What does “bad” and “good” cholesterol mean and what should we look for?

Based on the fact that it is best not to consult the analytical tests or any other medical test ahead of time and always allow the professional who requested them to be in charge of opening the envelope (or the link), the truth is that very few can resist the temptation to do so.

Oliver Thansan
Oliver Thansan
18 June 2023 Sunday 10:26
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What does “bad” and “good” cholesterol mean and what should we look for?

Based on the fact that it is best not to consult the analytical tests or any other medical test ahead of time and always allow the professional who requested them to be in charge of opening the envelope (or the link), the truth is that very few can resist the temptation to do so. Since there are many laboratories that directly deliver the analyzes to the patients, on more than one occasion there are misunderstandings: we consult the results, of which we understand little, we Google the meaning of what we do not understand and -hypochondriacs they know well what we are talking about– tragedy is served.

One of the markers that we usually focus on first is cholesterol, a term that we keep very much in mind, although we are often unaware of what it is, how it works, and what are the real consequences of not keeping it at healthy levels. According to the Spanish Heart Foundation, the term cholesterol "encompasses all the fat particles that circulate through our body and is present in all the cells of the human body, since it is necessary for the normal functioning of the body. Most cholesterol is produced in the liver, although it is also obtained through some foods.

The head of the Department of Cardiology at Quirónsalud Madrid, Roberto Martín Reyes, points out, for his part, that "there are many cholesterol particles, and although historically we have only heard of what we know as the "bad" or the "good" there are other forms, different fractions that are becoming increasingly important and that are currently being studied. It is very probable that more and more people talk about them”.

At present, however, in regular analyzes HDL cholesterol, LDL cholesterol and triglycerides are studied, which appear broken down along with total cholesterol, which is the number we usually look at. It is a mistake, according to Martín Reyes, who indicates that the number we really have to stop at is the so-called LDL or low-density cholesterol, also known as "bad cholesterol." “We speak of LDL cholesterol when we refer to those low-density lipoproteins that deposit cholesterol particles in the arteries and promote the appearance of arteriosclerosis, that is, they have an atherogenic effect. For its part, HDL, also known as "good" cholesterol, are those high-density lipoproteins that collect bad cholesterol particles and take them to the liver to be broken down, thus having an antiatherogenic effect and reducing the chances of having arteriosclerosis. ”, explains the Quirónsalud specialist.

Finally, “triglycerides are the most important fats in nature and are an energy reserve in our body. It has taken a long time to demonstrate that when they are above the established levels they produce arteriosclerosis and are a cardiovascular risk factor. However, they have a lower weight than cholesterol”, explains, for his part, Dr. Manuel Abeytua, president of the Vascular Risk and Cardiac Rehabilitation Section of the Spanish Society of Cardiology.

However, the figure that most people keep in mind is that of total cholesterol, which health authorities recommend to be less than 200 mg/dl. Martín Reyes explains why this data can be misleading in some cases: "Total cholesterol is the result of the sum of LDL, HDL and triglycerides divided by five and is traditionally used to establish whether cholesterol levels are of a patient who has not suffered any previous cardiovascular event are correct. This can lead to deception, since a patient can have high HDL cholesterol, which is positive, which can lead to the overall calculation ending up being higher than 200 mg/dl without this having to be worrisome," he explains. the cardiologist, and concludes: "some campaigns that have been carried out to sell products that reduce cholesterol have done a lot of damage and have alerted some people who, having their total cholesterol above what was established, had nothing to worry about" .

Regarding LDL or "bad" cholesterol, Martín Reyes explains that "some time ago the limit was set at 160 mg/dl, but it has been reduced to 130 mg/dl in those people who have not suffered a stroke or heart attack." In the case of people who have suffered from these conditions, the established safety limit is much lower: "If there has been a stroke or heart attack, in principle the limit was 100 mg/dl, it was lowered to 70 mg/dl and now it is of 55mg/dl”.

This means, in conclusion, that "a person can easily have LDL or "bad" cholesterol around 130 mg/dl and HDL or "good" cholesterol at 70-80 mg/dl: the established number of total cholesterol without actually having a problem.” For this reason, it is best that a medical professional always review the analyzes and draw the pertinent conclusions.

Dr. Martín Reyes indicates that there is a considerable percentage of the population that "has cholesterol above these 130 mg/dl, due to a sedentary lifestyle, being overweight, fast food and a series of factors related to diet and style of life". The good news is that with some changes in habits and diet it is relatively easy to get back to healthy levels. “The first thing to do if you have cholesterol problems is a low-fat diet, rich in fruits and vegetables, legumes, and quality protein. In patients who do not have cardiovascular disease, red rice yeasts can be taken, which are very helpful, and in some cases statins can be used as long as other dietary measures and the introduction of yeast do not work ”, he explains.

Statins are drugs used to reduce cholesterol, since they act as inhibitors of an enzyme and, therefore, block a fundamental step in the production of cholesterol by the body. According to the Spanish Heart Foundation, it is advisable to resort to them in the case of "patients with cardiovascular risk who do not reach the targets set for LDL cholesterol figures with changes in lifestyle and heart-healthy diet, in those who have already had some type of cardiovascular pathology and in those considered healthy but with elevated LDL levels”. In this last section, we also find those patients who suffer from "very high cholesterol levels associated with a genetic mutation, which occurs in very specific cases that must be treated with medication," concludes Dr. Martín Reyes.