Illustration of atherosclerosis forming in a blood vessel @BelgaImage
This Wednesday, February 16, 2022, the Belgian Cardiological League launched a new campaign to challenge popular beliefs regarding cholesterol. An initiative that takes the form of a series of information, figures and in-depth analyzes on the subject. The subject is all the more important since the diseases of the circulatory system in question here cause 25.9% of deaths in Belgium according to the Belgian statistical office (Statbel), ie the first cause of death. “We realize that this is a complicated subject to conceive and carries great debates, hence this message that the doctors wanted to pass on to put things straight.», Explains Sandrine Daoud, General Manager of the League.
What is cholesterol?
As the Cardiology League points out,cholesterol is a fatty substance (a lipid) which participates in the structure and functioning of our cells, entering into the composition of its membranes and allowing the production of certain hormones“. It is therefore a vital component for our body. There is LDL-cholesterol, which travels from the liver to the organs that need its action, and HDL-cholesterol, which goes the opposite way. The latter recovers the waste produced by our cells, intended to be destroyed by the liver. The whole thing therefore forms an essential cycle for our health.
What is the problem?
The concern is that cholesterol, especially LDL cholesterol, reacts very badly when it encounters an artery whose inner membrane (the intima) is damaged. It remains trapped there, oxidizes and produces free radicals harmful to the body. Then follows a series of reactions. Macrophages (a kind of white blood cells responsible in particular for cleaning up free radicals) try to intervene to solve the problem but end up forming foamy cells which swell. After a while, these cells form what is called an atheroma plaque which leads to atherosclerosis, that is to say an obstruction of the affected artery.
When the blood no longer passes, this causes an infarction, in other words the necrosis of the tissues which depend on this blood supply. The health of the patient can then be seriously endangered. If the artery in question irrigates the brain for example, it is the AVC (cerebral vascular accident). When it concerns the heart, it is the heart attack.
The Cardiological League warns here regarding the treacherous side of this disease. There are no warning signs that let a person know clearly if one of their arteries is clogging. Only its obstruction becomes visible, but by then it is already too late, with sometimes irreparable damage to the organs, even death. It is therefore easy to believe that you are in good health when in reality, this is not the case. “In general, this phenomenon is very gradual and it takes years», Tells us Olivier Descamps, cardiologist at the Saint-Luc university clinics in Brussels. “But when this clot forms, the patient suddenly feels these symptoms whereas before, he felt nothing».
What risk factors for a atherosclerosis?
To prevent this formation of atherosclerotic plaques, several factors must be taken into account. Olivier Descamps points in particular to a high and prolonged cholesterol level, especially that of LDL, which favors the appearance of the phenomenon. Hence the fact that LDL-cholesterol is sometimes caricatured as “bad cholesterol”. A misleading representation since at a reasonable level, it is essential for the organism. But when that LDL level rises dangerously, it’s too much.
«There are also in Belgium regarding ten children with major hypercholesterolemia. They are born with cholesterol levels of 1,000 mg in total, compared to 190-250 for a normal level in an adult. Without treatment, they can have a heart attack around 10-12 years old, even if they have no other risk factors.“, adds the cardiologist from Saint-Luc. He also recalls that nearly one person in 300 develops familial hypercholesterolemia where these levels are over 300 mg, that is to say less extreme but still very high. In other words, their cholesterol levels are naturally high because a genetic mutation prevents them from eliminating cholesterol normally through the liver and intestines. Result: on average, these patients develop heart disease around the age of 40, compared to 60 for the rest of the population.
But the problem is not just cholesterol, far from it. When a person has hypertension or diabetes, fat oxidation is facilitated, hence the acceleration of this atherosclerosis. If the arteries are weakened by a deleterious lifestyle (tobacco, poor diet, sedentary lifestyle, etc.), this obviously increases the probability that their membranes are damaged and therefore the occurrence of this famous reaction with cholesterol.
How to avoid atherosclerosis?
Therefore, attacking only cholesterol is not a good strategy. “Doctors do not treat cholesterol but cardiovascular risk», specifies Olivier Descamps. “In other words, we must first estimate the patient’s risk. If a person has already had a heart attack, for example, this means that their arteries are diseased and they might probably develop a second one. When the risk is so high, you have to tackle all the risk factors: drastically lower the cholesterol level, quit smoking, lose weight, do physical activity, have the most balanced diet possible. , etc Medicines are mostly given to this type of patients. Ditto if they have diabetes or hypertension for example».
On the other hand, if a person has a high cholesterol level when they are at lower risk (because they are sporty, adopt a healthy diet, etc.), there may be debate on the approach to follow. “The physician must quantify the patient’s risk. It’s like when it’s sunny outside, you’re not going to take your umbrella. It’s the same here“. If this individual has familial hypercholesterolemia, having a healthy lifestyle may not be enough to protect once morest heart attack and you have to go through medication, notes Olivier Descamps.
For others with above average but moderately high cholesterol levels, it depends. “We have precise equations with tables where we cross-reference data on a person’s cholesterol level, blood pressure, age, sex and tobacco consumption. This tool, called SCORE, gives a percentage risk of having a heart problem within 10 years. If this risk is 0%, obviously, we will not worry. At 1-2%, we just warn the patient, nothing more. It is only from 5% that we go further, possibly with medication if necessary. Above 10%, you have to drop the ‘atomic bomb’».
In general, the cardiologist recommends limiting your share of saturated fats in your diet to avoid atherosclerosis. In terms of drugs,the more it is reimbursed by INAMI, the more it is valid». «The INAMI, which is an independent body and certainly not influenced by pharmaceutical companies, sees what is scientifically validated to enact this. It does not necessarily prevent a medicine that has not been validated in this way from being marketed, but it can decide not to reimburse it“, he says, specifying that it is not because a product is more expensive that it is better.
