22 January 2013

The Good, the Bad, and the Ugly

It all started with 'high cholesterol', then came the 'good' and the 'bad' cholesterols. Now we have the last member of the notorious trio: the 'ugly cholesterol'.


The risk of ischaemic heart disease -- the leading cause of death worldwide -- is three times higher in persons with high levels of the so-called 'ugly' cholesterol. This is the finding of a new study of 73,000 Danes, which is shedding light on a long debate on this topic. The results have just been published in the Journal of the American College of Cardiology.

Most individuals believe that high cholesterol is life-threatening (despite all the evidence to the contrary). And many 'know' which type of cholesterol is the most frequent killer -- the 'bad' one, LDL -- or is it just the small, dense LDL and not the fluffy stuff.

Up until now, cholesterol has been divided into 'the good' HDL cholesterol, 'the bad' LDL cholesterol, with all the other sub-fractions, IDL, VLDL, etc, not getting a look in.

But now another 'cholesterol' has turned up in the mix: 'the ugly' cholesterol AKA 'remnant cholesterol'. And this one, it seems, is the really bad guy.

Professor Børge Nordestgaard, Chief Physician at Copenhagen University Hospital and Clinical Professor at the Faculty of Health and Medical Sciences at University of Copenhagen says:

    "LDL cholesterol or 'the bad' cholesterol' is of course bad, but our new study reveals that the ugly cholesterol likewise is the direct cause of atherosclerosis resulting in ischemic heart disease and early death. By examining 73,000 persons, we found that an increase in the ugly cholesterol triples the risk of ischemic heart disease, which is caused by lack of oxygen to the heart muscle due to narrowing or blocking of the coronary arteries"

     "I hope that this new knowledge will lead to better preventive treatment including lifestyle changes, as more than one in five individuals in affluent countries suffers from high ugly cholesterol. We also hope that the pharmaceutical industry will develop new drugs targeted specifically at raised ugly cholesterol levels"

So, what is ugly cholesterol?
"Ugly cholesterol is the result of high blood levels of normal fat (triglycerides),"  says Børge Nordestgaard. "The most important cause of high ugly cholesterol is overweight and obesity. Persons with high ugly cholesterol should therefore be advised to lose weight, but drugs such as statins and fibrates may also lower levels of ugly cholesterol in the blood."

Samples from 73,000 Danes with mutations

Anette Varbo, physician and PhD student at Copenhagen University Hospital, Was part of the research team behind the new findings. She says that the findings shed light on a long-standing debate among researchers on the so-called triglycerides, atherosclerosis and cholesterol. She says:
     "To be able to examine the relationship between ugly cholesterol and heart disease, we have used blood samples from persons having a mutation which means that they suffer from high ugly cholesterol their entire life. The research findings do therefore not depend on their lifestyle patterns in general. Unhealthy lifestyle factors such as smoking, fatty foods and overweight all increase the risk of heart disease, and the blood samples from persons having these mutations thus give the most accurate results"

So, another good reason to watch your weight, it seems. And the best way to do that is with a low-carb, high-fat diet.

Patents on statins are running out. What's the betting that BigPharma will now search for new drugs, or revamp existing ones for this 'new' use. And when those patents run out, no doubt there will be another 'cholesterol' discovered, and then another, and so on . . . until we have The Magnificent Seven.

Journal Reference:
1.     Anette Varbo, Marianne Benn, Anne Tybjærg-Hansen, Anders B. Jørgensen, Ruth Frikke-Schmidt, Børge G. Nordestgaard. Remnant Cholesterol as a Causal Risk Factor for Ischemic Heart Disease. Journal of the American College of Cardiology, 2012; DOI: 10.1016/j.jacc.2012.08.1026


Anonymous said...

'We also hope that the pharmaceutical industry will develop new drugs targeted specifically at raised ugly cholesterol levels"
No more to be said really is there?
I really find it annoying when they lump all fats under 'fatty food.' Funny how they never lump 'fruit and vegetables' under carbs and sugar!

Ed Terry said...

Ahh. We're just one study away from discovering "evil" cholesterol.

Oh wait, we've already done that.

Victor Wei said...

Dr Groves,

Thank you for all your great work that's made many people's lives better.

I had a few questions on the preferred diets for farm-raised animals. I understand 100% grass is the preferred diets for cows and lamb.

For chickens, what is the preference? I see pasture-raised chickens here that also have organic feeds (soybeans, corn, oats, wheat). What would you recommend?

What is the recommended diet for pigs? I've found local pasture-raised pork that gives the pigs access to grass, roots, wild flowers, grubs etc. but also gives the pigs a rotation through local oats, peas, rapeseed, sudan grass, and barley. The pigs are then finished the last 2 months with barley or apples (if in season). There is no soy here and "little corn." What are your thoughts?

Thanks for your support.

Barry Groves said...


Thank you for your kind comments.

To say that cattle should be fed 100% grass is not quite accurate. In with grass on good meadowland are many other plants. To save me lots of writing, Wikipedia has got a good article at http://en.wikipedia.org/wiki/Meadow.

Pigs' natural habitat is woodland where they live on roots, nuts (they love acorns), etc. The diet you mention is pretty good for a farmed animal and better than most would get.

Chickens are a bit more unusual. They are really carnivorous animals. They will do very well and be healthy eating worms, slugs, small mammals, etc. The problem with this diet,however, is that they don't lay many eggs!

You will probably know that wild birds lay one or, perhaps,two clutches of eggs a year. So would the farmyard hen if fed its natural diet. But we want lots of eggs - one a day, if possible. And it is possible - but only if they are fed an unnatural carbohydrate diet based on grains usually.

Unfortunately, although they will lay no end of eggs on such a diet, they will not be as healthy as they could be. If you can get hold of Dr Wolfgang Lutz's studies on hens published in the 1960s (if memory serves) - and in German - you will find them very enlightening.

So,I think the best we can do is to compromise - grain based diet, but truly free-range so that they can scavenge for their natural foods.

The good thing about hens is that they convert protein extremely efficiently. Cattle fed grain and soy are extremely inefficient converters.

Caroline Spear said...

Just what is "remnant" cholesterol? Please can you explain?

Always so reassuring to read your blog Barry, I share it with patients and anyone who will look! :-)

Many Thanks
Caroline :-)