Aiming For Cardiovascular Health
In recent weeks, we have been focusing our attention on a molecule essential for our metabolism: cholesterol.
We began by clarifying some common misconceptions regarding the terminology commonly used when referring to this topic; addressed how each of the main lipid molecules is absorbed by our bodies and the impact they have on cardiovascular health; and we also demonstrated our approach to optimizing lipid metabolism.
The main consequence of the dysregulation of this part of human metabolism is undoubtedly the development of atherosclerosis.
Unfortunately, the usual medical approach to these issues, except for particular exceptions, typically begins subtly around the age of 40 and more effectively around the age of 50.
However, atherosclerosis is a process that starts much earlier. From the age of 20, the development of atherosclerotic plaques can be observed, albeit faintly.
Therefore, it should be a concern of healthcare professionals to provide appropriate follow-up for their patients from that age onwards, to prevent reaching points of difficult reversibility when patients are 60 or older.
Currently, even the most widely used risk calculators by major scientific societies focused on cardiovascular risk, such as the European Society of Cardiology (ESC) or the American College of Cardiology (ACC), privilege approaching this topic from the age of 40, allowing only the calculation of a 10-year risk from this age. We must understand that this is due to the fact that these are instruments designed for population-level application. Nevertheless, in our personalized work, we should not overlook an individualized and precise study of our patients, regardless of their ages, taking the necessary measures to prevent cardiovascular disease. (link) (link)
As we saw in part III of our series on cholesterol, it is important to assess, at an early stage (and as accurately as possible), our atherogenic potential through the evaluation of Apolipoprotein B (ApoB) and Lipoprotein (a) - Lp(a).
ApoB values should be at least below 80 mg/dL (corresponding to the 20th percentile), as it is from this value that the greatest benefits of its reduction in our health may be observed (link). The majority of guidelines suggest a value between 65 and 80 mg/dL. (link)
This should always be the sought-after value for us, healthcare professionals, to assess as concretely as possible the number of LDL particles present in our circulation.
However, as we mentioned in previous texts, this is often done through a less precise method: LDL cholesterol concentration (c-LDL). A value of 80 mg/dL of ApoB will correspond roughly to a value of c-LDL of 70 mg/dL. In healthy adults, the usual target value is not so ambitious according to the ESC (100 mg/dL), but additional reduction could bring enormous benefits without any deleterious consequences. (link)
Regarding Lp(a), the most accepted cutoff for increased cardiovascular risk is 50 mg/dL (120 nm/L), so this should always guide our interventions. (link) (link)
In recent times, the target values for triglycerides have not undergone significant changes, with values below 150 mg/dL being ideal to avoid increasing cardiovascular risk. HDL cholesterol has increasingly been disregarded in assessing this risk, for example, there are currently no recommended values by the ESC. (link)
Despite this, it is not the values of the molecules mentioned in the previous paragraph that should guide our intervention, but rather those explained in the lines before. Only with them can we measure the effectiveness of the interventions we seek to adapt rigorously to those who seek us with the goal of improving their metabolic health, particularly concerning cardiovascular prevention.
