What You Need to Know About Low-Density Lipoprotein Learn How to Reduce High Cholesterol Levels

To understand why you have high cholesterol levels, it helps to know how your body uses the fat. Read on to learn what low-density lipoprotein is, how to interpret the results of your latest blood test and what you can do to lower your numbers. Cholesterol is a waxy, fat-like substance that’s found in all cells of the body. Your body needs some cholesterol to make hormones, vitamin D and substances that help you digest foods. Your body makes all the cholesterol it needs. However, cholesterol also is found in some of the foods you eat. Cholesterol travels through your bloodstream in small packages called lipoproteins (lip-o-PRO-teens). These packages are made of fat (lipid) on the inside and proteins on the outside. Two kinds of lipoproteins carry cholesterol throughout your body: low-density lipoprotein (LDL) and high-density lipoproteins (HDL). Having healthy levels of both types of lipoproteins is important. LDL cholesterol is sometimes called “bad” cholesterol. A high LDL level leads to a buildup of cholesterol in your arteries, which are blood vessels that carry blood from your heart to your body. HDL cholesterol is sometimes called “good” cholesterol. This is because it carries cholesterol from other parts of your body back to your liver. Your liver removes the cholesterol from your body. Many factors can affect cholesterol levels in your blood. You can control some factors, but not others. Factors You Can Control Diet Cholesterol is found in foods that come from animal sources, such as egg yolks, meat, and cheese. Some foods have fats that raise your cholesterol level. For example, saturated fat raises your low-density lipoprotein (LDL) cholesterol level more than anything else in your diet. Saturated fat is found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods. Trans fatty acids (trans fats) raise your low-density lipoprotein cholesterol and lower your high-density lipoprotein (HDL) cholesterol. Trans fats are made when hydrogen is added to vegetable oil to harden it and are fats found in some fried and processed foods. Limiting foods with cholesterol, saturated fat, and trans fats can help you control your cholesterol levels. Physical Activity and Weight Lack of physical activity can lead to weight gain. Being overweight tends to raise your low-density lipoprotein (LDL) level, lower your HDL level, and increase your total cholesterol level. (Total cholesterol is a measure of the total amount of cholesterol in your blood, including LDL and HDL). Routine physical activity can help you lose weight and lower your LDL cholesterol. Being physically active also can help you raise your HDL cholesterol level. Factors You Can’t Control Heredity High blood cholesterol can run in families. An inherited condition called familial hypercholesterolemia causes very high LDL cholesterol. (“Inherited” means the condition is passed from parents to children through genes.) This condition begins at birth, and it may cause a heart attack at an early age. Age and Sex Starting at puberty, men often have lower levels of HDL cholesterol than women. As women and men age, their LDL cholesterol levels often rise. Before age 55, women usually have lower LDL cholesterol levels than men. However, after age 55, women can have higher LDL levels than men. High blood cholesterol usually has no signs or symptoms. Thus, many people don't know that their cholesterol levels are too high. If you're 20 years old or older, have your cholesterol levels checked at least once every five years. Talk with your doctor about how often you should be tested. How High Cholesterol Is Diagnosed Your doctor will diagnose high blood cholesterol by checking the cholesterol levels in your blood. A blood test called a lipoprotein panel can measure your cholesterol levels. Before the test, you’ll need to fast (not eat or drink anything but water) for 9-12 hours. The lipoprotein panel will give your doctor information about your: Total cholesterol. Total cholesterol is a measure of the total amount of cholesterol in your blood, including low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol. Low-density lipoprotein (LDL) cholesterol is the main source of cholesterol buildup and blockages in the arteries. HDL cholesterol helps remove cholesterol from your arteries. Triglycerides (tri-GLIH-seh-rides). Triglycerides are a type of fat found in your blood. Some studies suggest that a high level of triglycerides in the blood may raise the risk of coronary heart disease, especially in women. If it’s not possible to have a lipoprotein panel, knowing your total cholesterol and HDL cholesterol can give you a general idea about your cholesterol levels. Testing for total and HDL cholesterol does not require fasting. If your total cholesterol is 200 mg/dL or more, or if your HDL cholesterol is less than 40 mg/dL, your doctor will likely recommend that you have a lipoprotein panel. (Cholesterol is measured as milligrams (mg) of cholesterol per deciliter (dL) of blood.) Here's how to interpret the results: A total cholesterol of less than 200 mg/dL is desirable; 200–239 mg/dL is borderline high; 240 mg/dL and higher is high. An optimum low-density lipoprotein (LDL) level is less than 100 mg/dL; 100-129 100–129 mg/dL is good. From 130–159 mg/dL is considered borderline high; 160-189 high and 190 and more is very high. For HDL levels: Less than Less than 40 mg/dL is a major risk factor for heart disease; 40–59 mg/dL is better; 60 mg/dL and higher is considered protective against heart disease. Triglycerides also can raise your risk for heart disease. If your triglyceride level is borderline high (150–199 mg/dL) or high (200 mg/dL or higher), you may need treatment. Factors that can raise your triglyceride level include: Being overweight or obese Lack of physical activity Cigarette smoking Excessive alcohol use A very high carbohydrate diet Certain diseases and medicines Some genetic disorders How High Blood Cholesterol is Treated High cholesterol levels are treated with lifestyle changes and medicines. The main goal of treatment is to lower your low-density lipoprotein (LDL) cholesterol