The European Society of Cardiology has recently shifted interest on bad cholesterol LDL. In the past it has discussed total cholesterol as an issue but it is bad cholesterol that is associated with cardiovascular disease and so it is now in the microscope as the biggest reason for concern. Low levels of bad cholesterol are in fact linked to a reduction in cardiovascular disease.

Dr. Maddalena Lettino, Head of the unit of Cardiological decompensation at Humanitas, spoke as a guest in the studio of “My doctor” on TV2000.



What damage can high bad cholesterol LDL cause?

Imagine the bad cholesterol LDL as a set of fat molecules that tend to accumulate inside the blood vessels. This material will collect at some points of the vascular wall, creating a restriction. The accumulation of cholesterol gives the vessels a greater susceptibility to the formation of blood clots. Thus, the risk of heart attack, stroke, and so on arises. That’s why it is important to reduce the material deposited in the blood vessels.


Is high blood pressure linked to high levels of bad cholesterol?

No, blood pressure and cholesterol have two completely different origins. They are, however, two powerful cardiovascular risk factors and therefore should be monitored and if necessary treated, because it is not sufficient to act on one and consider yourself safe on the other.


Can you lower bad cholesterol levels by changing your lifestyle?

To lower high bad cholesterol it is necessary to intervene on your lifestyle as it is to follow a drug therapy. The lifestyle is the first step, especially for those who have cholesterol values outside the normal but do not have other cardiovascular risk factors. It is therefore important to follow a proper and balanced diet, do regular exercise and quit smoking.

The therapy is indispensable in achieving lower bad cholesterol values. LDL values should be between 110 and 130 in healthy individuals, and between 70 and 100 in patients with diabetes or cardiovascular diseases.


What foods should we prefer?

Some foods can be helpful in lowering high cholesterol. Example include the fruits of the season, vegetables raw and cooked, white meat and lean fish. You should also include whole grains, nuts and seeds (in the right quantities), milk and low-fat cheese in your diet. You should also prefer grilled, steamed, broiled and boiled foods. In regards to condiments you should opt for extra virgin olive oil which you can use in increased amounts when raw. Avoid or limit fats, meats and sweets (which contain a lot of sugar). We give a green light to eggs, but in moderation, one or two eggs a couple of times a week.


What are statins and how do they work?

Statins are drugs that have saved the lives of millions of people. They block or reduce the production of cholesterol by the body. They have reduced cardiovascular mortality, however, they are associated – like all medications – with some side effects. The most frequent include muscle pain, feeling of heaviness in the muscles and cramps. This problem is to a large extent benign and although it does not produce irreversible effects on the muscles it can be a burden on patients. It is the responsibility of the doctors to figure out if your symptoms are disabling against the benefit of statins and if there are signs of muscle damage.


The novelty of monoclonal antibodies

The monoclonal antibodies have a different and complementary mechanism of action to that of statins. They were used in patients with hypercholesterolemia that are familiar with high values of cholesterol from a young age. These new drugs are administered subcutaneously, once or twice per month and today are experienced – in most cases – in addition to statin therapy, which is not giving the desired results. Monoclonal antibodies are also associated with fewer side effects and therefore should be more tolerated. In the future these drugs could spread to such an extent as to constitute another revolution after statins.