Ask the Doctor: Ethan A. Yalvac, M.D., FACC, RPVI, CBNC

Q. How much does cholesterol impact the likelihood of me developing coronary artery disease?

A. Cholesterols are a family of very important compounds in the human body. Cholesterol derivatives are the building blocks of every cellular membrane and are essential in numerous biochemical processes for maintaining good health.

The cholesterol in our blood has traditionally been categorized into two groups: “bad” LDL and “good” HDL. Simply put, LDL is a transport particle that helps deliver cholesterol from the liver to different tissues of the body. HDL serves to transport excess cholesterol back to the liver for reprocessing. Numerous studies have linked coronary artery disease (CAD) to elevated levels of LDL. Similarly, low levels of HDL have been correlated to the early development of CAD and aggressive progression of atherosclerosis. Atherosclerosis is the inflammatory process in which plaque is formed and deposited in the walls of our arteries.

Modern medicine has demonstrated that effective lifestyle modification and medical therapies that reduce LDL slow the disease process of CAD and reduce the risk for heart attack and stroke. However, the story is not quite that simple.

Over the last few years, research has demonstrated a menagerie of biologic players that work in concert to regulate our body’s cholesterol and lipid systems. Even LDL can be broken down into small and large forms. The smaller your LDL particles, the more atherogenic (plaque inducing) they appear to be. It is this complex interplay that lies below the surface of standard cholesterol testing that, in part, explains how some people may have seemingly “normal” cholesterol yet still suffer from CAD at a young age. Based on your family history, lifestyle, and other medical risk factors, your doctor can help you decide whether advanced lipid profiling is right for you.

Overall, our mothers’ maxims still hold true. An apple a day may truly keep the cardiologist away! The adoption of healthy diets founded primarily on fruits, vegetables, and complex non-refined carbohydrates that include sparing amounts of low fat dairy and wild caught fish is the best approach to optimizing your lipid profile. This strategy should include a lifelong commitment to exercise (at least 150 minutes of moderate exercise per week) and some form of healthy stress relief such as meditation. Further, avoidance of tobacco, excessive alcohol, traditional animal fats, and maintenance of a healthy weight are cornerstones to heart healthy living.

Despite best efforts, some people will still develop CAD. If you carry a diagnosis of CAD or have a family history of early CAD you should seek medical consultation to help reduce your risk for heart attack and stroke. This includes medication management of CAD risk factors such as dyslipidemia (high cholesterol), high blood pressure, and diabetes. The most important take away is to not live in denial of silent risk factors you might have and to ask your doctor how best to optimize your cholesterol and heart health.

Ethan A. Yalvac, M.D., FACC, RPVI, CBNC, is a board-certified cardiologist at Hoag.