What Are The Types Of Cholesterol
Cholesterol moves throughout the body carried by lipoproteins in the blood. These lipoproteins include:
- Low-density lipoprotein is one of the two main lipoproteins. LDL is often called the bad cholesterol.
- High-density lipoprotein is the other main lipoprotein. HDL is often called the good cholesterol.
- Very-low-density lipoproteins are particles in the blood that carry triglycerides.
The American Heart Association Recommends
All adults age 20 or older should have their cholesterol checked every four to six years. If certain factors put you at high risk, or if you already have heart disease, your doctor may ask you to check it more often. Work with your doctor to determine your risk for cardiovascular disease and stroke and create a plan to reduce your risk.
Measuring Ldl Cholesterol Levels
Given the severity of what it can lead to, its little wonder that screening LDL levels is an important and essential part of health evaluation. This is measured using a blood test called a lipoprotein profile. Heres a breakdown of how the assessment works:
- Fasting: You may have to fast for 9 to 12 hours before your appointment for an accurate LDL level. This means holding back from eating, having certain beverages, or taking some medications.
- Sampling: The lipoprotein test, like other blood tests, only requires a small sample of blood. Its usually drawn from a vein in the arm, and all youll feel is a pinprick.
- Multiple Measures: The amounts of four lipoproteins are measured: LDL, HDL, triglyceride, and total cholesterol levels. Other lipoproteins such as very low-density lipoprotein may be measured as well.
Recommendations as to how often you should have your cholesterol levels checked vary based on your age and health status. Typically, adults over the age of 20 should be screened once every five years, with the first test administered when children are 9 to 11. Men aged 45 to 65, and women 55 to 65 should be screened every one to two years.
However, more frequent assessment is needed for those who have certain risk-factors for heart disease, including:
Notably, in men over 40, LDL levels will be part of an equation used to determine risk of developing stroke or heart attack within 10 years.
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Health Problems Can Arise When You Have Elevated Levels Of Bad Cholesterol
A waxy compound found in your bodys cells, cholesterol is manufactured in the liver and present in some foods. There are two types of proteins that carry cholesterol through the bloodstream: high density lipoprotein and low density lipoprotein . HDL is considered good cholesterol, as it absorbs cholesterol and brings it back to the liver, whereas LDL is bad” cholesterol.
What makes LDL so concerning? Why is it bad? High levels can cause plaque to form in your arteries. In turn, this can lead to a range of serious conditions, such as coronary artery disease and peripheral artery disease , among others. These diseases are leading causes of heart attack and stroke.
This being the case, checking LDL levelsas part of a broader assessment of cholesterolis an essential part of a routine physical. If your levels are high, youll need to manage the condition, which can mean everything from adopting lifestyle changes to taking medication. Learning more about cholesterol and LDL helps you understand your health overall.
Verywell / Jessica Olah
Who Needs To Get Checked
Everyone should get their cholesterol checked, starting at age 20 and then every 4 to 6 years after that if their risk remains low.
After age 40, your doctor may want to check your levels more often. Typically, people assigned male at birth who are ages 45 to 65, along with people assigned female at birth who are ages 55 to 65, should have their cholesterol checked every 1 to 2 years.
Everyones risk for high cholesterol goes up with age. This is because the older we get, the harder it becomes for our bodies to filter out cholesterol.
A family history of high cholesterol can also increase risk.
While its impossible to control aging and family history, there are some behaviors that increase the risk of developing high cholesterol that can be changed
Individuals living with obesity and type 2 diabetes are more at risk for an increase in bad cholesterol and a dip in good cholesterol.
Its important to work with your doctor, who can provide support and resources, to help you adhere to their recommendations on how to lower your risk. Recommendations may include losing excess weight and focusing on finding what works best for you in managing your diabetes.
Other behaviors that may put you at a higher risk include:
- smoking, which can damage blood vessels and may lower good cholesterol
- eating a diet high in saturated and trans fat, which includes foods like fatty meats and dairy-based desserts
- not getting enough physical movement throughout the week
- drinking an excess of alcohol
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How Is The Total Cholesterol Or Blood Cholesterol Test Done
A blood test is a routine test. A phlebotomist is the person whose job it is to draw blood. Blood is usually drawn from the vein in your arm. You will sit down and the phlebotomist will wrap a rubber band around your upper arm so that the vein in your elbow sticks out. Then they will use a needle to puncture the vein and remove blood. The blood is sent to the lab to be examined.
Youve probably been at health fairs where testing is offered. In that case, the person performing the test takes a drop of blood from your finger. The finger stick test uses a small blade to poke a hole in the tip of your finger to get the blood.
What Is Ldl Cholesterol
Cholesterol is carried through the blood on two types of proteins called lipoproteins. These lipoproteins include LDL , which is sometimes referred to as bad cholesterol, and HDL , or what is typically referred to as good cholesterol.
The science over good and bad cholesterol has shifted quite a bit recently, so how can you be sure that youre not putting your health in danger? Read on for everything you need to know about LDL backed by the most recent science.
