Heart disease and stroke have been documented by the Centers for Disease Control and Prevention as the number 1 and number 4 leading causes of death here in the United States. I know what you’re saying already. Way to start it off positive! I get you. It’s not about not wanting to be positive, but about stating things so you can stay informed and plan ahead. I was recently asked by a client what the best way is to lower LDL (low-density lipoprotein) cholesterol, as it heavily contributes to heart disease and stroke. First, I avoid the term best as I have mentioned before that every individual, when it comes to the human body, is slightly different. All we can really do is look at the most recent research and see what is generalizable to supposedly most individuals. Second, LDL is not a cholesterol but a type of fat and protein complex produced in the liver that delivers cholesterol (a waxy fat substance) to all tissues in the body; think of it as a truck carrying cargo to a specific location. For Mobiles Spine Specialist, the goal is to lower LDL in a way that enhances heart function, respects tendon and muscle health, and supports long-term mobility.
What Is LDL Cholesterol?
As mentioned, LDL is a transport vehicle like a truck produced in your liver to distribute the substance of cholesterol to cells all over your body. Cholesterol is needed so that the body’s cells can maintain their integrity to keep your body running.
The ability for you to absorb and digest fat through the making of bile acids, the production of essential hormones such as testosterone, estrogen, progesterone and cortisol, and producing vitamin D which is needed for bone health, immune health, optimal muscle function, and optimal nerve communication in your brain, is all because of having enough cholesterol that is accessible to all cells. The main takeaway is that we cannot function without cholesterol. But just like anything in life, too much of something can sometimes turn detrimental.
The Ratios of Cholesterol Matter: HDL Cholesterol’s Role
So, LDL cholesterol, which we mentioned, is not cholesterol at all but is a type of transport vessel, like a truck, that delivers cholesterol made in the liver to all the cells in your body. It is aptly labeled bad because of what happens when there is excess.
When cholesterol levels are high due to liver production, diet, or both, it can be deposited in arterial walls, fueling plaque buildup and narrowing of arterial vessels (as seen above). We say that some people are genetically predisposed to greater atherosclerotic effects (narrowing and hardening of your arteries) from eating more cholesterol-dense foods (animal products and dairy) than others. Large epidemiologic and clinical data link higher LDL with increased risk of heart attack and stroke, particularly in people who already have hypertension or other risk factors like high triglycerides (fat tissue, particularly around the organs).
Just like LDL is a certain type of delivery vessel, “transport truck”, bringing cholesterol from the liver to all cells of the body, there is another vessel called HDL (high density lipoprotein), which bring cholesterol from all tissues (most notably your arteries which prevents heart attacks and stroke) back to the liver to be converted to bile and eliminated from the body by going to the bathroom. It seems appropriate to refer to HDL as a good thing to have, in the right proportion to LDL.
Munoz et al. (2009) presented further insights into who was at risk for attaining cardiovascular disease (which is an umbrella term that encompasses heart disease and stroke) in the threshold data ratios below.
Primary Prevention = Thresholds to prevent a first incident of stroke or heart attack with no history of cardiovascular disease.
Secondary Prevention = Thresholds to prevent a second incident of stroke or heart attack.
TC = Total cholesterol, HDL-C = High-Density Lipoprotein Cholesterol (fancy term for the type of “transport truck” that delivers cholesterol away from tissues (most notably your arteries) and back to the liver.
Triglyceride levels in relation to HDL-C as a ratio are also important in determining other issues, such as metabolic syndrome (a precursor to prediabetic or diabetic conditions), but we will not be getting specifically into that. Just know that the test results above should be requested and monitored at your yearly physical to prevent a cardiovascular incident.
The Role of Statin Medications in LDL Levels
Statins are medications (e.g., Atorvastatin, Rosuvastatin, Simvastatin) that are often prescribed to prevent heart attacks and strokes in individuals at increased risk, doing a pretty good job of lowering LDL levels by 30-50% and total cholesterol (remember they are two separate things). A potential issue with this is the ability to make lifestyle changes, such as exercise and physical activity, because statins can affect muscles and tendons during activities. This is a problem if your goal is to be able to self-manage your condition and to get off statin medications. While current research does not strongly correlate serious strain or worse rare tendon ruptures while being on statins, barriers to exercise, such as feelings of pain, weakness, and decreased tolerance to exercise, are a common occurrence both in research and anecdotally, which can be explained by the decrease in overall cholesterol production and the availability of LDL transporters of cholesterol to your cells.
If cholesterol is needed to maintain the health of cell membranes (including those of muscles and tendons), then having less of it available leads to increased rupture and inflammation of your tissues, slower overall recovery, and feelings of muscle and tendon aching and pain. Less cholesterol produced by your body leads to less Vitamin D production, which leads to less energy (ATP) produced for your muscles to perform physical activity. Less energy available affects your muscle’s ability to contract. Your muscles and tendons either tire quickly, feel heavy, or become susceptible to injury. This is a problem if your goal is to be able to self-manage your high LDL status through proactive exercise to eventually wean off statin medications. Consulting with your physician to obtain a comparable medication alternative if muscle/tendon pain and discomfort are getting in the way of naturally lowering your LDL levels through exercise is recommended.
If you’ve gotten this far, we appreciate you taking the time to read. Stay tuned next month when we address the latest natural solutions in diet and exercise to lower LDL and prevent future cardiovascular events!
Resources:
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