LDL cholesterol, when and how to take supplements and drugs to reduce it

There is one rule that should never be forgotten. Lower is better, the lower it is the less it is. The more you reduce the LDL cholesterolthe one defined as bad which represents a real causal factor of the heart attack, the more effective it can be protection from cardiovascular diseasessuch as heart attack and stroke.
But be careful: you shouldn’t just think about cholesterol. Instead, we need to think about the fkey players in global cardiovascular risk. The prevention of heart attack and stroke cannot be limited to the control of a single “risk factor”. We must act against the various enemies that arise, also because their negative effect on the heart does not add up, but multiplies.

Just think that based on the now historic results of the Framingham Study, a research that followed all the inhabitants of a US town for many years, having a total cholesterol in the blood that rises up to 300 milligrams per deciliter of blood means increasing by four times the risk of having a heart attack. But if who has this altered parameter is also a smoker, diabetic and has high blood pressure the risk of having a heart attack increases tenfold. For this reason, the doctor must indicate which lifestyles to adopt and when and how use any medications to reduce LDL cholesterolbased on the risk profile, which is different from person to person.

Not just a diet to reduce cholesterol

In general terms, if there is no particularly fearful risk profile (we are therefore not talking about subjects who have already had a heart attack and still have a high risk of an acute event) for hypercholesterolemia (modest) as for the increase in triglycerides according to experts First of all, we need to focus on lifestyles.
In this sense the supplement it can be a first approach for those with slightly high cholesterol values ​​but, in agreement with the doctor, aim to improve their lifestyle. When this is not sufficient, in those patients considered at high cardiovascular risk because they are in secondary prevention or because they are diabetic or have hypercholesterolemia and/or severe hypertriglyceridemia, it is necessary to resort to pharmacological therapy.

Having made this necessary introduction, there are also supplements and nutraceuticals that can help. These are different classes of products. With the term functional foods These are defined as foods rich or artificially enriched with natural substances (mostly vegetal) with proven health properties and pharmacological actions, such as, for example, foods containing fiber, phytosterols, omega-3, soy protein.

There are several nutraceuticals often also referred to as supplementsThese are substances of natural extraction (also mostly vegetal) with demonstrated pharmacological actions, such as, for example, bergamot, berberine, monacolines, policosanols. The rationale for the use of these substances arises from their peculiar actions which effectively affect lipid metabolism.

How to lower cholesterol

Let’s start with phytosterols. The plant sterols or phytosterols can help reduce intestinal absorption of cholesterol. But we must not forget that nutraceuticals can play a role. The classes of nutraceuticals most used to reduce cholesterol are: berberina, monacolina K (red rice fermentation product) and policosanols.
There little monacolina K inhibits hepatic cholesterol synthesis. It is contained in red yeast rice.
There berberine it reduces cholesterol by increasing the activity and availability of hepatic LDL receptors and also has a hypoglycaemic action, probably linked to its ability to increase the expression of insulin receptors.
At the table, then, you should never lack fiber. In fact, they can limit the intestinal absorption of cholesterol, thus promoting its elimination through the faeces. Positive effects on cholesterol have been described for various fibers: chitosan, pectin, glucomannan, beta-glucan (the latter also has beneficial effects on blood sugar values). All without forgetting polyphenols.

It also matters how you eat

You have to eat slowlyand also to reduce the risk of developing increased cholesterol. This is according to a study conducted by Giovanna Muscogiuri, a researcher in endocrinology, together with Luigi Barrea, professor of Applied Dietetic Sciences and Techniques, and the research group of the Italian Center for the care and well-being of patients with obesity of the Department of Clinical Medicine and Surgery – Endocrinology Unit of the Federico II University of Naples, directed by Annamaria Colao.
The research involved 187 people with obesity whose habits at the table were investigated, including the duration of meals: comparing those who eat lunch and dinner in less than 20 minutes with those who prolong the pleasure of the table beyond that, it clearly emerged that consuming meals quickly doubles the risk of developing high cholesterolespecially in those who are ultra-fast at dinner.

“Cholesterol is a known risk factor for cardiovascular diseases such as heart attack and stroke, but it is not the only metabolic element that worsens with a meal that is too hasty,” explains Annamaria Colao. Previous studies have shown that eating too quickly is associated with an increase in food consumption and our work confirms this, adding that those who eat in a few minutes more often consume a complete meal with a first course, second course, side dish and fruit. Furthermore, among the foods that can be eaten more quickly there are ultra-processed ones (like some sausages) which, in addition to being very caloric and unhealthythey also make us less able to control our caloric intake.”

The result is that gulping down food at the speed of light is associated with a greater risk not only of high cholesterol, but also of overweight and obesity.

How LDL-lowering drugs work

The goal to be achieved with lipid-lowering therapy is linked to the risk profile of the individual patient and any protective factors. The doctor can prescribe different drugs, which depend on the possible presence of multiple risk factors, but also protective factors. Let’s see, in summary, the action of some of them the most used drugs.
The statins they act by reducing the hepatic synthesis of cholesterol. Ezetimibe instead it blocks the intestinal absorption of cholesterol. Studies have shown that, in association with statins, it does not contribute to reducing cardiovascular risk. L’bempedoic acid is a first-in-class oral treatment that lowers LDL cholesterol levels and can be combined with other oral treatments to help lower them further. It inhibits ATP citrate lyase (ACL), an enzyme involved in the synthesis of cholesterol in the liver.
In more complex cases and when it is necessary to reduce cholesterol more significantly, one can resort to PCSK9 inhibitors which by inhibiting the function of the PCSK9 protein, allow the LDL receptors to be repeatedly ‘recycled’ to the cell surface, where they ‘capture’ and remove LDL from the blood, or Inclisiran.