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The doctor Vidal Tapia, cardiologist at HLA Clínica Montpellier, believes that «the way cholesterol is evaluated in patients is too shallow and leaves out key elements for early diagnosis of cardiovascular diseases.» He recommends including a complete lipid profile in routine blood tests.
He points out that cholesterol is essential for the body as it is involved in hormone production, digestion (as part of bile acids), and cell structure. However, excess cholesterol can be very harmful,» he insists.
In routine tests, the evaluation typically looks at total cholesterol; HDL, commonly known as ‘good cholesterol’; LDL, known as ‘bad cholesterol’ (although not all LDL subtypes are equally harmful); and triglycerides.
Additionally, the doctor explains that the so-called atherogenic index is often used, calculated by dividing total cholesterol by HDL. If this value is less than 5, it is usually considered normal, using phrases like «high cholesterol but compensated,» which, according to the cardiologist, is frequently repeated and not entirely correct.
In his opinion, this view is inadequate. «Lipid analysis is much more complex, and if not examined properly, it is impossible to treat effectively,» he states. Thus, he believes that it is essential to include more precise and revealing parameters in studies such as apolipoprotein A1 (Apo A1), apolipoprotein B (Apo B), and especially lipoprotein (a), whose measurement is crucial for a real assessment of cardiovascular risk.
«This factor is elevated in approximately 20% of the population. If the value is normal, there is no need to re-measure it,» he explains. «But in cases where it is high, it provides important information for treating the patient and discovering family members who also have high levels, treating them appropriately, and preventing many cardiovascular events.»
WHAT IS LIPOPROTEIN (A)
Lipoprotein (a) or Lp(a) is a particle of LDL cholesterol bound to apolipoprotein (a), making it significantly more harmful to the arteries: it is estimated to be up to six times more detrimental than LDL cholesterol.
According to Dr. Tapia, its presence at elevated levels (above 180) represents a cardiovascular risk comparable to that of familial hypercholesterolemia. Despite its impact, Lp(a) is not usually included in standard analyses, which, in the specialist’s opinion, is a serious omission.
«Although it cannot be reduced with diet or exercise, and common treatments like statins do not affect it, knowing its value is essential for accurately assessing cardiovascular risk and making more effective clinical decisions; incorporating this measurement at least once in a lifetime would allow for the detection of high-risk cases,» he states. Its level is determined 90% by genetics and can only be slightly reduced with very specific, restricted-use drugs administered subcutaneously.
Dr. Tapia believes it is entirely possible to have normal levels of cholesterol (LDL and HDL) but still have a very high cardiovascular risk due to Lp(a) and other particles like Apo A1 and Apo B. «These indicators can show a higher risk than expected and predict severe cardiovascular events more accurately than traditional analyses.»
The doctor also emphasizes that triglycerides, another component of the lipid profile, are often underestimated, yet they are also very important.
Currently, specific treatments are being developed to reduce lipoprotein (a) levels, and some of them are in advanced stages of clinical research. They are expected to be available on the market in one or two years, representing a significant advancement in personalized cardiovascular prevention.
HEALTHY HABITS
In the meantime, Dr. Tapia stresses the importance of adopting healthy habits as a foundation for overall risk control. Among his main recommendations are a balanced diet rich in fruits, vegetables, and fiber, and reducing the consumption of processed foods or those high in saturated fats, such as deli meats, sausages, whole milk, butter, aged cheeses, fried foods, pâtés, pastries, and sugary drinks.
He also points out certain foods and beverages that can help lower cholesterol, such as black or green tea, vinegar, lemon, tomato juice, and soy beverages. Additionally, he recommends incorporating sources of omega-3 like olive oil, fatty fish (sardines, salmon, trout, tuna, herring, mackerel), walnuts, and dark chocolate with high cocoa content.
In this sense, he emphasizes that the concept of a healthy diet is evolving, and that excessive sugar is now seen as one of the main triggers of chronic diseases in today’s society. This is compounded by the importance of avoiding tobacco and alcohol consumption, and maintaining a regular exercise routine as fundamental pillars of good cardiovascular health.
