We hear a lot these days about the relationship between saturated fats, cholesterol, and heart disease. What are the facts? It’s well established that a diet rich in saturated animal fats often leads to an increase in blood serum cholesterol, particularly in sedentary, overweight individuals. Conversely, a diet lower in saturated fats and higher in polyunsaturated fats leads to a lower serum cholesterol level. Studies have shown that a serum cholesterol level greater than 240 mg/dL (a desirable value is < 200 mg/dL) is correlated with an increased incidence of coronary artery disease, in which cholesterol deposits build up on the inner walls of coronary arteries, blocking the flow of blood to the heart muscles.

A better indication of a person’s risk of heart disease comes from a measurement of blood lipoprotein levels. Lipoproteins are complex molecules with both lipid and protein components that transport lipids through the body. They can be divided into three types according to density, as shown in Table 27.3. Very-low-density lipoproteins (VLDLs) act primarily as carriers of triglycerides from the intestines to peripheral tissues, whereas low- density lipoproteins (LDLs) and high-density lipoproteins (HDLs) act as carriers of cholesterol to and from the liver.

Figure 27.17 It’s hard to resist, but a high intake of saturated animal fat doesn’t do much for your cholesterol level. (credit: modification of work “food-chicken-meat- outdoors” by www.pixel.la/Flickr, Public Domain)

Evidence suggests that LDLs transport cholesterol as its fatty-acid ester to peripheral tissues, whereas HDLs remove cholesterol as its stearate ester from dying cells. If LDLs deliver more cholesterol than is needed, and if insufficient HDLs are present to remove it, the excess is deposited in arteries. Thus, a low level of low-density lipoproteins is good because it means that less cholesterol is being transported, and a high level of high-density lipoproteins is good because it means that more cholesterol is being removed. In addition, HDL contains an enzyme that has antioxidant properties, offering further protection against heart disease.

As a rule of thumb, a person’s risk drops about 25% for each increase of 5 mg/dL in HDL concentration. Normal values are >40 mg/dL for men and <50 mg/dL for women, perhaps explaining why premenopausal women appear to be somewhat less susceptible than men to heart disease.

Table 27.3 Serum Lipoproteins

Not surprisingly, the most important factor in gaining high HDL levels is a generally healthful lifestyle. Obesity, smoking, and lack of exercise lead to low HDL levels, whereas regular exercise and a sensible diet lead to high HDL levels. Distance runners and other endurance athletes have HDL levels nearly 50% higher than the general population. Failing that—some of us, but not everyone, wants to run 30 miles or bike 80 miles per week—diet is also important. Diets high in cold-water fish, like salmon and whitefish, raise HDL and lower blood cholesterol because these fish contain almost entirely polyunsaturated fat, including a large percentage of omega-3 fatty acids. Animal fat from red meat and cooking fats should be minimized because saturated fats and monounsaturated trans fats raise blood cholesterol.