From the desk of Dr. Z: AgelessRx Co-founder and Chief Medical Officer, Dr. Sajad Zalzala offers his insightful perspective into all topics related to longevity. With a wealth of experience and a deep-seated passion for disease prevention and extending healthy lifespans, Dr. Z is dedicated to sharing his knowledge on the secrets to longevity. Today, he shares his knowledge on the true connection between LDL and CVD.
Here’s what we’ll cover in this blog post:
- What LDL is
- Why LDL is “bad” cholesterol
- What recent studies show
- How this changes the way we approach LDL
If you’ve just heard of LDL, you might think it’s the only metric that matters for our cardiovascular health. Sometimes called “bad” cholesterol, LDL is also called the “most important” cholesterol to focus on. In fact, many consider LDL and CVD (cardiovascular disease) to go hand in hand.
But just how important is LDL? Is it as “bad” as some claim, or could there be more critical markers of our cardiovascular health? Recent research has challenged the clinical guidelines around LDL, suggesting that LDL may be less harmful than experts suggest.
What Is LDL?
LDL is short for low-density lipoprotein. Lipoproteins carry fats (cholesterol) through our blood to various tissues and organs throughout the body. Fat can’t travel through the bloodstream on its own, so LDL acts as a chauffeur, carrying fats to wherever they need to go in the body.
Sometimes, though, LDL can leave fat in our arteries. Over time, this can lead to plaque buildup, which can cause major cardiovascular events. That’s where HDL comes in.
HDL, or high-density lipoprotein, acts as an emergency rescue service for cholesterol. When LDL leaves fat behind, HDL swoops in to pick it up and bring it back to the liver, where it’s flushed from the body.
HDL only carries a small fraction of our blood cholesterol. In other words, HDL can’t naturally clear all fat from the arteries. The LDL cholesterol that’s left behind is what shows up on a standard LDL test.
But LDL tests won’t always show the other particles that LDL carries, which is the reason why LDL gets a bad reputation in the first place.
Why Is LDL “Bad” Cholesterol?
LDL isn’t bad on its own, but it rubs shoulders with a bad crowd, like LP(a) and ApoB.
Short for lipoprotein(a), LP(a) is a type of LDL particle that carries plaque-forming cholesterol. What sets LP(a) apart is the addition of an apolipoprotein(a). Our bodies try to clean as much LDL from our bodies as possible, but this additional protein acts like a mask, disguising LP(a) from our cells so they’re harder to clear from our bloodstream.
When that fat gets left behind in our bloodstream, ApoB makes those deposits stickier and more difficult for the body to clear. This drives plaque buildup in our arteries, leading to cardiovascular disease.
Because LDL is the vehicle for LP(a) and ApoB, it gets a bad reputation for the damage that these LDL particles cause. That’s why doctors consider LDL such an important biomarker of cardiovascular health. The idea is that lower levels of LDL mean lower risk of CVD, while higher levels equal higher risk.
But recent studies suggest that LDL levels alone don’t paint the full picture of our cardiovascular health, and that our optimal LDL levels may be more complex than we thought.
LDL and CVD
A 2024 study from the British Medical Journal investigated the correlation between LDL cholesterol levels and long-term mortality. The findings show a U-shaped relationship, with both very low (<80mg/dL) and very high (≥190mg/dL) LDL-C levels associated with increased mortality.
While optimal LDL levels have historically been below 100mg/dL, the study noted that the optimal LDL range for the lowest risk was 100-189mg/dL. This directly contradicts the current clinical guidelines that advocate for lower LDL levels to reduce CVD risk.
The study also suggests that LDL is a much more complex biomarker, challenging the assumption that lower LDL levels are always better. What doctors previously thought was an ideal range for LDL (below 100mg/dL) could instead increase CVD risk.
How Does This Change the Way We Approach LDL?
This study shows that LDL Your heart cardiovascular alone doesn’t provide a full picture of your longevity. So, why would LDL alone provide a full picture of your longevity?
LDL cholesterol can be a good indicator of cardiovascular health. However, LDL isn’t bad on its own. Instead, it’s all the things that LDL carries with it that could increase our risk for CVD. It’s good to stay within an optimal range for both HDL and LDL, but we need a more specific measure of our ApoB, LP(a), and other critical biomarkers to assess our true risk.
For example, we can have low LDL and high LP(a) levels at the same time. In this case, if a doctor were to look at your LDL levels alone, they might assume you’re in perfectly good health. But a closer look at your LP(a) levels would reveal a greater risk for CVD.
While it’s true that reducing LDL can reduce our risk of cardiovascular disease, it’s clear that LDL can’t be interpreted in isolation. Doctors need a comprehensive view of our critical biomarkers to fully assess any aspect of our health. As more studies emerge to confirm these findings, clinicians may begin relying on more comprehensive tests to reduce our risk for age-related diseases.
How Can We Keep Our LDL Levels Healthy?
Fortunately, we can take control of our own health with options like the Core Longevity Panel.
The Core Longevity Panel tests up to 11 key biomarkers with one blood test, including LP(a), ApoB, LDL, HDL, triglycerides, and total cholesterol. From here, your doctor can develop actionable insights to address areas of your health where your scores are lowest.
Avoiding saturated fats and prioritizing olive oil, fresh fruits, nuts, and lean protein is key. Research shows that the Mediterranean diet can lower CVD risk and improve LDL. If you’re not looking to micromanage your meals, switching to the Mediterranean diet might be the simplest option.
Exercise can increase HDL levels that help clear out LDL. The CDC recommends 150 minutes of exercise per week to help lower LDL levels.
Surprisingly, stress can also increase LDL. Stress hormones trigger inflammation and high blood sugar, which encourages the liver to produce more LDL. By taking time to clear our minds and manage stress, we can lower our LDL levels.
Your doctor may recommend treatments like Metformin, which can reduce CVD risk by reducing blood sugar levels and improving insulin sensitivity. Semaglutide has also shown promise by reducing triglycerides and increasing HDL to manage our LDL levels and improve CVD risk.
The key is to not focus solely on LDL, but our whole longevity. LDL is one aspect of our cardiovascular health, which is a fragment of our longevity journey. By setting a solid foundation with healthy lifestyle choices, comprehensive testing, and doctor-guided treatments, we’re doing more than just lowering our LDL—we’re giving ourselves more healthy years.
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Note: The above statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.