High Total Cholesterol Normal Ldl High Hdl Normal Triglycerides
In this case, the high total cholesterol is less troublesome since its largely due to elevated HDL . The fact that HDL is high and LDL is normal also makes for a favorable HDL:LDL ratio. Although, extremely high levels of HDL cholesterol can be due to genetics. Generally, HDL levels shouldnt exceed 116 mg/dL for men and 135 mg/dL for women.2
How Can You Lower Your High Triglycerides
You can make diet and lifestyle changes to help lower your levels.
- Lose weight and stay at a healthy weight.
- Limit fats and sugars in your diet.
- Be more active.
- Quit smoking.
- Limit alcohol.
You also may need medicine to help lower your triglycerides. But your doctor likely will ask you to try diet and lifestyle changes first.
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Atherosclerosis And Cardiovascular Disease
Despite being called good cholesterol, research suggests that very high levels of HDL may increase your risk of mortality.
In a 2017 Danish study , researchers analyzed the rate of mortality in groups of 52,268 European men and 64,240 women over an average of 6.4 years.
The researchers found the lowest mortality rates at HDL levels of 73 mg/dL in men and 93 mg/dL in women. Mortality rates increased significantly with HDL levels above 97 mg/dL in men and 135 mg/dL in women.
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Cholesterol Does Not Correlate With Degree Of Peripheral Atherosclerosis
Many studies have found an association between LDL or total cholesterol and peripheral atherosclerosis, depicted by angiography or ultrasonography, but only in dichotomous analyses, and again, differences have been found mainly between individuals with very high cholesterol concentrations and the rest. In ultrasonographic studies, where degree of carotic atherosclerosis was graded as a continuous variable, no correlation was found with individual LDLcholesterol concentrations. In similar studies using aortic and femoral angiography, no correlation was found either. Mean femoral intimamedia thickness was evaluated by ultrasonography in patients with familial hypercholesterolaemia and in control individuals with normal cholesterol. Using all observations, a correlation was found , but from a visual judgement of the scatterplot, within each group no clear correlation was present.
How Atherosclerotic Plaque Causes Damage
Stroke and atherosclerosis
There are two types of ischemic stroke caused by blood clots, narrowing of blood vessels to the brain caused by atherosclerosis or other particles.
Atherothrombotic stroke is the most common. It occurs when a blood clot forms on an atherosclerotic plaque within a blood vessel in the brain and blocks blood flow to that part of the brain.
A cerebral embolism happens when a wandering clot or some other particle, called an embolus, is carried by the bloodstream. It lodges in an artery leading to or in the brain and blocks the flow of blood. The embolism could be due to a piece of clot or plaque that broke off from an atherosclerotic plaque. However, most embolic strokes are due to blood clots that form in people with atrial fibrillation and enter the bloodstream.
Written by American Heart Association editorial staff and reviewed by science and medicine advisers. See our editorial policies and staff.
Last Reviewed: Jun 17, 2021
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Evidence That A High Cholesterol Does Not Cause Atherosclerosis
The findings by Sijbrands et al1 that unselected individuals from apedigree with familial hypercholesterolemia had a normal life span and astandard mortality close to one is further evidence that the LDL-hypothesis, the foundation of the cholesterol campaign, is wrong. Patientswith familial hypercholesterolaemia usually have a total serum cholesterolaround ten or even higher. Extrapolating from the data of the MR.FITscreenees2 a cholesterol value of that level is associated with a risk ofcoronary death that is at least ten times higher than in individuals witha low to normal cholesterol. The low standard mortality seen in the Dutchpedigree of individuals with familial hypercholesterolaemia is thereforebest explained by a protective effect of a high cholesterol in thiscondition, for instance against infections, as suggested by the authors.
This explanation is in accord with the idea that atherosclerosis has aninfectious origin, but also with the fact that in many studies a highcholesterol in old people was associated with a low risk of coronary andtotal mortality.
Uffe Ravnskov
1. Sijbrands EJG, Westendorp J, Defesche JC, de Meier PHEM, SmeltAHM, Kastelein JP. Mortality over two centuries in large pedigree withfamilial hyper cholesterolaemia: family tree mortality study. BMJ2001 322:1019-1023 .
