can make your blood cholesterol level go up. Saturated fat is mainly found in animal products like red meat and whole-milk dairy products, and from plant sources like coconut oil and milk, palm oil and cocoa butter which is often found in commercially prepared foods. Eating plenty of fresh vegetables and whole grains were proven to be best in lowering LDL levels.
  • Weight. Being overweight tends to increase your cholesterol. Losing weight can help lower your LDL and total cholesterol levels.
  • Sedentary Lifestyle. Not being physically active increases your LDL cholesterol. Being physically active for 30 minutes on most, if not all, days will help lower the bad cholesterol.

Things you cannot do anything about can also affect bad cholesterol levels:

  • Age and gender. As women and men get older, their cholesterol levels rise. Before the age of menopause, women have lower total cholesterol levels than men of the same age. After the age of menopause, women’s LDL levels tend to rise.
  • Heredity. Your genes partly determine how much cholesterol your body makes. High blood cholesterol can run in some families.

In general, the higher the LDL levels, the greater the chance for development of heart disease. The goal of treatment is to lower the LDL levels enough to reduce the risk for a heart attack or stroke. Therapeutic lifestyle modification can make a big difference in the management of elevated LDL levels. The value of eating right, maintaining ideal body weight, having regular exercise activities and not smoking cannot be overrated. These positive actions combined with the right drug treatment (statins) as prescribed by your doctor will prove to be beneficial.

But a lot of questions are raised as to what the LDL goal should be. According to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP3), diabetes is a high-risk condition and is considered a cardiovascular disease equivalent. The recommendation therefore for diabetic patients with no established heart disease is an LDL goal of 100 mg/dL. For diabetic patients with diagnosed cardiovascular disease, the recommendation is to keep the LDL levels at < 70 mg/ dL.

The American Diabetes Association concurs with this position and goes a step further in recommending giving statins to all diabetics over 40 years old, regardless of baseline LDL level – including those without overt cardiovascular disease. In the Heart Protection Study (HPS), a 30 percent reduction in LDL levels resulted in approximately 25 percent reduction in major vascular events regardless of baseline LDL.

Diabetic patients need to have periodic monitoring of cholesterol profiles, usually every 3-6 months, till target levels are reached. A healthy lifestyle and regular visits to your doctor is mandatory.

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