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.
Hdl Cholesterol: Too Much Of A Good Thing
As with many other good things in life, this usually helpful protein is best in moderation.
I used to be thrilled that my blood level of HDL cholesterol, the so-called good cholesterol, was high, the likely result of my devotion to daily physical activity. After all, HDL, for high-density lipoprotein, acts like an arterial cleanser, removing cholesterol from blood vessels and preparing it for removal outside the body.
An ample supply of HDL cholesterol in blood serum has long been linked to protection against coronary heart disease and stroke, so what could be bad?
I now know that, as with many other good things in life, there can be too much of this usually helpful protein. The best available evidence has shown that most of us would probably be best off aiming for moderation with regard to serum levels of HDL.
A series of studies, large and small, in this country and abroad shows that the relationship of HDL levels to heart disease and overall mortality forms a U-shaped curve: too little and too much of this blood lipid are, on average, associated with an elevated risk of heart disease, cancer and premature death.
Although cardiologists can still only guess at why very high HDL levels may incur a health risk, the findings reinforce the importance of focusing less on the good cholesterol and even more on the bad the level of LDL, or low-density lipoprotein, cholesterol that is still too high in as many as one-third of adults in this country.
How Do I Know What My Ldl Level Is
A blood test can measure your cholesterol levels, including LDL. When and how often you should get this test depends on your age, risk factors, and family history. The general recommendations are:
For people who are age 19 or younger:
- The first test should be between ages 9 to 11
- Children should have the test again every 5 years
- Some children may have this test starting at age 2 if there is a family history of high blood cholesterol, heart attack, or stroke
For people who are age 20 or older:
- Younger adults should have the test every 5 years
- Men ages 45 to 65 and women ages 55 to 65 should have it every 1 to 2 years
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How Is An Hdl Cholesterol Test Different From A Lipid Panel
A lipid panel always includes a measurement of HDL cholesterol, but HDL cholesterol levels can be tested without doing a full lipid panel.
A standard lipid panel measures total cholesterol, HDL cholesterol, and triglycerides. It then uses those measurements to calculate the amount of LDL cholesterol.
The Study That Backfired
Most of the drugs that doctors rely to prevent heart disease do not raise HDL cholesterol appreciably. That is why we suspect they have focused on lowering LDL cholesterol.
Then something strange happened. Along came a drug that does exactly that . Eli Lillys experimental drug evacetrapib was the star in a very large and expensive clinical trial called ACCELERATE. Hopes were high.
The drug was shown to lower LDL cholesterol up to 40 percent and raise HDL cholesterol up to 129 percent. Those are spectacular results and no other medication has been able to accomplish such impressive changes in lipid levels.
Over 12,000 patients were enrolled in this clinical trial at 540 sites in 37 countries. Hundreds of millions of dollars were invested and the expectations were that the drug would revolutionize the treatment of heart disease. Wall Street analysts anticipated that the drug would become a billion dollar blockbuster for Eli Lilly.
All that came to a screeching halt on October 15, 2015 when the clinical trial was stopped prematurely and the company abandoned further development of evacetrapib. Although the drug actually did what it was supposed to do in modifying blood lipids in all the right ways, it did not work to prevent heart attacks and strokes.
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Hdl: Is Higher Always Better
If HDL protects the heart, should it be as high as possible? The answer may depend on several factors.
Most people will find that their HDL cholesterol does not climb to levels that are considered too high. Though no upper limit has been established, HDL cholesterol does not naturally elevate to unhealthy high levels in people with normal cholesterol processing and metabolism.
In rare cases, however, HDL cholesterol can become too high.
An article in the journal Science discusses a rare genetic variant that may cause exceptionally high HDL levels. The genetic variant alters the way that HDL works in the body, and can increase the risk of heart disease.
The variant is found in a specific molecule known as SR-BI. The mutation in SR-BI causes increased levels of HDL and an increased risk of heart disease.
The people studied had levels of HDL greater than 95 milligrams per deciliter . These levels are abnormally high. The researchers found that some of the people in their study did have this rare genetic defect.
Another study found that people who recently had a heart attack and who have both high HDL and high levels of a substance called C-reactive protein were at higher risk of having another cardiac event. C-reactive protein is produced by the liver when inflammation occurs in the body.
Furthermore, cholesterol balance may be an important factor to consider, according to a review in Atherosclerosis.
What Are Ldl And Hdl
LDL and HDL are two types of lipoproteins. They are a combination of fat and protein. The lipids need to be attached to the proteins so they can move through the blood. LDL and HDL have different purposes:
- LDL stands for low-density lipoproteins. It is sometimes called the “bad” cholesterol because a high LDL level leads to a buildup of cholesterol in your arteries.
- HDL stands for high-density lipoproteins. It is sometimes called the “good” cholesterol because it carries cholesterol from other parts of your body back to your liver. Your liver then removes the cholesterol from your body.