2. Stamler J, Wentworth D, Neaton JD. Is relationship between serumcholesterol and risk of premature death from coronary heart diseasecontinuous and graded? JAMA 1986 256:2823-8.
How Does Atherosclerosis Affect My Body
Atherosclerosis is the primary cause of cardiovascular disease. Heart disease is the second leading cause of death in Canada. Types of cardiovascular disease include:
- Coronary artery disease: Coronary artery disease occurs when plaque builds up in the arteries that supply blood to your heart. When blood flow to your heart muscle slows or when the arteries become blocked, it can cause chest pain and heart attack.
- Small vessel disease: Small vessel disease occurs when plaque builds up in the small blood vessels of your heart. This can weaken your heart and cause chest pain, especially during exercise.
- Stroke: A stroke occurs when an artery that carries blood to your brain becomes blocked. This can cause temporary or permanent brain damage, and you may lose the ability to see, speak or to move parts of your body.
- Peripheral arterial disease : PAD occurs when plaque builds up in the arteries that supply blood to your arms or legs. This can cause numbness, pain and possibly infection in your affected limb.
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Consequences Of High Cholesterol And Atherosclerosis
Once again, the potential complications of atherosclerosis depend on which arteries are blocked:
- When blood supply to the heart is limited, it can lead to coronary heart disease. This, in turn, causes a lot of chest pain, but can also lead to heart attacks and heart failure.
- Peripheral artery disease is a consequence of limited blood supply to your arms and legs. These circulation problems will make your limbs more sensitive to temperatures, but will also cause pain in your extremities, making walking or picking up things more difficult. There have also been cases of peripheral artery disease leading to gangrene, which is the tissue death.
- Carotid artery disease means that your brain isnt receiving enough oxygen and nutrients, which are normally supplied by a healthy blood flow. One of the major complications that can appear is a stroke.
- Aneurysms are also a consequence of atherosclerosis, and they are the medical term used to describe the bulge in the artery walls. An aneurysm may show no warning signs at all, but will eventually cause pain in a more advanced stage. If an aneurysm bursts, it can lead to a series of other problems, such as internal bleeding. This generally happens very sudden, and can be a life-threatening problem.
- Chronic kidney disease may occur when atherosclerosis affects the arteries that supply blood to your kidneys. When this happens, your kidneys are no longer efficient at eliminating waste from your body.
A Convenient Choice Of Words
On February 20, 2007, Science Daily reported that researchers had shown total cholesterol levels to predict the risk of stroke in women. Women with the highest cholesterol levels, according to the article, had twice the risk of stroke as women with lower levels. The researchers claimed their findings underscored the importance of cholesterol levels as a risk factor for stroke, even if you have no history of heart disease and are otherwise healthy.8
The article left out one important fact: the study only looked at ischemic stroke.24 Did the women with high cholesterol levels have not only twice the risk of ischemic stroke but also half the risk of the much more dangerous and fatal hemorrhagic stroke? Was the incidence of total stroke any higher or lower in women with high cholesterol levels? We simply do not know the study did not address the question.
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How Can I Lower My Cholesterol
Talk with your healthcare provider about the best way to lower your cholesterol. Some people only need some simple lifestyle changes like eating less saturated fat. Others need lifestyle changes plus medication. People with medical conditions that affect their cholesterol may need a more complex approach. Talk with your provider about your medical history, family history and lifestyle factors. Together, youll come up with a plan for lowering your cholesterol numbers.
Remember that even the best plans take time to work. And we all have setbacks. Its OK to struggle, and its also OK to tell your provider when a plan isnt working. Sometimes even the strictest lifestyle changes dont lower your cholesterol numbers enough. Thats because most of your bodys cholesterol is produced by your liver. So, many other factors come into play that are out of your control and have nothing to do with whats on your dinner plate.
Take things one step at a time, and remember that having high cholesterol isnt a personal failure. Its a result of many small changes quietly happening inside your body. Take control of what you can, but know that medications and other medical interventions are there to fill in the gaps.
A note from Cleveland Clinic
Last reviewed by a Cleveland Clinic medical professional on 05/24/2022.
References
What Are The Symptoms Of Coronary Artery Disease
Angina, or chest pain and discomfort, is the most common symptom of CAD. Angina can happen when too much plaque builds up inside arteries, causing them to narrow. Narrowed arteries can cause chest pain because they can block blood flow to your heart muscle and the rest of your body.
