Jack and Jill, both non -smokers, walk out of their health care providers office satisfied that an annual check-up indicated a blood pressure under 140/90 and a blood sugar under 125. They were told that they were low risk for heart disease and their LDL cholesterol levels of 150 mg/dl were not of much concern. They were satisfied as they had heard somewhere in the news or maybe on a podcast that cholesterol no longer mattered like in the old days. Well, those old days are back with new data from a prospective study from Spain, the PESA trial.
The PESA study is following over 4,000 bank workers in Madrid free of known heart disease and assessing them for silent artery damage using heart artery calcium CT scans and ultrasounds of the carotid and femoral arteries. In a new report, researchers identified 1,779 of the study subjects that were like Jack and Jill and had total cholesterols under 240 mg/dl. A group of 740 participants had even better results with blood pressures under 120/80 and blood sugars under 100 mg/dl and were reported on too.
How frequently was silent hardening of arteries, called subclinical atherosclerosis, identified in the group of 1,779 subjects?
A whopping 50% had aging arteries that raise the risk of heart attack, stroke, vascular problems of the legs, and shorten lifespan. In the 740 superstars, the rate of silent vessel disease was still 38%. These numbers are striking but match test results I see in my advanced preventive cardiology clinic where I routinely do similar vascular assessments.
Should Jack and Jill be tested for silent heart and vascular artery disease?
Yes, they should and I have written repeatedly about the role of coronary artery calcium scans using CT as a cost effective way to assess individual risk. These scans are under $100 in my hospital and take under 5 minutes.
Should Jack and Jill be concerned about their LDL-cholesterol levels?
They should. In the PESA study, LDL cholesterol was an independent predictor of atherosclerosis in the overall group and the picture above shows how the higher the LDL cholesterol was in the study group, the greater the chance of disease in one or more artery systems. The authors of the study indicated that “LDL cholesterol, even at levels currently considered normal, is independently associated with the presence and extent of early systemic atherosclerosis in the absence of major cardiovascular risk factors. These findings support more effective LDL cholesterol lowering for primordial prevention, even in individuals conventionally considered at optimal risk”.
How low should Jack and Jill want their LDL cholesterol to be?
Even the nine study participants in PESA who had LDL cholesterol levels of 60–70 mg/dL range still had a 11% rate of subclinical plaques, leading the investigators to suggest that atherosclerosis develops when LDL cholesterol exceeds a threshold of approximately 50–60 mg/dL. Perhaps other factors like lipoprotein a, homocysteine, or hs-CRP were elevated in these subjects. The authors wisely recommended intensive lifestyle efforts for primordial prevention of artery damage starting as young as possible.
The Bottom Line: Do not walk out of your physical or workplace wellness exam complacent that your LDL cholesterol is elevated beyond optimal, even if other measures are OK. It might be a clue to progressive aging and damage of your heart and arteries. Ask for advanced testing and work with an experienced practitioner to bring your numbers into an optimal range using plant diets and exercise along with fasting protocols and nutraceuticals if needed. As 2017 closes and 2018 approaches, LDL cholesterol is back as an important measure of cardiovascular health to focus on. In reality, it never went away. To life!