Low-density lipoprotein (LDL) cholesterol, or “bad” cholesterol, collects in the walls of the blood vessels, causing them to narrow. High-density lipoprotein (HDL), or “good” cholesterol, moves LDL cholesterol out of the bloodstream.
The two main types of cholesterol are high-density lipoprotein (HDL), or “good” cholesterol, and low-density lipoprotein (LDL), or “bad” cholesterol. Some cholesterol is necessary, but high levels can be dangerous.
Along with smoking and high blood pressure, raised blood cholesterol is one of the main risk factors for heart disease. People can reduce their blood cholesterol with a healthful diet, exercise, and medication.
LDL cholesterol is usually called bad cholesterol. If there is too much LDL cholesterol in the blood, it builds up in the walls of the blood vessels, causing them to narrow and stiffen.
A buildup of LDL cholesterol reduces blood flow and can increase the risk of heart attack or stroke.
HDL, or good cholesterol, can move LDL cholesterol from the blood to the liver, where it is broken down as waste. HDL cholesterol is good cholesterol because it reduces the cholesterol level in the blood.
Higher HDL levels
The United States measures cholesterol in milligrams per deciliter (mg/dL). The
- total cholesterol below 200 mg/dL
- LDL cholesterol less than 100 mg/dL
- HDL cholesterol above 40 mg/dL for men and above 50 mg/dL for women
Different regions and countries may have varying guidelines, so speaking to a doctor about the most accurate and up-to-date ranges is wise.
However, if a patient has had an event before or is considered high risk, then these levels may not apply to them.
The total cholesterol to HDL cholesterol ratio is a way to calculate cardiovascular risk. A high total cholesterol to HDL ratio indicates a higher risk for heart disease. A person can measure it by dividing the total cholesterol by the HDL level.
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Total cholesterol fluctuates, so more than one blood test might be necessary for an accurate assessment. Levels can change following a meal, so a blood test is sometimes taken first thing in the morning before breakfast.
Studies suggest that the total cholesterol to HDL ratio is a better marker of the risk of heart disease than LDL cholesterol levels alone.
Non-HDL cholesterol
Another method of assessing cholesterol levels is calculating a non-HDL cholesterol level. A person can measure this by subtracting HDL cholesterol from the total cholesterol.
Similarly to LDL cholesterol, VLDL cholesterol can also build up inside the walls of blood vessels, which is undesirable.
Ideally, non-HDL cholesterol should be less than 130 mg/dL. A higher value increases the risk of heart disease.
Causes of high LDL cholesterol include:
- Eating a diet high in saturated fat: Diets high in saturated fats can increase LDL cholesterol levels.
- Inactivity: Not getting enough exercise can lead to weight gain, which links to an increase in cholesterol levels.
- Obesity: People who are overweight have an increased risk of high cholesterol levels.
- Medical conditions: Some of these
that can affect LDL cholesterol levelsTrusted Source include type 2 diabetes, underactive thyroid, liver conditions, and alcohol addiction. - Menopause: For some women, cholesterol levels can rise after menopause.
- Genetics: Familial hypercholesterolemia (FH) is an inherited form of high cholesterol that
puts peopleTrusted Source at risk of early heart disease.
Oftentimes, despite as many lifestyle modifications as possible, a person may still have high cholesterol. It can be that the only way to get down to the proper range is with medication. This should not be seen as a failure but a necessity to get a patient into typical levels to mitigate risk.
The following lifestyle changes
- maintaining a healthy weight
- exercising regularly
- quitting smoking
- using statin therapy when prescribed
People trying to lower their LDL cholesterol should also avoid eating saturated and trans fats. Foods high in saturated fat include:
- beef
- lamb
- pork
- poultry, especially with skin
- beef fat (tallow)
- lard and cream
- butter
- cheese
- ice cream
- coconut
- palm oil
- some baked and fried foods
Other diet tips to prevent LDL levels from creeping up include:
- Switch fat sources: Swap saturated fats for nut and seed oils or monounsaturated fats from olive, avocado, and canola oil.
- Increase fiber intake: A diet high in fiber can be suitable for total blood cholesterol levels. Soluble fiber found in fruits, vegetables, and oats is particularly beneficial.
A variety of things can improve HDL cholesterol levels, including:
- Omega-3 fatty acids: Omega-3 fatty acids can lower blood cholesterol when consumed as part of a balanced diet. The highest levels of omega-3 fatty acids are in oily fish, such as mackerel, trout, herring, sardines, fresh tuna, salmon, and halibut.
The American Heart Association recommendsTrusted Source eating two servings of particularly fatty fish weekly. - Regular exercise: Research shows that exercise and physical activity can raise HDL levels.
What happens if your HDL is low?
Low HDL can increase a person’s risk of cardiovascular conditions, such as heart disease and stroke. HDL absorbs cholesterol in the blood and transports it to the liver, which clears it from the body.
A person with low HDL can increase their levels by avoiding smoking, maintaining a moderate body weight, eating a nutritious diet, and getting regular physical activity.
Is an HDL of 35 too low?
Doctors consider an HDL level of 35 very low. Optimal HDL levels are at least
Is it better to lower LDL or raise HDL?
It is important to focus on cholesterol management as a whole, including eating a nutritious diet, avoiding saturated fats, and exercising. This can help lower LDL and raise HDL.
High LDL cholesterol is a risk factor for heart disease but can often occur without symptoms.
People over 40 should arrange a blood test to check their cholesterol levels and total cholesterol to HDL ratio.
Dietary and lifestyle changes can significantly affect HDL and LDL levels. If these levels do not improve with these changes, a doctor may recommend medications.
