The risk of ischemic heart disease – the leading cause of death worldwide – is three times higher in persons with high levels of the so-called ‘ugly’ cholesterol. This is the finding of a new study of 73,000 Danes, which is shedding light on a long debate on this topic. The results have just been published in the Journal of the American College of Cardiology.
Most individuals are aware that high cholesterol is life-threatening. But very few know which type of cholesterol is the most frequent killer. Cholesterol is divided into ‘the good’ HDL cholesterol, ‘the bad’ LDL cholesterol and ‘the ugly’ cholesterol. It is the so-called ‘ugly cholesterol’ – also called ‘remnant cholesterol’ – that is a really bad guy.
“LDL cholesterol or ‘the bad’ cholesterol’ is of course bad, but our new study reveals that the ugly cholesterol likewise is the direct cause of atherosclerosis resulting in ischemic heart disease and early death. By examining 73,000 persons, we found that an increase in the ugly cholesterol triples the risk of ischemic heart disease, which is caused by lack of oxygen to the heart muscle due to narrowing or blocking of the coronary arteries,” says Professor Børge Nordestgaard, Chief Physician at Copenhagen University Hospital and Clinical Professor at the Faculty of Health and Medical Sciences at University of Copenhagen.
“I hope that this new knowledge will lead to better preventive treatment including lifestyle changes, as more than one in five individuals in affluent countries suffers from high ugly cholesterol. We also hope that the pharmaceutical industry will develop new drugs targeted specifically at raised ugly cholesterol levels,” he emphasises.
Widespread disease worldwide
In Denmark alone, 20,000 persons are diagnosed with ischaemic heart disease every year, and some 150,000 Danes are currently affected by the disease. According to World Health Organization estimates, 17 million people die yearly from cardiovascular disease – the most frequent cause of death in the world. Ischemic heart disease is the most common cardiovascular disease.
“High ugly cholesterol is the result of high blood levels of normal fat (triglycerides). The most important cause of high ugly cholesterol is overweight and obesity. Persons with high ugly cholesterol should therefore be advised to lose weight, but drugs such as statins and fibrates may also lower levels of ugly cholesterol in the blood,” says Børge Nordestgaard.
Samples from 73,000 Danes with mutations
Anette Varbo, physician and PhD student at Copenhagen University Hospital, has been part of the research team behind the new findings. She says that the findings shed light on a long-standing debate among researchers on the so-called triglycerides, atherosclerosis and cholesterol.
“To be able to examine the relationship between ugly cholesterol and heart disease, we have used blood samples from persons having a mutation which means that they suffer from high ugly cholesterol their entire life. The research findings do therefore not depend on their lifestyle patterns in general. Unhealthy lifestyle factors such as smoking, fatty foods and overweight all increase the risk of heart disease, and the blood samples from persons having these mutations thus give the most accurate results,” says Anette Varbo.
The scientific article is based on the following three population studies: the Copenhagen General Population Study, the Copenhagen City Heart Study and the Copenhagen Ischemic Heart Disease Study.
Professor Børge Nordestgaard
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