How to optimize your blood lipids — with and without medication

Cardiovascular disease is the most common cause of death in Sweden. The most important measurable risk factor? Elevated blood lipids — specifically LDL cholesterol and ApoB. The good news: this is an area where the right intervention provides dramatic risk reduction.

Which blood lipids do we measure — and why?

• LDL cholesterol — the "common" risk marker
• ApoB — a more precise marker measuring the number of atherogenic particles
• HDL cholesterol — higher levels correlate with lower cardiovascular risk
• Triglycerides — linked to insulin resistance and metabolic health
• Lp(a) — genetic risk factor most people have never tested

Lifestyle strategies

Lifestyle changes are the foundation of lipid optimization and can provide significant improvements, especially when combined.

• Replace saturated fat with unsaturated (olive oil, nuts, avocado, fatty fish)
• Increase fiber from vegetables, legumes and whole grains
• Increase omega-3 intake
• Regular aerobic and strength training
• Weight loss if overweight (5% weight loss can lower LDL by 5–8%)
• Reduce alcohol and processed food

Pharmacological treatment

Different pharmaceuticals offer different effectiveness and side-effect profiles. The choice depends on each patient's individual risk profile, goals and circumstances.

Statins

Statins are a good choice for many people — they are cheap and fairly effective. However, they lower cholesterol production across most cells in the body, which means a propensity for side effects and a less elegant mechanism of action.

PCSK9 inhibitors

PCSK9 inhibitors have a very elegant mechanism of action — they increase the number of LDL receptors in the liver and remove LDL particles directly from the bloodstream, without impacting cholesterol production in other cells where cholesterol is actually needed. They have essentially no side effects, are extremely effective and easy to use as an injection every two weeks. The only downside is that they are fairly expensive. In clinical trials, PCSK9 inhibitors have also been shown to lower Lp(a) by up to 28% — something no other pharmaceutical has demonstrated.

Ezetimibe

Ezetimibe is an option that can be added as a secondary treatment if sufficient effect is not reached with statins or PCSK9 inhibitors.

Target values at Revi

• ApoB below 0.6 g/L — our primary target
• LDL cholesterol below 2.6 mmol/L for most, below 1.8 mmol/L for high risk
• Triglycerides below 1.0 mmol/L

How we work with lipids at Revi

We combine lifestyle strategies with individually adapted pharmaceutical treatments to tailor the best possible approach for each patient. Your doctor will adapt the lipid-lowering strategy based on your specific status, goals and situation.