Cholesterol & Atherosclerosis Archives | Surrey Cardiovascular Clinic

The SCVC Blog

Cardiovascular care news and articles from our expert team

LDL Cholesterol Reduction: Absolute Beats Relative? It’s “And,” Not “Or”

Modern lipid management requires both substantial percentage LDL reduction and achieving low absolute LDL levels. Relative reduction reflects treatment intensity, while absolute LDL determines residual risk. Trials consistently show “lower is better.” Even with good percentage drops, patients may remain undertreated—making combined pharmacological and lifestyle strategies essential to reduce atherogenic exposure and cardiovascular risk.

Cholesterol, LDL, and what we learnt from PCSK9 mutations in familial hypercholesterolaemia

PCSK9 binds to LDL receptors and directs them to be destroyed within the cell, rather than allowing them to recycle to the surface. When too much PCSK9 is present, fewer LDL receptors remain available to clear LDL from the blood. The result is simple: LDL levels rise. When that happens, the liver compensates by making even more cholesterol internally. This is why around 90% of the cholesterol in your blood is made by your liver, not absorbed from your diet.

UK Cholesterol, Apo B, LDL-C Targets

Small dense LDL (sdLDL) particles are the most atherogenic type of LDL. They are smaller and heavier, stay in the bloodstream longer and more likely to oxidise and enter artery walls. High sdLDL is typical of metabolic syndrome, diabetes, and high triglyceride states linked to visceral fat.Because sdLDL testing is specialised, the ApoB level and the LDL-C : ApoB ratio can be used to estimate particle size predominance:

Statin holiday

A key component of evaluating statin-related symptoms is tracking them systematically. A symptom diary can help you visualise the severity and frequency of side effects over time. A "year-at-a-glance" dot plot is particularly useful.

What the heck is LP(a)?

Lp(a) testing is advised for individuals at high risk for cardiovascular disease, including those with a prior stent or bypass operation, coronary syndrome or heart attack as well as anyone with a family history of coronary heart disease, high FAI (coronary inflammation) or high risk patterns on Cardiac CT angiograms. In our practice, Lp (a) is offered as part of our comprehensive Metabolic Health assessment (MHA1).

Bempedoic acid to lower LDL Cholesterol

Bempedoic acid offers a new avenue for patients who require an alternative to statins for managing high cholesterol. Its liver-specific action and excellent safety and side effect profile make it a valuable addition to available treatments we can use to combat high LDL cholesterol levels to reduce coronary inflammation and stabilise high risk coronary plaque.

What are the latest guidelines target for LDL?

For patients who have been diagnosed with an acute coronary syndrome, requiring bypass surgery or stent, or have CT Angiography and or raised FAI, the latest European and UK guidelines reflect the finding that there is no lower limit for LDL yet discovered, basically meaning the lower the better. These recommendations come after new trials with lower targets showed better outcomes. As a result, millions of people around the world need to be looking more carefully at whether they are taking sufficient medication to lower their LDL to these new targets, for the very best outcomes to be achieved.

LDL: the lower the better

Being born with almost no circulating cholesterol (or reduction of LDL to zero by drugs) results in nothing except a zero-lifetime risk of atherosclerosis (or cessation and reduction in atherosclerosis).

The Role of Gain of Function Mutations in Heart Disease

Gain-of-function mutations in PCSK9 increase LDL cholesterol by accelerating LDL receptor degradation, helping explain inherited cardiovascular risk. Unlike evolutionary adaptations such as sickle-cell heterozygote advantage, these mutations directly enhance protein activity. Understanding this genetic pathway has transformed cholesterol science and led to powerful new treatments for coronary artery disease.

Will PCSK9 Inhibitors replace statins?

This article looks into the role of PCSK9, the development of PCSK9 inhibitors, their efficiency, and their potential as a game-changer in the management of cardiovascular diseases. It provides a short exploration of the subject, drawing upon the most recent and relevant research and guidelines.