Physicians may often use the terms ‘good’ and ‘bad’ when discussing cholesterol with their patients, suggesting that lower levels of ‘bad’ cholesterol can help reduce the risk of cardiovascular events and developing cardiovascular disease (CVD).1,2 However, what is the difference between ‘good’ and ‘bad’ cholesterol and how can people ensure to maintain optimal levels of both.
Cholesterol is a type of lipid (fat), which plays an important part in the structure and function of cell membranes and is required for the synthesis of hormones and vitamin D.3 Around 80% of it is produced naturally in the body and is carried in the blood attached to proteins, forming ‘lipoprotein’ particles.3 Many people in Europe understand that there is a link between high cholesterol and the risk of cardiovascular events.4
There are two key types of cholesterol-carrying lipoprotein particles.1 High-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) can often be referred to as ‘good’ and ‘bad’ cholesterol, respectively, and an individual’s level of each is a key measure that physicians use when determining CVD risk.1 HDL-C (‘good’) cholesterol transports cholesterol to the liver where it can be removed from the body and is associated with protecting your arteries.1 LDL-C (‘bad’) cholesterol carries cholesterol to the body tissues and can lead to a build-up of so-called plaques on artery walls.1,3 This build up is understood to increase the risk of cardiovascular events and developing CVD.1 Contrary to prior suggestions, recent large-scale studies have failed to confirm the benefit of higher levels of HDL (‘good’) cholesterol in reducing CVD risk.5
While genetics can influence peoples’ levels of HDL-C and LDL-C cholesterol, lifestyle choices significantly impact the levels.1 People with CVD and those with an elevated risk of cardiovascular events are frequently encouraged to maintain a healthy diet and to exercise regularly in order to achieve long term optimal levels of HDL-C and LDL-C cholesterol.1 However, for individuals with high LDL-C cholesterol levels medical interventions can also be used where the risk is considered significant enough by a physician to warrant it.1
How can cholesterol be managed effectively?
There aren’t any specific/visible symptoms that result from unbalanced / high levels of ‘bad’ cholesterol, and the only way it can be identified is through the use of specific tests that take a reading of the level of cholesterol in your blood.6,7 For that reason, for those with elevated CVD risk or diagnosed with high levels of ‘bad’ cholesterol, it is important to regularly monitor cholesterol levels and attend regular physician’s appointments to discuss the readings.
The conventional wisdom regarding management of LDL-C cholesterol levels can be captured by the following principle: The lower the better, the longer the better.
How aware is the public of our cholesterol levels in Europe?
Whilst the risk associated with elevated cholesterol levels is generally well understood among the general population, only approximately 50% of individuals would be able to state their cholesterol levels.4 This reduces further for individuals from the UK and the Netherlands where less than 40% of individuals knew what their cholesterol levels were when asked.4
Better education around cholesterol and the role it plays in CVD is needed to ensure people across Europe understand the importance of monitoring their cholesterol levels as part of managing their CVD risk. Whilst not always possible, prevention remains the best approach to reduce the risk of CV events and improving patient outcomes. World Health Organisation data demonstrated that 80% of stroke and heart attack events are avoidable and a better understanding of cholesterol and improved monitoring is essential to help rectify this statistic.11 At Daiichi Sankyo Europe, we are dedicated to raising awareness of CVD and its risk factors to ultimately help reduce the impact of CVD in Europe.
 Bhatt, A. (2018) Cholesterol: Understanding HDL vs. LDL, Harvard Health Publishing. Available at: https://www.health.harvard.edu/blog/understanding-cholesterol-hdl-vs-ldl-2018041213608. Last accessed March 2023.
 Francois Mach (2020) “2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk,” European Heart Journal, 41, pp. 111–188. Available at: https://doi.org/10.1093/eurheartj/ehz455. Last accessed March 2023.
 Harvard Health Publishing. (2017). Harvard Medical School. How it’s made: Cholesterol production in your body. Available at: https://www.health.harvard.edu/heart-health/how-its-made-cholesterol-production-in-your-body. Last accessed March 2023.
 Daiichi Sankyo Europe. European Survey Report of Cardiovascular Disease, Daiichi Sankyo Europe / Censuswide. June 2021. Available here. Last accessed March 2023.
 Güleç, S. and Erol, C. (2020) “High-density lipoprotein cholesterol and risk of cardiovascular disease,” e-Journal of Cardiology Practice, 19(3). Available at: https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-19/high-density-lipoprotein-cholesterol-and-risk-of-cardiovascular-disease#:~:text=Although%20it%20is%20a%20common,those%20with%20extremely%20high%20HDLs. Last accessed March 2023.
 CDC. (2022). About Cholesterol. Available at: https://www.cdc.gov/cholesterol/about.htm. Last accessed March 2023.
 NHS.Getting tested - High cholesterol (2022) NHS choices. Available at: https://www.nhs.uk/conditions/high-cholesterol/getting-tested/. Last accessed March 2023.
 Carson, J.A. (2020) “Dietary cholesterol and cardiovascular risk: A science advisory from the American Heart Association,” Circulation, 141(3). Available at: https://doi.org/10.1161/cir.0000000000000743. Last accessed March 2023.
 BHF. High cholesterol - symptoms, causes & levels (2022). Available at: https://www.bhf.org.uk/informationsupport/risk-factors/high-cholesterol. Last accessed March 2023.
 Ference, B.A., et al. (2012) “Effect of long-term exposure to lower low-density lipoprotein cholesterol beginning early in life on the risk of coronary heart disease,” Journal of the American College of Cardiology, 60(25), pp. 2631–2639. Available at: https://doi.org/10.1016/j.jacc.2012.09.017. Last accessed March 2023.
 WHO.int. 2015. Cardiovascular diseases: Avoiding heart attacks and strokes. Available at: www.who.int/news-room/questions-and-answers/item/cardiovascular-diseases-avoiding-heart-attacks-and-strokes#:~:text=The%20good%20news%2C%20however%2C%20is,are%20the%20keys%20to%20prevention. Last accessed March 2023.
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