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Good Cholesterol, Bad Cholesterol?
The higher the cholesterol level, the higher the risk of developing cardiovascular disease. But what exactly is meant by the cholesterol level? And is there a clear limit to when cholesterol is harmful?
To answer these questions, it is worth taking a quick look at how cholesterol works in the body. Cholesterol is one of the so-called blood fats (lipids) and is an important building block for our body cells. Since it is not soluble in water or blood on its own, the body packages it in protein molecules. Depending on how the cholesterol is packaged, a distinction is made, for example:
- HDL cholesterol: This form of transport of cholesterol is colloquially known as "good cholesterol". People with normal or high HDL cholesterol are less at risk of developing cardiovascular disease than people with low HDL cholesterol.
- LDL cholesterol: This form of transport of cholesterol is colloquially known as "bad cholesterol". High levels of LDL cholesterol are associated with a high risk of cardiovascular disease.
There are also other blood lipids such as triglycerides and lipoprotein (a).
So when people talk about “cholesterol levels that are too high”, they usually mean LDL cholesterol. So far, however, there is still no consensus as to when exactly an LDL cholesterol level is considered “too high”, since the cholesterol level is just one of many factors that determine the risk of suffering a stroke or heart attack. Taken alone, the cholesterol value doesn't say much.
One risk factor rarely comes alone
There are numerous so-called risk factors, the interaction of which determines the likelihood of a heart attack or stroke. In addition to high blood pressure and high cholesterol, these risk factors also include:
- Age: the risk increases with age, as the vessels become stiffer and less elastic
- Gender: Men are at higher risk than women
- Family predisposition: if close relatives developed cardiovascular disease at a young age, there is a familial predisposition that increases your own risk
- Smoking status: Smokers are at a higher risk than non-smokers
- Type 2 diabetes: People with type 2 diabetes (colloquially often called "diabetes") are at a higher risk than comparable people without type 2 diabetes
Which blood pressure and cholesterol values are favorable?
The exact target values for blood pressure and cholesterol to aim for depends on various factors; In addition, there are sometimes different recommendations depending on the country and specialist society. For example, the European cardiologist association ESC and the German cardiologist association DGK are in favor of staggering the LDL cholesterol target values depending on the individual risk of cardiovascular diseases. The following target values have been recommended since 2019:
- At extreme risk: <1.0 mmol / L (i.e. below 40 mg / dL)
- At very high risk: <1.4 mmol / L (i.e. below 55 mg / dL)
- At high risk: <1.8 mmol / L (i.e. below 70 mg / dL)
- At medium risk: <2.6 mmol / L (i.e. below 100 mg / dL)
- At low risk: <3.0 mmol / L (i.e. below 116 mg / dL)
Following the recommendations of the ESC and DGK, the blood pressure should be below 140/90 mmHg. B. with type 2 diabetes lower target values can apply.
How you can reduce your risk of stroke
The level of blood pressure and cholesterol level in each of us depends on both our genes and our own lifestyle - however, the extent to which predisposition in comparison to lifestyle determines the values varies greatly from person to person. For most people, however, lifestyle has a major impact on blood pressure and cholesterol levels - good news because there is a lot you can do for your own health!
The most important lifestyle measures include:
- Eating a balanced diet, d. H. Whole grain food with lots of fruit and vegetables
- Do not smoke
- Get enough exercise
- Make sure you have a healthy body weight
You can find out more about how you can lower your cholesterol levels through a healthy lifestyle in the article "Diet & Exercise: Lowering Cholesterol the Natural Way".
However, if your values are still too high despite lifestyle changes, then it is important to get the values under control with appropriate medication. Your doctor will work with you to set the target values and discuss which medications are suitable for you. Doctors often recommend a statin for people with high cholesterol levels, as this group of active ingredients has been shown not only to lower the LDL cholesterol level, but also to reduce the risk of cardiovascular diseases and extend life expectancy. In the article "Down with the blood lipids: Why lowering cholesterol with statins and the like is so important" you will find an explanation of all the important groups of active substances that are used in the treatment of high cholesterol levels.
Author: Annukka Aho-Ritter, medproduction GmbH, www.medproduction.de
Date: August 2020
Internists online, Federal Association of German Internists e.V .:
www.internisten-im-netz.de (accessed: 08/2020)
Health information, Institute for Quality and Efficiency in Health Care (IQWiG):
www.gesundheitsinformation.de (accessed: 08/2020)
2019 ESC / EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. European Heart Journal 2020; 41 (1): 111-188. (Access: 08/2020)
ESC / EAS Pocket Guidelines Diagnostics and Therapy of Dyslipidemia, Version 2019:
https://leitlinien.dgk.org/files/2020_pocket_leitlinie_dyslipidaemie_fuer_homepage_.pdf (accessed: 08/2020)
Weingärtner O, Landmesser U, March W et al. Commentary on the guidelines (2019) of the ESC / EAS on the diagnosis and treatment of dyslipidemias. Cardiologist 2020; 14: 256-266.
2016 European Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal 2016; 37: 2315-2381 (accessed: 08/2020)
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