level. The two main ways to lower your cholesterol include: Therapeutic Lifestyle Changes (TLC): TLC is a three-part program that includes a healthy diet, weight management, and physical activity. TLC is for anyone whose LDL cholesterol level is above goal. Medicines: If cholesterol-lowering medicines are needed, they’re used with the TLC program to help lower your low-density lipoprotein cholesterol level. Your doctor will set your LDL goal. The higher your risk for heart disease, the lower he or she will set your LDL goal. Lowering Cholesterol Using Therapeutic Lifestyle Changes TLC is a set of lifestyle changes that can help you lower your LDL cholesterol. The main parts of the TLC program are a healthy diet, weight management and physical activity. The TLC Diet With the TLC diet, less than 7% of your daily calories should come from saturated fat. This kind of fat is found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods. No more than 25%-35% of your daily calories should come from all fats, including saturated, trans, monounsaturated, and polyunsaturated fats. You also should have less than 200 mg a day of cholesterol. The amounts of cholesterol and the types of fat in prepared foods can be found on the foods' Nutrition Facts labels. Foods high in soluble fiber also are part of the TLC diet. They help prevent the digestive tract from absorbing cholesterol. These foods include: Whole-grain cereals such as oatmeal and oat bran Fruits such as apples, bananas, oranges, pears, and prunes Legumes such as kidney beans, lentils, chick peas, black-eyed peas, and lima beans A diet rich in fruits and vegetables can increase important cholesterol-lowering compounds in your diet. These compounds, called plant stanols or sterols, work like soluble fiber. A healthy diet also includes some types of fish, such as salmon, tuna (canned or fresh), and mackerel. These fish are a good source of omega-3 fatty acids. These acids may help protect the heart from blood clots and inflammation and reduce the risk of heart attack. Try to have about two fish meals every week. You also should try to limit the amount of sodium (salt) that you eat. This means choosing low-salt and "no added salt" foods and seasonings at the table or while cooking. The Nutrition Facts label on food packaging shows the amount of sodium in the item. Try to limit drinks with alcohol. Too much alcohol will raise your blood pressure and triglyceride level. (Triglycerides are a type of fat found in the blood.) Alcohol also adds extra calories, which will cause weight gain. Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is a glass of wine, beer, or a small amount of hard liquor. Weight Management If you’re overweight or obese, losing weight can help lower low-density lipoprotein (LDL) cholesterol. Maintaining a healthy weight is especially important if you have a condition called metabolic syndrome. Metabolic syndrome is a group of risk factors that raise your risk for heart disease and other health problems, such as diabetes and stroke. The five metabolic risk factors are a large waistline (abdominal obesity), a high triglyceride level, a low HDL cholesterol level, high blood pressure, and high blood sugar. Metabolic syndrome is diagnosed if you have at least three of these metabolic risk factors. Physical Activity Routine physical activity can lower LDL cholesterol and triglycerides and raise your HDL cholesterol level. People gain health benefits from as little as 60 minutes of moderate-intensity aerobic activity per week. The more active you are, the more you will benefit. For more information about physical activity, go to the U.S. Department of Health and Human Services' "2008 Physical Activity Guidelines for Americans," the Health Topics Physical Activity and Your Heart article, and the NHLBI's "Your Guide to Physical Activity and Your Heart." Cholesterol-Lowering Medicines In addition to lifestyle changes, your doctor may prescribe medicines to help lower your cholesterol. Even with medicines, you should continue the TLC program. Medicines can control high blood cholesterol, but they don’t cure it. Thus, you must continue taking your medicine to keep your cholesterol level in the recommended range. The five major types of cholesterol-lowering medicines are statins, bile acid sequestrants (seh-KWES-trants), nicotinic (nick-o-TIN-ick) acid, fibrates, and ezetimibe. Statins work well at lowering low-density lipoprotein (LDL) cholesterol. These medicines are safe for most people. Rare side effects include muscle and liver problems. Bile acid sequestrants also help lower LDL cholesterol. These medicines usually aren’t prescribed as the only medicine to lower cholesterol. Sometimes they’re prescribed with statins. Nicotinic acid lowers LDL cholesterol and triglycerides and raises HDL cholesterol. You should only use this type of medicine with a doctor’s supervision. Fibrates lower triglycerides, and they may raise HDL cholesterol. When used with statins, fibrates may increase the risk of muscle problems. Ezetimibe lowers LDL cholesterol. This medicine works by blocking the intestine from absorbing cholesterol. While you’re being treated for high blood cholesterol, you’ll need ongoing care. Your doctor will want to make sure your cholesterol levels are controlled. He or she also will want to check for other health problems. If needed, your doctor may prescribe medicines for other health problems. Take all medicines exactly as your doctor prescribes. The combination of medicines may lower your risk for heart disease and heart attack. While trying to manage your cholesterol, take steps to manage other heart disease risk factors too. For example, if you have high blood pressure, work with your doctor to lower it. If you smoke, quit. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke. If you’re overweight or obese, try to lose weight. Your doctor can help you create a reasonable weight-loss plan. How Well Do You Understand Cholesterol? Cholesterol is much maligned, yet many people don’t understand this essential substance and how it works in our bodies. Do you know your HDL from your LDL? How about which lifestyle choices influence cholesterol levels?