What is sticky cholesterol and what does it do to your heart? Can statins help?

WHAT IS LP(a) OR STICKY CHOLESTEROL?

“LP (a) is formed in the liver with protein and fat molecules attached to it. It carries cholesterol through the blood and works through low-density lipoprotein (LDL), commonly known as the bad cholesterol. That’s why the quantum of its presence is a risk marker for CVD. It builds up along the walls of blood vessels and sticks to them like a Velcro band, accelerating blood-clotting and increasing a person’s risk of heart attack or stroke. It promotes inflammation, which increases the likelihood of plaques rupturing and can narrow the aortic valve,” says Dr Balbir Singh, Chairman, Cardiac Sciences, Cardiology, Cardiac, Electrophysiology-Pacemaker, Max Hospital. “This is concerning for most Indians as those suffering from high blood pressure and diabetes have genes linked to Lp(a),” he adds.

Since Lp (a) is a risk marker, the only way to figure out your cardiac threat is to undergo an extended lipid profile, which shows the presence of Lp(a). “Just two days ago, we had to put two stents in a 41-year-old woman who had already had a bypass surgery at age 35. Still her grafts got blocked. We found very high levels of Lp(a),” says Dr Singh.

HOW DO WE LOWER STICKY CHOLESTEROL?

‘Since it is a marker, the only way to lower it is to lower the way it functions, through LDLs, particularly the small density LDLs. While the total LDL counts of Indians are lower than Caucasians, the proportion of small density LDLs is higher. These are more toxic for the walls of the blood vessels. So you see, we have a milieu for heart disease and need to get our LDL levels down aggressively,” says Dr Singh.

According to the New York Center for Prevention of Heart Disease, “Individuals with an abundance of small LDL have a 300 per cent more heart disease risk than people with large LDL. This explains why approximately 50 per cent of people who suffer a heart attack have ‘normal’ blood cholesterol levels.”

HOW CAN WE MEASURE SMALL DENSE LDL?

There is the Nuclear Magnetic Resonance (NMR) particle analysis and the Gradient Gel electrophoresis, both of which can separate the quality and quantity of the respective types of LDL. If your markers include diabetes, HDL below 35, and triglycerides above 250, then get assessed for small dense LDL.

WHAT CAUSES SMALL DENSITY LDL?

There is genetic pre-disposition but a sedentary lifestyle involving minimal activity or exercise, a fat-heavy diet and insulin resistance or pre-diabetes result in elevated numbers.

HOW CAN WE TREAT SMALL DENSITY LDL

“The only way to reduce any kind of LDL concentration is through statins. Many studies have shown up to a 90 per cent reduction of cardiac events with medication that lowers LDL. That’s why Indian guidelines are different for this precise reason. Very low LDL levels can prevent much of cardio-vascular events. In extreme cases we should work towards the less than 30 mg/dL marker. And we need to start lipid-lowering drug therapies early on besides positive lifestyle changes for those at risk, ” says Dr Singh. “While dietary guidance and correction can reduce LDL by ten per cent and you cannot do without medication, it is advisable that you maintain safe levels by sticking to a Mediterranean diet — fruits, vegetables, fish and low fat milk,” he adds.