New research shows that levels of remnant particle cholesterol, also known as "ugly cholesterol," in the blood are much higher than experts previously thought. This research explored the link between remnant cholesterol and cardiovascular disease and came to an alarming conclusion. Researchers from the University of Copenhagen and Copenhagen University Hospital in Denmark led the study. Their findings now appear in the journal Atherosclerosis.

Hopes are high that this finding could have a positive impact on both the prevention and treatment of cardiovascular disease in the future. The team used data from the Copenhagen General Population Study, which included cholesterol specific test results from around 9,000 people.

Using an advanced measuring method called metabolomics, researchers were able to identify the amounts of good, bad, and "ugly" cholesterol within each sample. They found that equal parts of all of these types of cholesterol make up total cholesterol, which means that the impact of having higher levels of ugly cholesterol is much greater than scientists previously thought.

"Our results show that the amount of remnant cholesterol in the blood of adult Danes is just as high as the amount of the bad LDL [low-density lipoprotein] cholesterol," says chief physician professor Børge Nordestgaard, from the University of Copenhagen and Copenhagen University Hospital.

"We have previously shown that remnant cholesterol is at least as critical as LDL cholesterol in relation to an increased risk of myocardial infarction and stroke, and [this] is therefore a disturbing development."

—Professor Børge Nordestgaard

Measuring cholesterol and what it means

When someone gets their cholesterol checked, it is not a single blood test result. Instead, the test results include different levels of different types of cholesterol: high-density lipoprotein (HDL) (or good cholesterol), LDL (or bad cholesterol), triglycerides, and total cholesterol.

Generally, for better health outcomes, people should strive for higher levels of HDL and lower levels of LDL and triglycerides. Breaking it down in this way provides more information than a simple total cholesterol test.

The method the scientists used in this study (metabolomics) offers even more vital information. Prior studies on this topic have shed some light on remnant cholesterol; researchers have found that being overweight or having obesity was the main cause of high levels of both remnant cholesterol and triglycerides in adults.

Nordestgaard notes that with the new knowledge the team gleaned from this study, the prevention of cardiovascular disease should not only focus on LDL cholesterol, as that is not the only type that can lead to health issues.

"So far, both cardiologists and [physicians] have focused mostly on reducing LDL cholesterol, but in the future, the focus will also be on reducing triglycerides and remnant cholesterol," he says.

High cholesterol treatment

If someone discovers that their cholesterol levels are not optimal, there are a few options available for treatment. Focusing on heart healthy foods—which includes eating more fruits and vegetables, whole grains, nuts, poultry, and fish—is a good way to help improve these levels. It is also important to reduce the consumption of foods high in saturated fat and sugar.

Also, people should try to avoid being sedentary, as physical activity can help improve cholesterol levels. Furthermore, cigarette smoking increases the risk of coronary heart disease in people with high cholesterol. Making lifestyle changes—such as improving the diet, getting more exercise, and quitting smoking—can help improve cholesterol levels. However, if those methods do not work, doctors can also prescribe medication.

Losing weight may be the best thing someone can do to lower their "ugly" cholesterol and triglyceride levels. "Our findings point to the fact that prevention of myocardial infarction and stroke should not just focus on reducing the bad LDL cholesterol, but also on reducing remnant cholesterol and triglycerides," said Nordestgaard.