Cedars-Sinai Cardiologist Says High LDL, Not Smoking, Is Top Heart Risk
Dr. Norman Lepor of Cedars-Sinai says high LDL cholesterol is the biggest risk factor for heart problems, even though tobacco is the worst habit. He outlined diet, exercise and medication steps to keep levels down.
A cardiologist reveals high LDL cholesterol, not smoking, is the biggest risk factor for heart problems, according to Dr. Norman Lepor of Cedars-Sinai. He draws a line between a harmful habit and a risk factor, and says the two are closely linked.
Heart disease remains the leading cause of death in the United States. It rarely comes down to one thing. Genetics, age, diet, activity level, sleep and stress all play a role.
Many of the factors that matter most cannot be seen or felt day to day. A person can feel fine for years while changes build inside the body.
Habit versus risk factor
"Using tobacco is the worst habit for heart health, but having high levels of LDL cholesterol is the biggest risk factor [for experiencing cardiovascular health issues]," Dr. Lepor said. He explained that habits describe what people do, while risk factors describe what raises the odds of disease.
LDL is often called "bad" cholesterol because too much of it can contribute to plaque buildup in the arteries. Over time, that buildup can narrow blood vessels and raise the risk of heart attack and stroke.
High cholesterol typically causes no symptoms. Routine blood work is the only way to know where levels stand.
Tobacco does not get a pass. "Smoking and vaping significantly increase the risk of stroke, heart attack and peripheral vascular disease, which can lead to leg amputations in severe cases," Dr. Lepor said.
He added that regular tobacco use can cause plaque to build up in the coronary arteries, which can raise LDL cholesterol levels.
What Lepor recommends
Dr. Lepor advised avoiding trans fats, which are commonly found in fried foods. He also recommended minimizing foods high in sodium and saturated fat.
Instead, he suggested foods rich in unsaturated fats, such as seafood, avocado and nuts. He regularly recommends the Mediterranean diet to his patients, which emphasizes plant-based foods and healthy fats. Staying active is another key way to help keep LDL levels down, he said.
For people whose cholesterol is already high, Dr. Lepor strongly encouraged talking with a doctor about prescription medications such as statins. Taking a prescribed drug consistently matters as much as filling the prescription, he said.
The Cleveland Clinic estimates that 90% of heart disease could be prevented through diet and lifestyle habits. Even when heart problems run in a family, genes are not destiny, the report noted.
