Cardiovascular disease risk is multifactorial with influences from your lifestyle, socioeconomics, and genetics. While you cannot affect your genetics there are a number of lifestyle factors that can have a profound effect on reducing your risk of cardiovascular disease and to many respects, attenuate genetic influences altogether. These factors include:
Maintain a healthy weight and waist circumference.
Stay regularly active.
Drink alcohol in moderation.
Quit tobacco/e-cigarette use.
Improve your stress resilience.
Maintain good sleep hygiene.
The first step in the development of cardiovascular disease is a process called atherosclerosis, where fatty plaques start to form in the innermost part of your arteries, causing the space for the blood to flow through to become smaller. This smaller opening reduces blood flow and increases the likelihood of a blockage occurring en-route to the heart (causing a heart attack/angina) or to the brain (causing a stroke/TIA). The above mentioned lifestyle factors all influence this process by either affecting the amount of damage caused to the arteries that allows for fats to enter the inner lining; causing changes to your weight; or by affecting the amount of “bad fats”, that are in your arteries and available to form the fatty plaques.
The three main types of tested “cholesterol” are Low-Density Lipoproteins (LDL), High-Density Lipoproteins (HDL), and Triglycerides. LDL cholesterol is synthesized from mostly less healthy fat sources (e.g. foods high in saturated and trans-modified fats), the production of LDL cholesterol within your body is increased when carrying excess weight around your waist and when smoking cigarettes. LDL cholesterol is needed for healthy hormone production and in the transport of the other types of cholesterol. HDL cholesterol is synthesized from healthy fat sources (e.g. oily fish, nuts, seeds, avocados, etc.). This type of cholesterol is called cardio-protective cholesterol and helps to return excess cholesterol back to the liver for metabolism and excretion as bile salts, whilst also helping with tissue repair and reducing the risk of blood clots. HDL cholesterol production is increased when regularly exercising but is suppressed by smoking, elevated stress levels, and poor sleep quality. Finally, Triglycerides are energy molecules created from the breakdown of your food intake. This molecule is composed of 3 fatty acids combined with 1 sugar unit and contributes toward increased cardiovascular disease risk when excess concentrations are in the blood while fasted. Triglycerides are typically elevated when the body’s utilisation of dietary nutrients is out of balance (i.e. consuming excess food or alcohol). Triglyceride levels are often higher after meals but should remain low between meals if being properly utilised within the body.
Current standard lipid profiles assess cholesterol levels by measuring total cholesterol, triglycerides, and HDL cholesterol concentration in your blood. LDL cholesterol is not directly measured, instead it is calculated using the other results. Total cholesterol is how much of all the different types of cholesterol are in your blood and as a result tells us very little of any practical use. Elevated total cholesterol levels tell us nothing about cardiovascular disease risk on its own and can only point toward the need for further testing. As a result, this outdated measure should not be used for tracking or assessing cardiovascular disease risk. As LDL cholesterol is a calculation assuming that all remaining cholesterol that is not HDL or triglycerides is LDL, it too has limited practical use as this number will include other known forms not covered here such as very low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), and apolipoproteins. The remaining results have some practical use but will hopefully be replaced by more accurate tests looking at cholesterol particle number and not concentration in the future. The key results to focus on are your HDL Cholesterol, triglycerides, and the ratio between these two (Note: HDL/Triglyceride ratio is rarely reported on your blood results but can be calculated yourself using the below link:
HDL/Triglyceride Ratio Calculator - www.thebloodcode.com/calculators/
Reference ranges for HDL Cholesterol, Triglycerides, and HDL/TG Ratio are as follows:
HDL Cholesterol: Ideal >1.03 mmol/l (Men), >1.27 mmol/L (Women)
Triglycerides: Ideal < 1.7 mmol/L
HDL/TG Ratio: Ideal 0.5 – 1.9
Your body composition (i.e. how much of you is made from fat or muscle), has a significant impact on your risk for developing cardiovascular disease. Excess body fat, specifically excess fat carried around the waist increases the production of bad forms of cholesterol, increases blood pressure, and increases your risk of developing diabetes, an independent risk factor for developing cardiovascular disease. Therefore, try to maintain a healthy BMI of between 18.5 and 24.9 kg/m2 for Non-South Asian populations and between 18.5 and 23.0 kg/m2 for South Asian populations and a healthy waist circumference of less than 94cm (Men) or 80cm (Women) for Non-South Asian populations or less than 90cm (Men) or 80cm (Women) for South Asian populations (Note: South Asian populations include those from the India, Pakistan, Bangladesh, South East Asia, Japan, and China). For additional help in how to lose excess body fat efficiently and keep it off forever, check out my weight loss blog