Dyslipidaemia and Cardiometabolic Health: What You Need to Know for Risk Management.

Understanding cardiometabolic health is crucial to improving longevity and managing the risk factors associated with heart disease and metabolic conditions. Cardiometabolic diseases are the leading cause of mortality globally, and dyslipidaemia—a condition of abnormal blood lipid levels—plays a significant role in this spectrum of diseases. This article will outline key aspects of dyslipidaemia, LDL subfractions, apolipoprotein-B, glucose regulation, and other vital factors to support better management and prevention strategies.

What is Dyslipidaemia?

Dyslipidaemia refers to abnormal levels of blood lipids (fats) that can increase the risk of cardiovascular disease. It often includes elevated total cholesterol (TC), high low-density lipoprotein (LDL), low high-density lipoprotein (HDL), and elevated triglycerides. Dyslipidaemia can further break down into sub-fractions, each with unique implications for health.

LDL, the "bad cholesterol," consists of various sub-fractions, including:

• Large, buoyant LDL (LDL 1 & 2): Considered less likely to cause artery blockages.

• Small, dense LDL (LDL 3+), IDL, and VLDL: These are more atherogenic, or likely to lead to plaque formation in arteries. When LDL particles are small and dense (mean size < 268 angstroms), they’re more likely to contribute to heart disease than larger particles.

LDL Subfractions and Cardiovascular Risk

LDL sub-fractions are a significant factor in determining heart disease risk. Research highlights two main LDL phenotypes:

• Phenotype A: Mean LDL particle size above 268 angstroms, indicating a lower cardiovascular risk.

• Phenotype B: Mean particle size below 268 angstroms, associated with increased risk for atherosclerotic heart disease within the next five years .

High-sensitivity C-reactive protein (hs-CRP) testing is often recommended to check for inflammation alongside these markers, as inflammation plays a major role in cardiovascular disease progression.

Apolipoproteins and Lipoprotein(a): More Than Just Cholesterol

Apolipoproteins, proteins that help transport fats, come in several forms with varied functions and risks:

• Apolipoprotein B (ApoB): Increases the atherogenic properties of LDL, VLDL, and other lipoproteins. ApoB-48 originates from the intestines, while ApoB-100 comes from the liver. Elevated levels of ApoB are linked to a higher cardiovascular risk .

• Lipoprotein(a): A genetically determined risk factor for atherosclerosis. Unlike other lipoproteins, high levels of Lipoprotein(a) have been shown to increase the risk of thrombosis and inflammation, adding a layer of complexity to cardiovascular risk assessment .

Glucose Regulation in Cardiometabolic Health

Glucose dysregulation, or impaired blood sugar control, is commonly found in individuals with cardiometabolic disease. Elevated fasting glucose levels increase cardiovascular disease risk, making glucose control critical for prevention and management. Studies show that glucose and insulin resistance are significant in both the development and progression of cardiovascular disease .

Dietary and Lifestyle Strategies for Cardiometabolic Health

A multi-faceted approach can effectively reduce the risk of cardiometabolic diseases. Key strategies include:

Diet:

• Adopt a predominantly plant-based, whole-food diet, rich in anti-inflammatory and antioxidant foods .

• Limit red meat consumption to two servings per week to help reduce inflammation .

• Aim for a diverse intake, targeting 12 different wholefoods each day and 30 unique wholefoods per week to ensure nutrient variety and optimal gut health.

Lifestyle:

• Regular physical activity (aiming for 10,000 steps a day) and strength-building exercises help improve muscle mass and reduce visceral fat, contributing to better metabolic health .

• Prioritise stress management to reduce chronic inflammation and improve heart health. Techniques like mindfulness and yoga can support this process .

Functional and Standard Testing in Cardiometabolic Risk

Testing can help identify early signs of dyslipidaemia, inflammation, and glucose dysregulation, providing a clearer picture of cardiometabolic risk. For an initial assessment, standard cholesterol profiles, fasting glucose, and basic anthropometrics (like BMI and waist-hip ratio) are sufficient. However, for those at higher risk, a comprehensive cardiovascular profile—including LDL sub-fractions, Lipoprotein(a), and ApoB levels—is ideal .

Targeting Inflammation and Oxidative Stress

Two main biological processes—oxidative stress and inflammation—are central to cardiometabolic disease progression. To manage these, consider foods and supplements rich in antioxidants such as:

• EPA/DHA: Found in fish oils, these omega-3 fatty acids are effective for reducing inflammation .

• Vitamin C, Vitamin E, Glutathione, and Selenium: Important for combating oxidative stress.

Closing Thoughts

Cardiometabolic disease, driven by factors like dyslipidaemia, inflammation, and glucose dysregulation, requires an integrated approach to prevention and treatment. Dietary, lifestyle, and targeted medical strategies, combined with regular testing, can significantly reduce risk factors, supporting a long and healthy life.

References

1. Leopold JA, Maron BA, Loscalzo J. The application of big data to cardiovascular disease: paths to precision medicine. J Clin Invest. 2020;130(1):29-38.

2. Mehta, A., Shapiro, M.D. Apolipoproteins in vascular biology and atherosclerotic disease. Nat Rev Cardiol. 2022;19(2):168–179.

3. Gianazza, E., et al. Proteomic studies on apoB‐containing lipoprotein in cardiovascular research. Mass Spectrometry Reviews. 2021.

4. Farzam K, et al. Lipoprotein A. In: StatPearls [Internet]. StatPearls Publishing; 2024.

5. Poznyak AV, Litvinova L, Poggio P. Effect of Glucose Levels on Cardiovascular Risk. Cells. 2022;11(19):3034.

6. Scheiber A, Mank V. Anti-Inflammatory Diets. In: StatPearls [Internet]. StatPearls Publishing; 2024.

7. Shi W, Huang X, Schooling CM. Red meat consumption, cardiovascular diseases, and diabetes. Eur Heart J. 2023;44(28):2626-2635.

8. Lu Y, et al. Association Between Skeletal Muscle Mass and Cardiovascular Risk. J Occup Environ Med. 2023.

9. Chinnaiyan KM. Role of stress management for cardiovascular disease prevention. Curr Opin Cardiol. 2019;34(5):531-535.

10. Devaraj S, Semaan JR, Jialal I. Biochemistry, Apolipoprotein B. In: StatPearls [Internet]. StatPearls Publishing; 2024.

11. Khan, R., Lone, A., et al. Fish oil and inflammation. Nutrients. 2021.