Blood-lipids: Nutrition vs. Lifestyle

Introduction:

Approximately 90,000 people died in 2023 in Austria according to the official Statistics’ cite. The majority were over the age of 80 and passed away due to age-related diseases, primarily cardiovascular disease and cancer. When adjusted for age, the two conditions are also considered among the leading causes of death generally in Austria [1].

Against the backdrop of these developments, this article discusses the influence of blood lipid levels on the risk of cardiovascular disease and the extent to which these can be influenced by diet and lifestyle. Pharmacological therapies and individualized recommendations fall outside of the scope [2].

What is the significance of blood lipids for heart health?

Dyslipidemia (the condition of elevated blood lipids) plays a central role in the development of atherosclerosis. It can lead to the formation of so-called plaques within the vessel wall that cause them to thicken, stiffen, and narrow in diameter. In severe cases, without timely intervention, this may result in thrombosis or embolism and can even be fatal [2].

When discussing elevated blood lipids, three parameters are most frequently mentioned in the literature: apolipoprotein B (apoB), LDL, and lipoprotein(a) (Lp(a)). LDL cholesterol represents the most important clinical target parameter, whereas apoB is not even part of the standard lipid panel, despite the fact, that it more accurately reflects the current number of plaque-forming particles.

Other important parameters include Lp(a), which is not directly an indicator of dyslipidemia but rather an additional genetically determined risk factor, long-term elevated triglycerides, which can also indirectly increase cardiovascular risk, and HDL cholesterol (also known as the “good cholesterol”), which was attributed a strong preventive effect until a few years ago, but is no longer considered a primary therapeutic target. This is because interventions that increase HDL levels typically also lower triglycerides, apoB, and LDL cholesterol and thus contribute to improved health through other mechanisms. An isolated increase in HDL has not been shown to reduce cardiovascular risk [2][3].

What are possible causes of elevated blood lipids?

Our genes could have a great influence on the bloodlipidprofile

When searching for the cause of elevated blood lipid levels, one may quickly find oneself at a crossroad where lifestyle and genetics meet.

Often the causes lie in a combination of a person’s genetic predisposition and lifestyle factors and it is therefore important to consider multiple aspects and not focus on individual lipid parameters, as they could be influenced by different determinants. For instance, Lp(a) levels are predominantly genetically determined and can only be influenced minimally, and clinically insignificantly, by lifestyle change [4]. It is, however, considered a highly relevant marker for cardiovascular risk.

For all other blood lipids mentioned above, multiple causes exist. While family history and genetics may play a primary role, diet and physical activity can also significantly influence these levels. Other factors include diabetes, chronic kidney disease, hypothyroidism, liver damage, and excessive alcohol consumption or medication overload [5].

Given the many influencing factors, does it even make sense to focus on diet, or is it irrelevant?

Nutrition as a double-edged sword: both as a risk and protective factor

Olive oil is rich in unsaturated fats

Let us begin with the least modifiable parameter: Lp(a). As one of the most important cardiovascular risk indicators, it is genetically determined and can therefore be hardly influenced by diet [4]. For this reason, it is better suited to focus on the other more adjustable parameters when monitoring lifestyle changes and their impact on our health.

Elevated body weight, particularly an increased proportion of visceral body fat, is strongly associated with a higher risk of cardiovascular disease [6][7]. Excess adipose tissue contributes to metabolic alterations such as insulin resistance, chronic low-grade inflammation, and unfavourable changes in lipid metabolism, all of which promote atherosclerosis.

Beyond body weight alone, diet directly affects blood lipid concentrations. LDL cholesterol is of particular importance, as it plays a causal role in atherosclerotic plaque formation and is responsive to dietary composition [8]. ApoB reflects the total number of atherogenic lipoprotein particles, including LDL, and is influenced by similar nutritional and metabolic factors [5]. Therefore, dietary strategies that lower LDL cholesterol typically also reduce apoB concentrations, contributing to a more favorable cardiovascular risk profile.

The selection of dietary fats plays a particularly important role. While plant-based fats such as rapeseed oil (the most widely used oil worldwide) and olive oil can have beneficial effects, saturated fats (e.g., butter, lard, processed meats, or coconut oil) and trans fats (mainly found in processed foods due to the industrial hydrogenation of vegetable oils) can increase LDL levels and thereby elevate cardiovascular risk.

Another relevant dietary factor is sugar, or in its complex form: carbohydrates. While LDL or apoB are hardly affected by reducing total sugar intake in individuals with normal body weight, triglyceride levels can indeed be lowered this way. However, quality makes a crucial difference. A high intake of dietary fibre from whole grains and vegetables instead of refined flour and simple sugars can provide the greatest overall benefit when keeping blood lipid levels in check [8]. In contrast, a low-carbohydrate diet in individuals of normal weight may even have the opposite effect. Replacing carbohydrates with fat may lead to an increase in LDL levels [9].

