The Truth About Cholesterol
By Nilima Desai, MPH, RD
If you are one of the millions of Americans who get an annual check-up, your doctor most likely checks your cholesterol levels as part of the routine visit. Total cholesterol is part of a comprehensive lipid panel test. The lipid panel usually contains information on total cholesterol and all its individual particles, such as low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, very low-density lipoprotein cholesterol (VLDL), and triglycerides (TGs). These lab values enable your healthcare provider to better understand your overall risk of heart disease and decide if further action is required.
What do all these terms mean?
Total cholesterol: Cholesterol is a waxy substance found in your blood and comes from two different sources. Your liver produces cholesterol, and it can also be obtained from animal-based food products such as dairy, eggs, and red meats. Cholesterol has a negative connotation associated with it, but not all cholesterol is bad. In fact, cholesterol is important since it is a structural component of all cells, and your body needs it to make hormones and bile acids to aid in the process of digestion. Cholesterol only becomes problematic if blood levels rise above the recommended amount. According to the National Institutes of Health (NIH) National Cholesterol Education Program (NCEP) ATP III guidelines for adults, a total cholesterol level below 200 mg/dL is desirable.1
Low-density lipoprotein cholesterol: Also called the “bad” cholesterol, since LDL particles carry cholesterol from the liver to the rest of the body. High circulating levels of LDL cholesterol can form deposits in the walls of the arteries, forming plaque. Over time, plaque build-up can cause narrowing of the arteries, limiting blood flow. This process can increase the risk of coronary artery disease (CAD) development.
According to research, small, dense LDL particles are a better predictor than plasma LDL concentrations alone for atherosclerotic plaque formation and may be an important contributing factor in the development of CAD.2 An LDL cholesterol level below 100 mg/dL is considered optimal per the ATP III guidelines.1
Very low-density lipoprotein cholesterol: VLDL is formed in the liver from triglycerides, cholesterol, and apolipoproteins. VLDL is converted to LDL in the bloodstream and therefore considered a “bad” cholesterol.
High-density lipoprotein cholesterol: Also called the “good” cholesterol, since HDL particles carry cholesterol to your liver from other parts of the body, where it can be removed from your bloodstream before the plaque build-up can occur in your arteries. Therefore, the higher the HDL levels, the better it is for your heart health. The recommended levels are 60 mg/dL or higher for both men and women.1
Triglycerides: This type of fat found in your blood is used as a form of energy. Any extra calories from the food you consume are stored in the form of triglycerides within your fat cells throughout the body. High levels of triglycerides along with high LDL and/or low HDL can increase the risk of heart disease. The recommended level for triglycerides is < 150 mg/dL.1
Determining if you are at risk
According to the American Heart Association, people over the age of 20 should get their cholesterol levels checked every four to six years.3 Along with your lipid profile numbers, your doctor will also look at other risk factors such as your age, gender, family history, smoking status, other comorbidities such as diabetes, high blood pressure, etc., to determine if you are at an increased risk of developing heart disease.3
What is the solution?
So what should you do if your doctor tells you need to reduce your LDL levels and increase your HDL levels in your body? According to the 2013 American Heart Association/American College of Cardiology (AHA/ACC) guidelines on lifestyle management to reduce cardiovascular risk,4 consuming a dietary pattern that emphasizes fresh fruits, vegetables, whole grains, legumes, lean meats such as poultry and omega-3 rich fish (salmon, halibut, tuna, mackerel), unsaturated fats such as olive and avocado oils, and nuts is beneficial in lowering LDL cholesterol.
The AHA/ACC guidelines further emphasize limiting intake of sweets and sugar-sweetened beverages such as sports drinks, sodas, and juices. Reducing intake of saturated and Trans fats to less than 5% of total daily calorie intake is recommended. Including moderate-intensity physical activity 3-4 times a week for at least 40 minutes is also recommended to reduce LDL and non-HDL cholesterol levels.
- Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circulation. 2002;106:3143.
- Rajman I, et al. LDL particle size: an important drug target? Br J Clin Pharmacol. 1999;48(2):125-133.
- http://www.heart.org/HEARTORG/Conditions/What-Your-Cholesterol-Levels-Mean_UCM_305562_Article.jsp#.WsldvIjwZPY Accessed April 5, 2018.
- Eckel RH, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;129(25 Suppl 2):S76-S99.