Cholesterol values, how important are they?

Currently, in Italy, the overall weight of cardiovascular diseases on total deaths is close to 50%. For this reason, for many years now, the attention of an impressive number of researchers has focused on the risk factors involved in the development of atherosclerotic disease, as it is mainly responsible for deaths from cardiovascular accidents.

Cholesterol values have long been the reference standard for assessing this type of risk. Simple to measure and cheap - but now considered superficial and insignificant - total cholesterol is only one of many predisposing factors, such as hypertension, diabetes mellitus, cigarette smoking, obesity, hypertriglyceridemia, and family history. such pathologies and physical inactivity. This is the picture that emerges from the latest studies in the sector, which have acquired greater sensitivity, specificity and critical spirit over time. For some years now, therefore, we have begun to talk more and more about metabolic syndrome, homocysteine, hyperuricemia, platelet aggregation, apolipoproteins [Lp (A1) and Lp (B)], free radicals, proinflammatory factors (especially the C reactive protein or PCR), nitric oxide and many other "cardiovascular risk thermometers".

At this point it is legitimate to ask whether the classic monitoring of cholesterol values should be retired or not. Although the answer to this question, of course, is negative, a conscientious doctor should direct his patients, especially those considered at risk, to much more thorough examinations.

Cholesterol and triglyceride values (expressed in mg on dL of plasma) that should be observed in the prevention of cardiovascular diseases in the healthy population (*)
Parameter	Desirable values	Values at moderate risk	High risk values
Total cholesterol	<200	200-239	> 240
LDL cholesterol	<130	130-159	> 160
HDL cholesterol (**)	Men> 39 Women> 45	Men 35-39 Women 40-45	Men <35 Women <40
Triglycerides	<200	200-400	> 400

(*) The reference ranges vary according to the characteristics of the patients; in addition to age and sex, all the aforementioned risk factors must be considered, such as the presence of cardiovascular pathologies, familiarity with this kind of disorders, obesity, smoking habits and so on. In these last cases the desirable cholesterol and triglyceride levels are clearly lower than those reported in the table.

(**) The HDL and total cholesterol values are also used to calculate an extremely important parameter, called a risk index, which represents a valid and statistically significant tool for assessing the patient's cardiovascular risk.

DESIRABLE RISK INDEX: Total cholesterol / HDL less than 5 if man or 4.5 if woman

According to recent guidelines, total cholesterol values are not significantly correlated with the quantification of cardiovascular risk. It is therefore better to avoid going crazy to bring the total cholesterol threshold below 200 mg / dL and concentrate, rather, on improving the good fraction or HDL, on strengthening the immune system and on the consumption of antioxidants and anti-inflammatory foods. Blue fish, olive oil, walnuts and linseed oil (but without exaggerating with the quantities), green tea, probiotics, prebiotics, fruit, vegetables and whole foods, represent some of the best allies against cholesterol ... without forgetting the practice of a regular and specific physical activity (which is one of the best methods to increase the values of the HDL fraction).

The benefits of regular exercise combined with a healthy and balanced diet are also the best way to strengthen the body's immune defenses. This could also have a protective role against cardiovascular risk; in fact it has been seen that some infectious agents, such as Helicobacter pylori, Chlamidia pneumoniae and various viruses, including Cytomegalovirus, could be involved in the pathogenesis of atherosclerosis.

Caloric moderation and diet sobriety are another key element in controlling cardiovascular risk. A few extra pounds of fat, not to mention too many glasses or smoke, would in fact frustrate the positive results obtained on the food front.

Among the new emerging risk factors, one of the most important for assessing cardiovascular risk - again through a simple blood test - is homocysteine, a sulfur amino acid originating from the metabolism of methionine (another amino acid commonly found in animal foods) . Against a daily requirement in the adult estimated at around one gram of methionine, the average introduction of the western population is more or less double.

Plasma homocysteine values above 12 mmol / l increase cardiovascular risk.

It is important to note that, just as a familial hypercholesterolemia can be kept under control with the generous consumption of fish, whole foods, fruits, vegetables and ... see: cholesterol diet, hyperomocysteine can be controlled by consuming adequate amounts of folic acid (vitamin present in raw green leafy vegetables, less cooked ones), vitamin B6 and vitamin B12 (mainly contained in food of animal origin). Conversely, low levels of these micronutrients can aggravate the risks associated with this condition.

To decrease the number of cardiovascular events, it is therefore necessary to associate the evaluation of additional risk factors to the classic monitoring of cholesterol values. Even more important is the commitment on the dietary and behavioral front, which involves the involvement of the population through information campaigns aimed at increasing sensitivity towards these issues.