Understanding Cholesterol during times of COVID

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COVID-19 has been the hottest topic so far in 2020 and we all are busy with warding off the coronarvirus. While we are drawing most of our attention to the pandemic, have we made enough effort into maintaining our cardiovascular health? Dr. Henry Kok, a specialist in cardiology, pointed out that cholesterol has indeed been triggering a red alert in the developed world and in Hong Kong, nearly half of the population at the age of 15 to 84 has high cholesterol levels⁽¹⁾.

Dr. Henry Kok commented, “There are different researches looking into blood cholesterol levels in different ethnic populations. According to data from the United States, hyperlipidemia is more commonly seen in Whites and Asians, and is less prevalent in Blacks⁽²⁾. Although dietary intake does affect our cholesterol level, our genetic makeups play an important role in blood cholesterol.”⁽³⁾

Surprisingly, the incidence of heart disease in different ethnic groups is as follows – the highest in Blacks, followed by Asians, and lowest in Whites⁽⁴⁾. “The reason for such interesting findings is that there are many other risk factors for heart disease including smoking, excessive alcohol consumption, family history and health conditions such as diabetes⁽⁵⁾. However, cholesterol is the one that people don’t pay a lot of attention to because we usually won’t experience symptoms of having high blood cholesterol levels.” Dr. Kok added.

Cholesterol is a waxy substance found in all body cells and our body needs cholesterol for various functions, ranging from producing hormones to transporting fat-soluble vitamins⁽⁶⁾. However, too much of “bad” cholesterol, low-density lipoprotein (LDL-C), contributes to the build-up of plaques in the blood vessels. Accumulation of plaques hardens and narrows the blood vessels, which then limits the blood flow to the vital organs. This could result in serious health problems such as heart attack and stroke⁽⁶⁾. So, how much is too much? “LDL-C goal should be individualized,” Dr. Kok suggested.

“Before 2004, with intensive lifestyle intervention and medication, we could only bring high-risk patients’ LDL-C level down to around 1.8mmol/L the lowest. It was very impressive if the level dropped from 5-7mmol/L to 1.8mmol/L, as that could achieve a significant reduction in heart attacks, stroke, or even death rates⁽⁷⁾. What about lower than 1.8mmol/L? In the 2010s, there were considerable concerns about adverse effects of very low LDL-C levels, for example, hemorrhagic stroke and increase in cancer risks⁽⁸⁾. When it came to around 2018, with stronger scientific evidence from larger-scale studies, lower rates of heart attack, stroke and death were, in fact, seen with lower LDL-C levels, without any increase in hemorrhage in the brain nor cancer incidence⁽⁹⁾.”