Cholesterol: Should We Really Demonize It?

Cholesterol is an essential lipid: it is a component of cell membranes, and is used to produce hormones and vitamin D. The problem arises when low-density lipoproteins (LDL) oxidize and accumulate in arterial walls.

LDL vs HDL

• LDL ("bad cholesterol"): transports cholesterol to tissues. In excess, it deposits in arteries.
• HDL ("good cholesterol"): returns cholesterol to the liver for elimination. A high level is protective.
• Triglycerides: another type of blood fat, elevated in cases of excessive sugar and alcohol intake.

When to Treat?

The target LDL threshold depends on overall cardiovascular risk, not an isolated number. A patient who has already had a heart attack aims for LDL < 0.55 g/L, while a person at low risk can tolerate a higher LDL.

Statins: Proven Benefit

Statins reduce LDL by 30 to 50% and decrease cardiovascular events by 25 to 35% in clinical trials. Muscle side effects, while real, are less common than perceived (the nocebo effect plays a significant role).

Non-Medicinal Measures

• Reduce saturated fatty acids (processed meats, butter, excessive cheese)
• Increase soluble fiber (oats, legumes)
• Consume omega-3s (fatty fish, nuts)
• Engage in regular physical activity (increases HDL)