LDL-Cholesterol

LDL-Cholesterol is often referred to as the ‘bad’ cholesterol because it can contribute to the formation of fatty deposits in the blood vessels. It is currently the best-studied single risk factor for cardiovascular diseases, among others, and one of the most important starting points in preventive medicine.

Key Facts

LDL stands for low-density lipoprotein - it transports cholesterol from the liver to the cells in the body. The LDL-containing subgroup of cholesterol can be deposited in the walls of blood vessels and form plaques there. This process is known as arteriosclerosis (see below). Links in the development of dementia and cancer are also the subject of much scientific debate. The LDL value is one of the most important laboratory parameters for assessing cardiovascular risk. To the surprise of many, the level of cholesterol is largely genetically predetermined (up to 80% is said to be uninfluenceable), but can always be actively influenced to a certain extent by certain behaviour (visceral fat, diet, exercise, etc.). The aim is to keep LDL as low as possible - different target ranges apply depending on the individual risk. The assessment is therefore always carried out in conjunction with other risk factors and risk modifiers. For this purpose, risk groups are created in line with the guidelines, which help us to define the LDL target range using a statistical 10-year or lifetime risk. Depending on the risk, this is - <3.0mmol/l for otherwise unaffected and healthy people - <2.6mmol/l for people with a low to moderate risk, where an adjustment should be discussed, e.g. due to age or secondary factors. In this risk group, a detailed evaluation of all identifiable factors is particularly important in order to be able to make a targeted recommendation. - <1.8mmol/l for people at high risk due to either numerous or particularly prominent risk factors or very high cholesterol levels. - <1.4mmol/l for people at very high risk, i.e. particularly pronounced risk factors or even events that have already occurred, such as a heart attack or stroke, in order to prevent further events. Good cholesterol control is always recommended for people with diabetes. Lowering cholesterol by 1mmol/l results in a 22% reduction in the relative risk of suffering a heart attack, stroke or sudden cardiac death, even at low levels that are already well controlled. The scientific evidence for this is overwhelming, despite some particularly loud dissenting voices.

Apolipoprotein B

Apolipoprotein B is a protein that sits on all atherogenic (vessel-damaging) lipoproteins (including LDL and Lipoprotein (a)) - its value therefore shows how many potentially ‘bad’ cholesterol particles are circulating in the blood. The latest scientific findings suggest that the predictive power of Apolipoprotein B even exceeds that of LDL-Cholesterol.

Key Facts

Apolipoprotein B is the main component of lipoproteins such as LDL, VLDL and Lipoprotein (a), which transport cholesterol in the blood. Each of these particles carries exactly one ApoB molecule - so the ApoB value not only shows how much cholesterol is being transported, but also how many potentially vascular-damaging particles are travelling in the blood. All of these particles can be deposited in the arteries and lead to the development of arteriosclerosis. Compared to the LDL value, AFpoB often provides an even more accurate assessment of cardiovascular risk, especially in people with elevated triglycerides or a conspicuous metabolic profile. In modern guidelines, ApoB is increasingly recommended as a complementary or even preferred risk marker, especially in people with metabolic syndrome, diabetes or a family history. Similar to LDL-Cholesterol, the number of these particles is to a large extent genetically predetermined (up to 80%), but can always be actively influenced to a certain extent by certain behaviour (visceral fat, diet, exercise, etc.). Here too, the aim is to keep the ApoB as low as possible - depending on the individual target range. The assessment is therefore always carried out in conjunction with other risk factors such as blood pressure, smoking, sugar metabolism, family history and lifestyle. For this purpose, risk groups are created in accordance with the guidelines, which help us to define the ApoB target range using a statistical 10-year or lifetime risk. Depending on the risk, this is - <1.0g/l for otherwise unaffected and healthy people - <1.0g/l for people with a low to moderate risk, where an adjustment should be discussed, e.g. due to age or secondary factors. In this risk group, a detailed evaluation of all detectable factors is particularly important in order to be able to make a targeted recommendation. - <0.8g/l for people at high risk due to either numerous or particularly prominent risk factors or very high cholesterol levels. - <0.65g/l for people at very high risk, i.e. particularly pronounced risk factors or even events that have already taken place, such as heart attacks or strokes, in order to prevent further events. Good cholesterol control is always recommended for people with diabetes.