Fear the Ugly Cholesterol

Ischemic heart disease risk increases with elevated nonfasting remnant cholesterol

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Cholesterol: the good, the bad and the ugly. The "ugly" cholesterol is one to fear. It can break your heart.

High cholesterol is one risk factor for ischemic (where blood flow is blocked) heart disease. This disease is the leading cause of death worldwide. 

A recent study found that patients with high levels of "ugly" cholesterol were 2.8 times more likely to develop ischemic heart disease. 

"Have your cholesterol checked regularly.   "

Anette Varbo, MD, of Department of Clinical Biochemistry, Copenhagen University Hospital, Denmark, and colleagues led the study to test if "ugly" cholesterol is associated with an increased risk for ischemic heart disease. 

Ischemic heart disease reduces blood supply to the heart. This disease puts people at risk for heart attacks and death. 

The body needs cholesterol to function properly. Cholesterol is a fat produced by the liver which helps cells stay healthy. It aids in the production of hormones the body needs. Cholesterol is transported around the body by lipoproteins, which are made of fat and protein. 

Unfortunately, not all cholesterol found in the body is good. LDL cholesterol (the "bad" cholesterol) is carried from the liver to cells all over the body. If there is too much for the body to handle, it can create a build up of plaque. Plaque is not good because it can clog arteries and reduce blood flow.

HDL cholesterol (the "good" cholesterol) helps the body get rid of the bad cholesterol. It takes the unwanted cholesterol from cells back to the liver and ultimately out of the body.

Remnant cholesterol (the "ugly" cholesterol) is made up of fatty triglycerides that are carried through the blood. The triglycerides are formed from excess calories, sugar or alcohol that eventually get stored as fat in cells. "Ugly" cholesterol is very hard to move through the blood and, like "bad" cholesterol, clogs up arteries.  

The "ugly" cholesterol is measured using a non-fasting remnant cholesterol test. The tests measures the remnant (left over) "ugly" cholesterol that gets trapped in the interior of the artery wall. 

A total of 73,513 participants were used in the study. Of these, 11,984 were diagnosed with ischemic heart disease between 1976 and 2010. 

Study participants had blood drawn to test their cholesterol levels. Researchers compared the participants with ischemic heart disease to participants without the disease. 

Results showed that an elevated ugly cholesterol increase of 1 mmol/l (39 mg/dl) was associated with a 2.8 times increased risk of developing ischemic heart disease. 

Study authors suggested that future intervention studies should further examine the benefits of lowering remnant cholesterol levels and triglyceride-rich proteins on ischemic heart disease. 

The study had some limitations. The patients' genetics may account for some of the increased risk. 

This study, titled "Remnant Cholesterol as a Causal Risk Factor for Ischemic Heart Disease," was published in the Journal of the American College of Cardiology. It was supported by the Danish Medical Research Council, the Danish Heart Foundation, Herlev Hospital, Copenhagen University Hospital, Copenhagen County Foundation and Chief Physician Johna Boserup and Lise Boserup's Fund. Dr. Varbo and colleagues disclosed that one author received lecture and/or consulting fees from AstraZeneca, Merck, Pfizer, Kara Bio, Omthera, Sanofi-Aventis, Regeneron and ISIS Pharmaceuticals.

Reviewed by: 
Review Date: 
January 26, 2013
Last Updated:
August 19, 2013