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Ask The Doctor: Can Hdl Cholesterol Be Too High
Q.I know I need to keep my LDL cholesterol low and my HDL cholesterol high, but can HDL ever be too high?
A. For high-density lipoprotein levels, it does appear that the higher, the betterat least to a point. But you should also think about how you achieve that level. HDL is known as the “good” cholesterol particle because it functions to clear cholesterol from the arteries and deliver it back to the liver. Higher HDL levels are associated with a lower risk of heart disease. HDL levels lower than 40 milligrams per deciliter are considered worrisome, and levels higher than 60 mg/dL are considered excellent.
One recent study that examined high levels of HDL reported the benefits extended until 90 mg/dL in men, but then leveled off, which suggests no further benefit even with higher levels. A man’s HDL level is predominantly determined by genetics, or inherited factors. Moderate-intensity exercise, three to four times a week, is an important mechanism to raise HDL with the bonus of other health benefits. Other methods to raise HDL are not so healthy. For instance, medications or supplements, like niacin, have shown disappointing results in controlled studies. Alcohol intake is known to increase HDL, but consuming more than two standard drinks a day can raise your risk of high blood pressure, heart attack, and stroke.
–William Kormos, MD
What Causes Low Hdl Cholesterol
There are many reasons why some people have low HDL and others have high HDL. Genes appear to play the most important role by determining how much HDL cholesterol your body makes and the proportion of different subtypes.
Lifestyle choices also affect HDL levels. Smoking, carrying too many pounds, and lack of physical activity tend to lower HDL. So does a diet high in refined carbohydrates . Medications such as beta blockers, anabolic steroids, progestins, and benzodiazepines can also depress HDL.
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What To Know About Triglycerides
In addition to cholesterol, you might hear about your triglycerides, another kind of fat found in the bloodstream. Women should pay particular attention to this. A high level of triglycerides seems to predict an even greater risk for heart disease in women compared with men, says Michos.
When you take in more calories than you need, your body converts the extra calories into triglycerides, which are then stored in fat cells. Triglycerides are used by the body for energy, but people with excess triglycerides have higher risk of medical problems, including cardiovascular disease. Drinking a lot of alcohol and eating foods containing simple carbohydrates , saturated fats and trans fats contributes to high triglycerides. High levels may also be caused by health conditions such as diabetes, an underactive thyroid, obesity, polycystic ovary syndrome or kidney disease.
Triglycerides also circulate in the bloodstream on particles that may contribute to plaque formation. Many people with high triglycerides have other risk factors for atherosclerosis, including high LDL levels or low HDL levels, or abnormal blood sugar levels. Genetic studies have also shown some association between triglycerides and cardiovascular disease.
High Cholesterol: Prevention, Treatment and Research
Other Studies As Well
Studies in the past have shown that when compared to patients with more moderately high HDL levels, those with very high HDL levels that is a threshold of 90 mg/dL or more seem to have a bigger risk for heart disease, explains Dr. Tavel.
So which levels are truly harmful? The answer is vague.
Another study links very high levels of the good cholesterol with increased mortality.
Men with extremely high HDL levels had a 106 percent higher mortality rate than those with a normal HDL level.
Women with extremely high HDL had a 68 percent higher mortality rate than did the normal group.
Men with very high levels but not extremely high, had a 36 per cent higher death rate.
Subjects with extremely low HDL also had a high death rate.
And who had the lowest mortality of both genders? Those with a moderate level of the good cholesterol.
Professor Børge Nordestgaard, one of this studys authors, advises that people not get caught up with trying to get their HDL as high as possible.
He points out in the paper that HDLs are the smallest of the lipoproteins, and that we need to pay more attention to the bigger lipoproteins like LDL and triglycerides.
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The Copenhagen City Heart Study
Individuals aged 20100 years were invited randomly from the general population of Copenhagen using information from the Danish Civil Registration System. Information on health, lifestyle etc. was obtained from questionnaires, which were reviewed with an investigator on the day of attendance, and from a physical examination. Blood was drawn for biochemical measurements. For this study 9387 individuals from the 1991 to 1994 examination of the CCHS were included .
Does Age Make A Difference To Recommended Cholesterol Levels
No, recommended cholesterol levels do not change based on age. It was once thought that high cholesterol becomes less of a problem as one ages. However, there is now good evidence that lowering high cholesterol is of benefit even in the elderly.
Previously, there was also concern that some cholesterol-lowering drugs like statins may interfere with ones cognitive function and that this might be more of an issue in the elderly. This has now been debunked. Nevertheless, it is worth starting with a low dose and gradually increasing to avoid any potential side effects.
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Hdl Carotid Artery Plaque And Heart Disease Risk In Women
While the study is well-conducted, the issue may not be the size or number of HDL particles but rather the use of carotid artery plaque to assess HDLs benefits, says Alan Tall, MD, professor of medicine at Columbia University Medical Center in New York City.