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The doctor Vidal Tapia, cardiologist at HLA Clínica Montpellier, believes that «the way cholesterol is evaluated in patients is too shallow and leaves out key elements for early diagnosis of cardiovascular diseases.» He recommends including a complete lipid profile in routine blood tests.
He points out that cholesterol is essential for the body as it is involved in hormone production, digestion (as part of bile acids), and cell structure. However, excess cholesterol can be very harmful,» he insists.
In routine tests, the evaluation typically looks at total cholesterol; HDL, commonly known as ‘good cholesterol’; LDL, known as ‘bad cholesterol’ (although not all LDL subtypes are equally harmful); and triglycerides.
Additionally, the doctor explains that the so-called atherogenic index is often used, calculated by dividing total cholesterol by HDL. If this value is less than 5, it is usually considered normal, using phrases like «high cholesterol but compensated,» which, according to the cardiologist, is frequently repeated and not entirely correct.
In his opinion, this view is inadequate. «Lipid analysis is much more complex, and if not examined properly, it is impossible to treat effectively,» he states. Thus, he believes that it is essential to include more precise and revealing parameters in studies such as apolipoprotein A1 (Apo A1), apolipoprotein B (Apo B), and especially lipoprotein (a), whose measurement is crucial for a real assessment of cardiovascular risk.
«This factor is elevated in approximately 20% of the population. If the value is normal, there is no need to re-measure it,» he explains. «But in cases where it is high, it provides important information for treating the patient and discovering family members who also have high levels, treating them appropriately, and preventing many cardiovascular events.»
WHAT IS LIPOPROTEIN (A)
Lipoprotein (a) or Lp(a) is a particle of LDL cholesterol bound to apolipoprotein (a), making it significantly more harmful to the arteries: it is estimated to be up to six times more detrimental than LDL cholesterol.
According to Dr. Tapia, its presence at elevated levels (above 180) represents a cardiovascular risk comparable to that of familial hypercholesterolemia. Despite its impact, Lp(a) is not usually included in standard analyses, which, in the specialist’s opinion, is a serious omission.
«Although it cannot be reduced with diet or exercise, and common treatments like statins do not affect it, knowing its value is essential for accurately assessing cardiovascular risk and making more effective clinical decisions; incorporating this measurement at least once in a lifetime would allow for the detection of high-risk cases,» he states. Its level is determined 90% by genetics and can only be slightly reduced with very specific, restricted-use drugs administered subcutaneously.
Dr. Tapia believes it is entirely possible to have normal levels of cholesterol (LDL and HDL) but still have a very high cardiovascular risk due to Lp(a) and other particles like Apo A1 and Apo B. «These indicators can show a higher risk than expected and predict severe cardiovascular events more accurately than traditional analyses.»
The doctor also emphasizes that triglycerides, another component of the lipid profile, are often underestimated, yet they are also very important.
Currently, specific treatments are being developed to reduce lipoprotein (a) levels, and some of them are in advanced stages of clinical research. They are expected to be available on the market in one or two years, representing a significant advancement in personalized cardiovascular prevention.
HEALTHY HABITS
In the meantime, Dr. Tapia stresses the importance of adopting healthy habits as a foundation for overall risk control. Among his main recommendations are a balanced diet rich in fruits, vegetables, and fiber, and reducing the consumption of processed foods or those high in saturated fats, such as deli meats, sausages, whole milk, butter, aged cheeses, fried foods, pâtés, pastries, and sugary drinks.
He also points out certain foods and beverages that can help lower cholesterol, such as black or green tea, vinegar, lemon, tomato juice, and soy beverages. Additionally, he recommends incorporating sources of omega-3 like olive oil, fatty fish (sardines, salmon, trout, tuna, herring, mackerel), walnuts, and dark chocolate with high cocoa content.
In this sense, he emphasizes that the concept of a healthy diet is evolving, and that excessive sugar is now seen as one of the main triggers of chronic diseases in today’s society. This is compounded by the importance of avoiding tobacco and alcohol consumption, and maintaining a regular exercise routine as fundamental pillars of good cardiovascular health.
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