Abstract
The associations between dietary cholesterol and heart disease are highly controversial. While epidemiological studies and clinical interventions have shown the lack of correlation between cholesterol intake and cardiovascular disease (CVD) risk, there is still concern among health practitioners and the general population regarding dietary cholesterol. In this review, several clinical studies utilizing cholesterol challenges are analyzed in terms of changes that occur in lipoprotein metabolism resulting from excess consumption of cholesterol. Dietary cholesterol has been shown to increase both LDL and HDL in those individuals who respond to a cholesterol challenge without altering the LDL cholesterol/HDL cholesterol ratio, a key marker of CVD risk. Further, dietary cholesterol has been shown to increase only HDL with no changes in LDL with average cholesterol consumption and during weight loss interventions. Ingestion of cholesterol has also been shown to increase the size of both LDL and HDL particles with the associated implications of a less atherogenic LDL particle as well as more functional HDL in reverse cholesterol transport. Other changes observed in lipoprotein metabolism are a greater number of large LDL and decreases in small LDL subfractions. All this information put together points to specific roles of dietary cholesterol in substantially altering intravascular processing of lipoproteins as well as reverse cholesterol transport.
Highlights
Elevated levels of plasma LDL cholesterol (LDL-C) are associated with increased risk of cardiovascular disease (CVD) [1]
It is important to remember that low levels of HDL cholesterol such as we observe in the case of metabolic syndrome (MetS) and in diabetic individuals represent a well established risk for the development of CVD [2]
Guidelines, the balance between LDL and HDL is considered a key marker of CVD risk making the LDL-C/HDL cholesterol ratio a valuable tool for the assessment and clinical management of individuals at risk for heart disease [3]
Summary
Elevated levels of plasma LDL cholesterol (LDL-C) are associated with increased risk of cardiovascular disease (CVD) [1]. It is important to remember that low levels of HDL cholesterol such as we observe in the case of metabolic syndrome (MetS) and in diabetic individuals represent a well established risk for the development of CVD [2]. It is still not part of the NCEP/ATP guidelines, the balance between LDL and HDL is considered a key marker of CVD risk making the LDL-C/HDL cholesterol ratio a valuable tool for the assessment and clinical management of individuals at risk for heart disease [3]. It is important to understand that these individuals classified as hyper-responders to dietary cholesterol do not constitute the whole population (about 25%) and that the majority of people have a normal response to dietary cholesterol [5]
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