For many people, the first clue that they have CAD is a heart attack. Symptoms of heart attack include
- Chest pain or discomfort
- Weakness, light-headedness, nausea , or a cold sweat
- Pain or discomfort in the arms or shoulder
- Shortness of breath
Over time, CAD can weaken the heart muscle. This may lead to heart failure, a serious condition where the heart cant pump blood the way it should.
Learn the facts about heart disease, including coronary artery disease, the most common type of heart disease.
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What Are The Risk Factors For Atherosclerosis
Anyone can have atherosclerosis. But some people have a higher chance of developing it.
Some risk factors you cant change. These non-modifiable risk factors include:
- Family history of premature cardiovascular disease.
- Older age .
Some medical conditions raise your risk for atherosclerosis, including:
- Diabetes mellitus. Diabetes makes a person 2 to 6 times more likely to develop atherosclerosis. This condition puts younger women at risk.
- High blood pressure . High blood pressure that persists for a long time can damage your artery wall. If your blood pressure is higher than 110/75 mm Hg, you face a greater risk. And that risk goes up the more your blood pressure goes up.
- High cholesterol. High levels of LDL, or bad cholesterol, can be especially dangerous.
- Obesity. Obesity raises your blood pressure, blood sugar and cholesterol levels. It also causes inflammation throughout your body.
Lifestyle factors also play a role. These factors include:
- Have an annual checkup with your primary care provider.
Evidence From Mendelian Randomization Studies
Although the association between LDL-C and the risk of ASCVD is strong, graded, and reproducible in meta-analyses of prospective cohort studies, these studies are not randomized and are therefore unavoidably vulnerable to confounding, reverse causation, and other forms of bias. Mendelian randomization studies introduce a randomization scheme into an observational study specifically to assess whether an observed association between an exposure and an outcome is likely to be causal.
Numerous variants in multiple genes have been reported to be associated with lower LDL-C levels., Each of these variants is inherited approximately randomly at the time of conception in a process sometimes referred to as Mendelian randomization. Therefore, inheriting an LDL-C lowering allele in one of these genes is analogous to being randomly allocated to treatment with an LDL-C-lowering therapy, while inheriting the other allele is analogous to being randomly allocated to usual care. If the variant under study is associated solely with LDL-C and not with other lipid or non-lipid pleiotropic effects, and if allocation is indeed random, then comparing the risk of ASCVD among persons with and without such a variant should provide an unconfounded estimate of the causal effect of lower LDL-C levels on the risk of ASCVD in a manner analogous to a long-term randomized trial.
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What Medical Problems Affect My Cholesterol Levels
Medical problems and cholesterol have a two-way relationship. High cholesterol can cause medical problems like atherosclerosis. But some medical conditions can also put you at a higher risk of having high cholesterol. Here are some conditions that may affect your cholesterol levels.
Chronic kidney disease
People with chronic kidney disease face a higher risk of developing coronary artery disease. Thats because CKD causes plaque to build up more quickly in their arteries. People with early-stage CKD are more likely to die from heart disease than kidney disease.
CKD causes you to have more triglycerides in your blood. It also causes you to have more very low-density lipoprotein cholesterol. VLDLs are particles that carry triglycerides. Meanwhile, CKD lowers your good cholesterol levels and prevents your HDLs from working as they should. CKD also changes the structure of your bad cholesterol particles so they cause more harm.
HIV
People with HIV are nearly twice as likely as people without HIV to have a heart attack or stroke. Researchers used to think this higher risk came from HIV medications . They believed those medications raised a persons cholesterol. But newer research shows the culprit is actually a persons immune system.
Even if your HIV is under control, your immune system may still be activated. This puts your body in a state of chronic inflammation. This inflammation triggers plaque buildup and atherosclerosis.
