Cholesterol: The Good, The Bad (And The Ugly?)

Cholesterol: The Good, The Bad (And The Ugly?)

Cholesterol gets a bad reputation — but the truth is more nuanced. Cholesterol is a waxy, fat-like substance found in every cell of your body. Your body needs cholesterol to make hormones, vitamin D, and substances that help you digest food. The problem arises when you have too much of the wrong kind.

The Good, The Bad, and The Ugly

• LDL (“bad”) cholesterol — low-density lipoprotein; carries cholesterol to cells but can build up in artery walls, forming plaques that narrow and harden arteries (atherosclerosis), increasing the risk of heart attack and stroke

• HDL (“good”) cholesterol — high-density lipoprotein; carries cholesterol away from cells and back to the liver for removal from the body; higher HDL is protective against heart disease

• Triglycerides — a type of fat in the blood; high triglycerides combined with low HDL or high LDL are associated with increased cardiovascular risk

• VLDL (“the ugly”) — very low-density lipoprotein; carries triglycerides and is associated with plaque formation in arteries

The Genetics of Cholesterol

Cholesterol levels are significantly influenced by genetics. Familial hypercholesterolaemia (FH) — caused by mutations in the LDLR, APOB, or PCSK9 genes — causes very high LDL cholesterol from birth and dramatically increases the risk of early heart disease. Even without FH, variants in genes including APOE, CETP, LPL, and LIPC influence HDL, LDL, and triglyceride levels. Understanding your genetic cholesterol profile allows you to take targeted preventive action.

Managing Cholesterol

• Eat a diet low in saturated and trans fats; increase fibre, omega-3s, and plant sterols

• Exercise regularly — aerobic activity raises HDL and lowers LDL and triglycerides

• Maintain a healthy weight and avoid smoking

• Get regular cholesterol checks, especially if you have a family history of high cholesterol or heart disease