It’s common knowledge that “bad” LDL cholesterol and blood pressure are a dangerous mix—but new research shows a specific type of LDL cholesterol could increase the risk of heart attack and stroke in people who already have high blood pressure (hypertension). High levels of lipoprotein(a), (the “sticky” cholesterol)  is particularly concerning for those with high blood pressure. “We found that the overwhelming amount of cardiovascular risk in this diverse population appears to be due to hypertension,” says lead study author Dr. Rishi Rikhi, a cardiovascular medicine fellow at Atrium Health Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. “Additionally, individuals with hypertension had even higher cardiovascular risk when lipoprotein(a) was elevated.”

People with high Lp(a) and low hypertension had no increased risk. But the higher the lipoprotein(a) combined with hypertension, the higher the risk. “The fact that lipoprotein(a) appears to modify the relationship between hypertension and cardiovascular disease is interesting, and suggests important interactions or relationships for hypertension, lipoprotein(a) and cardiovascular disease,” Dr. Rikhi says. “More research is needed.”

So why is lipoprotein(a) so dangerous? Lipoprotein(a) is an LDL variant made of protein and fat which carries cholesterol to your arteries. “That protein makes these particles invade artery walls more aggressively than regular LDL,” says cardiologist Dr. Donna Polk, associate professor of medicine at Harvard Medical School. People with high levels of Lp(a) are more likely to develop dangerous atherosclerosis (fatty deposits in the arteries), and are subsequently at higher risk for peripheral artery disease (leg blockages), aortic stenosis (narrowing of the heart’s aortic valve), and an increased risk of heart attack. Lipoprotein(a) is genetic, and can cause a heart attack in an otherwise healthy person (for example, The Biggest Loser star Bob Harper, who had a heart attack at 52). 

Lipoprotein(a) cannot be decreased or managed through lifestyle factors—but there are other ways to help support heart health. Read on.

A heart healthy diet such as the Mediterranean diet has been shown to benefit heart health. “The Mediterranean diet is more than a ‘diet.’ It’s a heart-healthy eating plan,” says cardiology nurse practitioner Teresa Scanlan. “For most people, what is good for your heart is good for your brain and the rest of your body, too. The Mediterranean diet is a way of eating based on the traditional cuisine of countries bordering the Mediterranean Sea. While there is no single definition of the Mediterranean diet, it is typically high in vegetables, fruits, whole grains, beans, nuts and seeds, and olive oil.”

Healthy fats are another important part of the Mediterranean diet. “They’re eaten instead of less healthy fats, such as saturated and trans fats, which contribute to heart disease,” Scanlan says. “Olive oil is the primary source of added fat in the Mediterranean diet. Olive oil provides monounsaturated fat, which has been found to lower total cholesterol and low-density lipoprotein, also known as LDL or ‘bad’ cholesterol, levels. Nuts and seeds also contain monounsaturated fat.”

Regular exercise is a non-negotiable for heart health. “Aerobic exercise and resistance training are the most important for heart health,” says Johns Hopkins exercise physiologist Kerry J. Stewart, Ed.D. “Although flexibility doesn’t contribute directly to heart health, it’s nevertheless important because it provides a good foundation for performing aerobic and strength exercises more effectively.”

A combination of aerobic exercise, resistance training, and flexibility exercises are all important for heart health, helping to raise good cholesterol (HDL) and lower bad cholesterol (LDL). “Scientific data has consistently shown that aerobic or cardio style exercise improves not just the circulation within your heart, but the circulation throughout your entire cardiovascular system,” says cardiac rehabilitation expert Erik Van Iterson, PhD, MS. “That generally means the ability to circulate blood in an effective and efficient way and typically leads to reductions in cardiovascular risk. Exercise is the simplest form of medicine. It’s something you can control and you can take into your own hands.”6254a4d1642c605c54bf1cab17d50f1e

Unchecked stress can wreak havoc on your heart. “Stress left unchecked can cause something as awful as Broken Heart Syndrome, cardiomyopathy. So, it’s really important to remember that taking care of others means taking care of yourself first,” says cardiologist Leslie Cho, MD. 

“People often underappreciate the negative effects that psychosocial stress can have on their heart health,” says Niti Aggarwal, MD. “Psychosocial stressors are life situations that cause unusual or intense stress, such as divorce, family conflicts, death of a loved one, prolonged illness or natural catastrophe. Studies have shown that depression and psychosocial stress are associated with heart attacks. In addition, high stress levels have been shown to negatively affect health recovery after a heart attack. Therefore, it’s important to address the traditional and nontraditional risk factors for heart disease to maintain a healthy heart. It is also important to recognize that the traditional and nontraditional risk factors for heart disease affect women differently than men.”

According to the National Heart, Lung and Blood Institute (NHLBI), cholesterol screenings should start at age 9-11 and be repeated every five years. Men aged 45-65 and women aged 55-65 should be screened every 1-2 years, and those over 65 should be tested every year. Those at increased risk of heart disease may need to be tested more frequently. 

Getting tested at a medical office is far preferable to at-home tests. “Home cholesterol tests, in contrast, don’t offer any real advantages,” says Harvard Health. “They don’t provide accurate information about your cardiovascular risk. Nor do they tell you much about the impact of diet or exercise on your cholesterol. Some home tests can also be very tricky to understand. They report cholesterol levels in terms of the current national guidelines. The targets and cut-offs in these guidelines vary, depending on other health conditions, and you may need a doctor to help you figure out which standards apply to you. In general, you’re better off not checking your cholesterol at home. Let a lab give you the detailed information you need.”

Belly fat, also known as visceral fat, is a particularly dangerous type of fat hidden deep in the abdomen, surrounding organs such as the liver and kidneys. Known as “active” fat, visceral fat is linked with an increased risk of heart disease, even in otherwise healthy people.  “Studies that have examined the relationship between abdominal fat and cardiovascular outcomes confirm that visceral fat is a clear health hazard,” says Dr. Tiffany Powell-Wiley, chief of the Social Determinants of Obesity and Cardiovascular Risk Laboratory at the National Heart, Lung, and Blood Institute in Bethesda, Maryland. 

A healthy diet, watching portion sizes, regular exercise, sleep, limiting alcohol, avoiding tobacco, and stress management are just a few ways to effectively banish belly fat. “One reason excess visceral fat is so harmful could be its location near the portal vein, which carries blood from the intestinal area to the liver,” says Harvard Health. “Substances released by visceral fat, including free fatty acids, enter the portal vein and travel to the liver, where they can influence the production of blood lipids. Visceral fat is directly linked with higher total cholesterol and LDL (bad) cholesterol, lower HDL (good) cholesterol, and insulin resistance.”