Thyroid disease
Lupus
Polycystic ovary syndrome
What Exactly Are Triglycerides
Triglycerides are lipids or fats. They are, in part, what helps you sustain energy throughout the day. Your body makes triglycerides from unused calories, stores them, and releases them from fat cells into the blood when they are needed. They may also freely circulate in the bloodstream when introduced.
| Triglycerides Level Chart |
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Procedures To Unclog Arteries
Using invasive procedures, doctors can see and unclog arteries, or provide a path for blood to go around blocked arteries. Treatments include:
- Angiography, angioplasty, and stenting. Using a catheter put into an artery in the leg or arm, doctors can enter diseased arteries. This procedure is called cardiac catheterization. Blocked arteries are visible on a live X-ray screen. A tiny balloon on the catheter can be inflated to compress cholesterol plaque in the blocked arteries. Placing small tubes called stents helps to keep open blocked arteries. The stent is usually made of metal and is permanent. Some stents have medicine that helps keep the artery from getting blocked again.
- Surgeons harvest a healthy blood vessel from the leg or chest. They use the healthy vessel to bypass blocked arteries.
These procedures involve a risk of complications. They are usually saved for people with significant symptoms or limits caused by the cholesterol plaques of atherosclerosis.
Show Sources
American Heart Association: “Atherosclerosis,” “Cholesterol,” “Common Cardiovascular Diseases,” “What is Atherosclerosis?” “LDL and HDL Cholesterol: What’s Bad and What’s Good?” “Cholesterol-Lowering Drugs,” “Phytochemicals and Cardiovascular Disease,” “Effects of Normal, Pre-hypertensive, and Hypertensive Blood Pressure Levels on Progression of Coronary Atherosclerosis,” “Antiplatelet Agents,” “Anticoagulants,” “Anticoagulation,” “Questions and Answers About Statin Therapy.”
CDC.gov.
The Work Of Weston Price: Its Enduring Value
Weston Price promoted two theories about the relationship of nutrition and oral health to degenerative disease, which have long been ignored but have more recently gained support. In his earlier career, Price conducted 25 years of research demonstrating the ability of oral pathogens to cause cardiovascular and other systemic diseases. His work focused primarily on the tendency of the root canal procedure to facilitate this process.45 In his classic work on nutrition, Nutrition and Physical Degeneration, he connected nutritional status during development to deformities of the oral palate as well as to the risk of tuberculosis. Price believed that developmental deformities of the chest cavityproduced by the same nutritional causes as the deformities of the oral palatemade a person more vulnerable to the tuberculosis bacterium. For these reasons, he placed a special emphasis on the importance of nutritional preparation for and support of pregnancy and lactationpractices he universally observed among the healthy indigenous groups he studied.2 Modern science is now rediscovering the links between vascular disease and oral health and fetal nutrition.
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Cholesterol Does Not Correlate With Degree Of Coronary Calcification
In contrast to conventional angiography, electron beam angiography detects coronary plaques independent of their location in the vessel wall, but only calcified plaques. Degree of coronary calcification seems a good surrogate for degree of coronary atherosclerosis, because it correlates strongly with total plaque volume and obstructive coronary disease, and is a powerful predictor of clinical outcome. Nonetheless, degree of coronary calcification did not correlate with any lipid fraction in the blood.
Mechanisms Of Lipoprotein Oxidation In Vitro And In Vivo
The precise mechanisms that generate oxidized lipoproteins in vivo are still only partially understood. LDL circulating in the plasma appears to be protected from oxidation, both by dietary antioxidants such as vitamin E and C and by protective enzymes including glutathione peroxidases , peroxiredoxins, PAF-acetylhydrolase , and paraoxonases . Penetration of LDL into the artery wall occurs at branch points in the aorta and other places with turbulent flow and shear stress. Retention of LDL in the intima, due to interactions with extracellular matrix such as chondroitin sulfate-rich proteoglycans, sequesters LDL away from the antioxidant environment of the plasma and exposes LDL to oxidation. A variety of oxidases and peroxidases generate strong oxidants that can readily oxidize LDL. These include myeloperoxidase , xanthine oxidase , NADPH oxidases , and inducible nitric oxide synthase . Oxygenases such as lipoxygenases have also been shown to oxidize LDL in vitro . The extent that each of these enzymes contributes to lipoprotein oxidation in vivo and thus to atherosclerosis remains to be fully elucidated, and there is much we do not understand about these individual processes. This is illustrated by studies on MPO and the 12/15-Lipoxygenase, the two enzymes most closely linked to lipoprotein oxidation.
MYELOPEROXIDASE
12/15-LIPOXYGENASES
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