Q:
Do people with high LDL cholesterol generally have other risk factors for heart disease?
A:
Yes, there’s often overlap. You can have a family history and high LDL genetic disorder; you can be obese and have high LDL cholesterol. About half the people with high blood pressure have high LDL cholesterol or other lipid abnormalities (such as high triglycerides or low HDL cholesterol). Cigarette smoking is not associated with LDL cholesterol but it is associated with a low level of HDL cholesterol, which may be one of the major mechanisms whereby it mediates its cardiovascular toxicity.
Q:
Other than family history, what are some of the most important mechanisms that cause high LDL cholesterol?
A:
Being overweight, trans-fat intake, dietary composition. Those are the major mechanisms.
Q:
Is diet generally more important than family history?
A:
No. Family history is very important, and the response to diet is probably under genetic control. New research has shown that our genes are evolving as we become more industrialized. As we eat more processed food, we’re gaining more weight and the risk factors are becoming worse. So it becomes a moving target, but genes are very important.
Q:
Lately there’s been a lot of attention placed on the relative importance of inflammation over cholesterol. Is inflammation potentially a more important risk factor?
A:
Atherosclerosis is lipids and inflammation—it’s both. It’s not one or the other. So I don’t think we can separate them out. You can dissect a plaque, and you’ll find that it has cholesterol in it, that it comes from lipoproteins, and that it has inflammatory cells in it. They’re both important.
Cholesterol:Your Cholesterol Number
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