Based on Dr. Tall’s research,6 HDL is not protective for carotid plaque or stoke…The real message may be that HDL has a different relationship in carotid plaque than it does to coronary heart disease.
We found that HDL cholesterol mass efflux is strongly protective against coronary heart disease, but not carotid plaque or stroke,6 says Dr. Tall. “Although the measurements that made on carotid plaque are consistent with our findings, our data apply to a broader population, not just postmenopausal women,” he says.
What does this mean for patients?
I still think that HDL is related to a lower risk of coronary artery disease, Dr. Tall tells EndocrineWeb. Whether its a direct effect or a marker, there is a measure of protection there. However, if there are other risk factors such as high LDL, or high blood pressure, those still need to be treated.
What, if anything, does this mean for women who are looking to reduce their risks of heart disease, especially early in menopause when concerns about cardiovascular risk increase substantially?
A Closer Look At Good Cholesterol In Heart Disease
To assess the beneficial role of HDL, Dr. El Khoudary and her team identified 1,380 middle-aged or older women from the MESA study and analyzed their ultrasound images of the carotid artery to determine arterial wall thickness. The carotid artery is the main channel for delivering blood to the brain.
The researchers also measured both the size and number of lipoprotein particles present. Study participants are broken into several groups based on menopausal status:
- Surgical menopause
- Natural Menopause ,
- Perimenopause .
According to investigators,2 the surgical menopause group’s mean total HDL particle concentration was 27.47 mol/L. In the natural menopause group, it was 26.60 mol/L, and in the perimenopause group, it was 25.81 mol/L. In all groups, large HDL particles numbered between 6.51 mol/L and 7.08 mol/L, while the number of small HDL particles ranged from 19.30 mol/L to 20.39 mol/L.
“Our findings suggest that associations between concentrations of large HDL particles and atherosclerosis depend on time elapsed since menopause, Dr. El Khoudary says. On the other hand, small HDL particlesas well as the total number of HDL particlesappear to be protective, irrespective of time elapsed since menopause.
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How To Lower Cholesterol: Know Your Fats
The American Heart Association recommends that just 25% to 35% of your daily calories come from fats such as those found in fish, nuts, and vegetable oils. For healthy people, saturated fat should comprise no more than 7% of your total calories. On a 2,000 calorie-a-day diet, that’s about 140 calories worth of saturated fat. If you need to lower your LDL cholesterol, limit saturated fat to 5% to 6% of calories, or about 11 to 13 grams of saturated fat on a 2,000-calorie diet. Reduce trans fats to less than 1% of your total daily calories. This means avoiding fried foods and many junk foods.
High Cholesterol Risk Factors
You may really be at a higher risk of getting high cholesterol If:
- you live with obesity
- have a low physical activity level
- tobacco products to smoke
- having a history of elevated cholesterol in the family
- If you have diabetes, kidney illness, or hypothyroidism.
People of all genders, ages, and ethnicities also have high cholesterol
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Answering Our Readers Question About High Hdl
Perhaps your cardiologist wants to lower your LDL-C and total cholesterol with atorvastatin . It might raise your HDL-C levels, but its not clear whether that would be problematic.
To learn more about these and many other risk factors for heart disease along with non-drug approaches for optimizing cardiovascular health, you may want to consult our eGuide to Cholesterol Control & Heart Health. This online resource is available in the Health eGuides section of this website.
Our radio show/podcast for this week was with a preventive cardiologist and a lipidologist . You may find this conversation particularly relevant to the ongoing questions about statins and cholesterol. Just click on the arrow inside the green circle below the photo of Dr. Michael Blaha, Director of Clinical Research for the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease.
It seems that there may be more to staving off heart attacks than simply lowering LDL cholesterol and raising HDL cholesterol with a drug. One other lipid fraction that rarely gets mentioned is worth your consideration. That happens to be Lp. Here is an article that you may find intriguing. It might explain why some people who take statins still get heart attacks:
Most people have had their LDL cholesterol measured. Have you ever had your Lp tested? Did you know that statins may actually raise this key risk factor?
How Is An Hdl Cholesterol Test Different From A Low
An HDL cholesterol test and LDL cholesterol test measure different types of cholesterol. The two types of cholesterol are transported in the blood in distinct kinds of particles.
In common descriptions, HDL cholesterol is known as good cholesterol while LDL cholesterol is bad cholesterol. The amount of HDL cholesterol compared to LDL cholesterol can be an important consideration in cardiovascular health.
Measuring HDL cholesterol is more straightforward than measuring LDL cholesterol. For this reason, levels of LDL cholesterol are most often calculated using a formula based on levels of total cholesterol, HDL cholesterol, and triglycerides. In some situations, though, a doctor may prescribe a direct LDL test.
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