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Transport Into The Cell
When a cell requires additional cholesterol , it synthesizes the necessary LDL receptors as well as PCSK9, a proprotein convertase that marks the LDL receptor for degradation. LDL receptors are inserted into the plasma membrane and diffuse freely until they associate with clathrin-coated pits. When LDL receptors bind LDL particles in the bloodstream, the clathrin-coated pits are endocytosed into the cell.
Vesicles containing LDL receptors bound to LDL are delivered to the endosome. In the presence of low pH, such as that found in the endosome, LDL receptors undergo a conformation change, releasing LDL. LDL is then shipped to the lysosome, where cholesterol esters in the LDL are hydrolysed. LDL receptors are typically returned to the plasma membrane, where they repeat this cycle. If LDL receptors bind to PCSK9, however, transport of LDL receptors is redirected to the lysosome, where they are degraded.
There Are Two Main Types Of Cholesterol
The two main lipoproteins responsible for transporting cholesterol are low-density lipoprotein and high-density lipoprotein .
LDL cholesterol is whats known as bad cholesterol. Too much LDL cholesterol leads to fatty buildups that clog arteries atherosclerosis. Narrows arteries make it difficult for blood to travel through the body, and it makes your heart work harder to pump blood. Excess LDL cholesterol increases your risk for heart disease, heart attack, stroke, peripheral artery disease.
In general, you want lower levels of low-density lipoprotein cholesterol.
HDL cholesterol is commonly referred to as good cholesterol. Research shows a correlation between higher HDL levels and a lower risk for heart disease. High-density lipoproteins help carry LDL cholesterol through the blood and back to the liver. The liver then breaks down LDL cholesterol, allowing the body to remove it as waste.
In general, you want higher levels of high-density lipoprotein cholesterol.
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What Do Your Cholesterol Results Mean
When you have a cholesterol test, it is really important that your healthcare professional explains the results to you to prevent unnecessary worry and confusion.
Its not just your total cholesterol thats important and your results will include different types of cholesterol. If you are only given your total cholesterol, ask for a break-down of the other numbers. Its possible to have a healthy total cholesterol number but an unhealthy balance of the different types of cholesterol.
As a minimum, you should be given your total cholesterol and HDL numbers, then you can work out your ratio of total cholesterol to HDL cholesterol .
You might also have your triglycerides tested, these are another type of blood fat which are linked to heart disease.
Ask for a print out of your results if you are not able to speak to your GP, nurse or pharmacist.
Your results should include:
- Total cholesterol
This is sometimes written as ‘serum cholesterol’ or ‘TC’ and refers to your overall level of cholesterol.
- Non-HDL cholesterol
- HDL cholesterol
- TC:HDL ratio
You might be given a TC:HDL ratio, which is the ratio of HDL compared to the total cholesterol. If not, you can work it out from your HDL and total cholesterol numbers. This should be as low as possible. Above 6 is considered high.
Comparing And Contrasting A Direct Ldl Cholesterol Test And A Non
A non-HDL cholesterol test uses a formula to estimate the levels of all types of bad cholesterol, including cholesterol inside low-density lipoproteins, intermediate-density lipoproteins, very low-density lipoproteins, and lipoprotein particles.
Calculating non-HDL cholesterol requires measuring total cholesterol and HDL cholesterol. The amount of HDL cholesterol is then subtracted from total cholesterol.
Unlike a direct LDL cholesterol test, a non-HDL cholesterol test does not provide a specific result for LDL cholesterol. In addition, non-HDL cholesterol levels are calculated, which is in contrast to a direct LDL cholesterol test that involves an actual measurement of LDL cholesterol by the laboratory.
While non-HDL cholesterol can be a useful tool for assessing cardiovascular disease risk, most patient care guidelines focus on LDL cholesterol levels.
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What Types Of Cholesterol Are There
There are two different types of cholesterol including:
- “Bad Cholesterol” which carry cholesterol particles throughout your body. LDL cholesterol is bad because it builds up in the walls of your arteries, making them hard and narrow which can increase the risk of a heart attack.
- “Good Cholesterol” which picks up excess cholesterol and takes it back to the liver. Having high HDL is linked to lower risk of heart disease, heart attack, and stroke.
Whats A Healthy Cholesterol Level
- LDL cholesterol for adults should be below 100 mg/dL.
- HDL cholesterol for men should be over 40 mg/dL.
- HDL cholesterol for women should be over 50 mg/dL.
- Total cholesterol should be between 125 and 200 mg/dL.
Cholesterol levels typically increase with age, which means that it becomes increasingly important to monitor cholesterol levels and take steps to manage your cholesterol as you get older.
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What Factors Affect Cholesterol Levels
A variety of factors can affect your cholesterol levels. They include:
- Diet: Saturated fat, trans fat and cholesterol in the food you eat increase cholesterol levels. Try to reduce the amount of saturated fat, trans fat and cholesterol in your diet. This will help lower your blood cholesterol level. Saturated and trans fat have the most impact on blood cholesterol.
- Weight: In addition to being a risk factor for heart disease, being overweight can also increase your triglycerides. Losing weight may help lower your triglyceride levels and raise your HDL.