Conclusion:

Diet has a significant influence on several blood lipid parameters, particularly LDL cholesterol and triglycerides, and therefore on cardiovascular risk. Maintaining a healthy body weight and an appropriate body fat percentage already shows substantial prevention potential.

As mentioned, the selection of specific foods also plays an important role for overall health. Fat quality, in particular, is crucial. Regular consumption of saturated fatty acids such as lard, butter, or coconut oil, as well as trans fats in processed and industrially hydrogenated foods, can negatively affect the blood lipid profile. In contrast, unsaturated fats from high-quality plant oils and omega-3 fatty acids from certain fish have more favourable effects.

Additionally, a plant-based dietary pattern rich in whole grains, vegetables, and fresh fruit appears to offer the greatest benefits. One example is the so-called mediterranean diet, which is frequently cited in this context. Moving toward a vegetarian or even vegan diet may also help reduce cardiovascular risk [10][11].

To identify the most appropriate measures for oneself, it is always advisable to consult a registered dietitian, as additional factors that can only be assessed individually should be considered when making dietary changes.

References

[1]	P.-W. Michaela, „Jahrbuch der Gesundheitsstatistik 2023,“ Statistik Austria, Wien, 2025.
[2]	G. Thanassoulis und H. Aziz, „MSD Manual,“ Merck Sharp & Dohme Corp, April 2022. [Online]. Available: https://www.msdmanuals.com/de/profi/herz-kreislauf-krankheiten/arteriosklerose/atherosklerose?query=atherosklerose. [Zugriff am 2026].
[3]	J. G. Mørland, P. Magnus, S. E. Vollset, D. A. Leon, R. Selmer und A. Tverdal, „Associations between serum high-density lipoprotein cholesterol levels and cause-specific mortality in a general population of 345 000 men and women aged 20–79 years,“ International Journal of Epidemiology, Bd. 52, Nr. 4, pp. 1257-1267, 2023.
[4]	K. Schmidt, A. Noureen, F. Kronenberg und G. Utermann, „Structure, function, and genetics of lipoprotein (a),“ Journal of Lipid research, Bd. 8, Nr. 57, pp. 1339-1359, 2016.
[5]	M. H. Davidson und M. Altenburg, „Dyslipidämie,“ MSD Manuals, Mai 2025. [Online]. Available: https://www.msdmanuals.com/de/profi/endokrine-und-metabolische-krankheiten/fettstoffwechselst%C3%B6rungen/dyslipid%C3%A4mie?_gl=1*6k20pl*_up*MQ..*_ga*NzgzODc5OTY0LjE3NzAxMTY5MDg.*_ga_CJ792HFYYC*czE3NzAxMTY5MDgkbzEkZzAkdDE3NzAxMTcwMDUkajYwJGwwJGgw. [Zugriff am Februar 2026].
[6]	C. Magnussen, F. M. Ojeda und e. al., „Global Effect of Modifiable Risk Factors on Cardiovascular Disease and Mortality,“ The New England Journal of medcine, Bd. 389, Nr. 14, pp. 1273-1285, 2023.
[7]	N. Mohammadian Khonsari, P. Khashayar, E. Shahrestanaki und e. al., „Normal Weight Obesity and Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis,“ Frontiers in endocrinology: A Systematic Review and Meta-Analysis, 2022.
[8]	M. Schoeneck und D. Iggman, „The effects of foods on LDL cholesterol levels: A systematic review of the accumulated evidence from systematic reviews and meta-analyses of randomized controlled trials,“ Nutrition, Metabolism & Cardiovaskular disease, Bd. 31, Nr. 5, pp. 1325-1338, 2021.
[9]	A. Soto-Mota, Y. Flores-Jurado, N. G. Norwitz und e. al., „Increased low-density lipoprotein cholesterol on a low-carbohydrate diet in adults with normal but not high body weight: A meta-analysis,“ The American Journal of Clinical Nutrition, Bd. 119, Nr. 3, pp. 740-747, 2024.
[10]	C. A. Koch, A. W. Kjeldsen und R. Frikke-Schmidt, „Vegetarian or vegan diets and blood lipids:,“ European Heart Journal, pp. 1-16, 2023.
[11]	J. F. López-Gill, A. García-Hermoso, M. Á. Martínez-González und F. Rodríguez-Artalejo, „Mediterranean Diet and Cardiometabolic Biomarkers in Children and Adolescents,“ Jama Network Open, Bd. 7, Nr. 7, 2024.