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Lipid modification - primary and secondary CVD prevention - Background information
What is the relationship between blood lipids and cardiovascular health?
- The underlying pathophysiology of ischaemic cardiovascular disease is atheromatous arterial disease.
- Cholesterol is deposited in the walls of arteries, resulting in a build up of atheroma (fatty plaque).
- The walls of the arteries become stiff and thickened (atherosclerosis), and eventually restrict blood flow, causing conditions such as angina and intermittent claudication. As the plaque enlarges it can erode or rupture through the arterial lining, with formation of a clot (thrombus) over the exposed surface. This can result in sudden occlusion of the artery, causing myocardial infarction or stroke (depending on which arterial system is affected). If a piece of clot breaks off it can travel along the artery and cause a blockage to blood flow further downstream (arterial embolism).
- Total cholesterol is an important predictor of cardiovascular disease (CVD) events.
- Low-density lipoprotein (LDL) cholesterol is a more accurate predictor of CVD events than total cholesterol. LDL cholesterol is the primary target for reducing cardiovascular risk with lipid-modifying treatment.
- High-density lipoprotein (HDL) cholesterol is inversely related to cardiovascular risk. Higher levels of HDL cholesterol are associated with lower risk, even when the total cholesterol level is normal.
- The ratio of total to HDL cholesterol takes account of the risks associated with both types of cholesterol, and is used in tools to estimate cardiovascular risk. These tools include the charts and calculator recommended by the second Joint British Societies' guideline on CVD risk assessment [British Cardiac Society et al, 2005].
- Triglyceride level is a risk factor for cardiovascular disease, and is independent of total cholesterol.
- Elevated fasting triglycerides (greater than 1.7 mmol/L) are associated with increased CVD risk [British Cardiac Society et al, 2005].
- Note: high levels of triglycerides (greater than 10 mmol/L) are associated an increased risk of acute pancreatitis.
- Blood lipids are only one of many important risk factors associated with the development of CVD.
[Ohlsen and Rogers, 2004; Thompson, 2004; Durrington and Sniderman, 2005; British Cardiac Society et al, 2005]
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