- Exercise: Regular exercise can lower total cholesterol levels. Exercise has the most effect on lowering triglycerides and raising HDL. You should try to be physically active for 30 minutes on most days of the week.
- Age and sex: As we get older, cholesterol levels rise. Before menopause, women tend to have lower total cholesterol levels than men of the same age. After menopause, however, womens LDL levels tend to rise and HDL can drop.
- Heredity: Your genes partly determine how much cholesterol your body makes. High blood cholesterol can run in families.
Where Can I Find More Information About The Treatment Of High Cholesterol
Ask your doctor where you can find information on cholesterol. Your library may have books on high cholesterol and heart disease. The Web sites of the National Heart, Lung, and Blood Institute and the American Heart Association have good information. Their addresses are and .
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What Are Ldl Cholesterol Particle Size Patterns A And B
The LDL patterns A and B refer to the size of LDL cholesterol particles in the blood. Some doctors believe that small LDL cholesterol particles in the blood may pose a greater risk for developing atherosclerosis and heart attacks than the absolute level of LDL cholesterol in the blood. The size of LDL cholesterol particles is primarily inherited.
A special blood test called polyacrylamide gradient gel electrophoresis can measure particle size and determine whether a person has blood cholesterol LDL pattern A or LDL pattern B.
Persons with LDL cholesterol pattern A have large, buoyant LDL cholesterol particles. Individuals with pattern A are more likely to have normal blood levels of LDL cholesterol, HDL cholesterol, and triglycerides. Pattern A is usually not associated with an increased likelihood of atherosclerosis.
Persons with LDL cholesterol pattern B have predominantly small and dense LDL cholesterol particles. Pattern B is frequently associated with low HDL cholesterol levels, elevated triglyceride levels, and the tendency to develop high blood sugar levels and type II diabetes mellitus. Individuals with pattern B are also more likely to develop high blood triglyceride levels after a fatty meal . Pattern B is associated with accelerated atherosclerosis and a 3 to 5- fold increase in heart attack risk. Pattern B is believed to be the most important cause of atherosclerosis in people with normal or near normal total and LDL cholesterol levels.
What Medications Are Used To Reduce Ldl Cholesterol
There are several classes of drugs prescribed for high LDL. These include:
- Statins: These drugs inhibit the activity of enzymes in the liver that produce cholesterol, lowering LDL, while raising HDL. The most commonly prescribed types include Lipitor , Lescol , and Advicor , among many others.
- Cholesterol absorption inhibitors: This type of drug, most commonly available as Zetia and Vytorin , prevents the intestines from absorbing cholesterol.
- Bile acid sequestrants: By spurring the intestine to shed more cholesterol, drugs like Colestid , Welchol , and Questran help lower LDL levels.
- PCSK9 inhibitors: This newer class of cholesterol-lowering drug, available as Repatha and Praluent , has shown great promise in lowering LDL. These monoclonal antibodies inhibit proprotein convertase subtilisin/kexin 9 , a protein that regulates cholesterol levels.
- Adenosine triphosphate-citrate lyase inhibitors: In adults with genetic high cholesterol, or those with heart disease, ACL inhibitors like Nexletol and Nexlizet may be prescribed. These are combined with statins and lifestyle changes to improve LDL levels.
- Fibrates: Drugs of this type, such as Lopid andfenofibrate , primarily moderate triglyceride levels, though they can also lower LDL.
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Another Type Of Fat Found In The Blood Mainly From The Food We Eat
Whats healthy? Less than 1.7 mmol/L ideally on a fasting sample, or less than 2.3 mmol/L on a non-fasting sample.
What should I do? Very high triglyceride levels can cause a painful condition called pancreatitis. People can have raised levels for many reasons, but the most common reasons are lifestyle-related:
- Being apple-shaped .
- Developing or having type 2 diabetes.
Excessive alcohol consumption.
You can keep your triglyceride levels low by losing weight, being more active and eating sensibly, especially by cutting back on alcohol, sugary foods and saturated fats, and eating more fruits, vegetables, pulses and wholegrains.
What Does My Ldl Cholesterol Mean
As with total cholesterol, the higher your LDL level is, the higher your risk for heart disease. However, LDL level is a better predictor of heart attack risk than total blood cholesterol is.
According to the American Heart Association, most people with a total blood cholesterol of 200 mg/dL will have an LDL of about 130 mg/dL. A person who has a total blood cholesterol of 240 mg/dL probably has an LDL of about 160 mg/dL. These are averages only. Your own LDL cholesterol may be higher or lower.
If you do not have heart disease or diabetes and you have fewer than two risk factors for heart disease, your LDL level should be less than 160 mg/dL.
If you do not have heart disease or diabetes but have two or more risk factors for heart disease and your 10-year risk of having a heart attack is 20% or less, your LDL level should be less than 130 mg/dL.
If youve had angina, heart attack, balloon angioplasty, bypass surgery, stroke, or other evidence of atherosclerosis, if you have diabetes, or if your 10-year risk of having a heart attack is greater than 20%, your LDL level should be less than 100 mg/dL.
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