Cholesterol and Cardiovascular Health: The Hidden Connection
- MedReport Foundation
- 4 minutes ago
- 6 min read
A patient visited hospital for a routine health checkup. He had complained of mild chest
discomfort and tiredness for the past two weeks. He attributes work stress and irregular sleep. So, the doctor advised lipid profile test. The laboratory test results show elevated total
cholesterol and LDL levels along with decreased HDL levels, indicating an increased risk of
cardiovascular disease.
Introduction
The cardiovascular system comprises mainly the heart and blood vessels. Cardiovascular
disease (CVD) is a collective term of disorder in the heart and blood vessels. Globally, it is
the leading cause of death. More than three quarters of death occurs in low – and middle-
income countries, due to insufficient knowledge and lack of awareness. The highest death
rate has been registered for the CVD. It is evident among several risk factors of CVD that
abnormal cholesterol levels in serum are a major risk factor for the occurrence of CVD (1,2).
Cholesterol
Cholesterol is a fat -like substance that plays a major role in human health. The cholesterol
can be taken by dietary food or synthesized by the body (3). The function is to maintain
cellular membrane process, immunity, signaling and pathway regulation, plays important role
in hormone production like synthesis of vitamin D, bile acids and oxysterols (4).
Types
The following are the types of cholesterol present in the blood
a) Low density lipoprotein (LDL)
It is known as bad cholesterol. LDL transport cholesterol from liver to rest of the body
(5). A high level of LDL is linked to a major risk of CVD (6). It directly damages the
blood vessel (7).
b) High density lipoprotein (HDL)
It is also called as good cholesterol. Through the process of reverse cholesterol
transport, remove excess cholesterol from the blood stream, which prevents the
buildup of fats (6). The HDL transport cholesterol from various body tissues to liver
(5). Low level of HDL shows increased risk of heart disease (7).
c) Triglyceride
The triglyceride uses different types of lipoproteins to transport in blood, among
which VLDL is the most important. The high level of triglyceride increases risk for
cardiac health and inflammation in the pancreas (7).
Role Of Cholesterol In Body
Cholesterol is often considered as bad. It has many roles in body function.
• Cholesterol maintains cell structure, flexibility and permeability. By clustering
cholesterol in areas form lipid rafts gathers important proteins for cell signaling.
• Cholesterol binds to toxins like endotoxin acts as scavenging process where neutralize
toxins from the blood.
• Cholesterol helps to produce many hormones namely: adrenal hormones like cortisol,
vitamin D, sex hormones such as estrogen, progesterone, testosterone. Vitamin D
plays a major role in insulin resistance, CVD, and bone muscle disorder. 80% of
cortisol is produced from the circulating cholesterol.
• Cholesterol can be oxidized to form oxysterol. It can play a major role in immune
regulation.
• Cholesterol is converted into bile acids. Through this process excess cholesterol can
be removed easily. These help in digestion and improve absorption. (4)
Cholesterol And Heart Disease
It is evident that atherosclerosis is caused by cholesterol (3). When the cholesterol is not
properly eliminated from the body. It forms plaque along the artery walls, making arteries
stiff and clogged leading to atherosclerosis. Indeed, atherosclerosis forms heart attack, stroke, heart or kidney failure, obesity and diabetes (6).
Types of heart disease include
• Coronary heart disease- deposition of fats in the artery walls.
• Arrhythmia- shows irregular heartbeat.
• Myocardial infraction- arteries get blocked where oxygenated blood stops supply to
other heart muscles.
• Atherosclerosis - buildup of plaque in arteries. It interrupts the blood flow to other
parts of the body
• Mitral valve prolapse (MVP)- the mitral valve, a part of heart which regulate blood
flow between hearts left atrium and left ventricle. During this MVP, the valve did not
close during contraction, leading to bulging back to the left atrium. (8)
Pathophysiology Of Atherosclerosis
• Generally, arteries are like walls of the tube that transfer oxygen-rich blood from the
lungs and heart to other body tissues (5).
• Atherosclerosis starts with endothelial dysfunction caused by several factors such as
increased LDL, smoking, diabetes and blood pressure.
• When blood cholesterol level become elevated, the inner walls of arteries get thickens
where lipoprotein accumulate in the arterial walls. Majorly the LDL particle entered
the arterial wall and became trapped. This LDL particle undergoes oxidation and is
taken up by macrophages, leading to the formation of foam cells.
• The smooth muscle cells move from artery to inner layer of the arterial wall (intima)
after the formation of foam cells. These cells produce extracellular matrix components
that contribute to formation of fibrous plaque. Several immune response cells are
involved in the development of atherosclerosis.
• These plaques become unstable and make them prone to rupture. When plaque
rupture occurs, it leads to blood clot formation and platelet aggregation. So, it blocks
the artery and leads to serious complications (9).
Risk Factors
The following are the most common risk factors that cause CVD:
• Smoking
• Increase in LDL and decrease in HDL
• High blood pressure
• Swelling in the artery wall
• Obesity
• Lack of Physical inactivity (10)
Symptoms
The most common symptoms include
• Loss of feeling in the face, arm or leg
• Difficult to understand
• Severe headache
• Temporary loss of consciousness.
The particular symptoms of heart attack and stroke include
• Pain in the center of chest, left shoulder, elbows, jaw or back
• Weakness in face, arm or leg.
• Difficulty in breathing
• Stomach upset or vomiting. (1)
Diagnosis
Lipid abnormalities can be diagnosed through lipid profile analysis
• Triglyceride - < 150 mg/dL
• LDL - <100 mg/dL
• HDL - > 40 mg/dL (11)
The following are the several imaging techniques to monitor cardiac disease.
• ECG (electrocardiography) – a simple way to diagnose heart structure. It is used to
check heart attacks and arrhythmias.
• Echocardiography – clearly shows the structure and thickness of the heart. It also
shows movement of the heart wall and movement of the heart.
• DSA (digital subtraction angiography) - diagnose the blockage of coronary arteries
disease.
• CMR (cardiac magnetic resonance imaging) – uses magnetic field to assess the
location and size of the heart. It also understands the structure of the pericardium (12).
Reference
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Prospective Cohort Studies. IJERPH [Internet]. 2022 [cited 2026 May 7]; 19(14):8272
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