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There are two main types of cholesterol: high-density lipoprotein (HDL) and low-density lipoprotein (LDL). (Lipoproteins are made of fat and protein, and serve as vehicles for your cholesterol to travel through the blood.) Cardiologists are often asked about low-density lipoprotein (LDL) versus high-density lipoprotein (HDL). The difference is important to understand.
HDL clears from the body via the liver. HDL may therefore prevent the buildup of plaque, protect your arteries, and protect you from atherosclerotic cardiovascular disease. It is considered the “good” cholesterol, and higher levels are better. A good goal to aim for is higher than 55 mg/dL for women and 45 mg/dL for men. The higher your HDL cholesterol numbers, the lower your risk is for heart disease, vascular disease, and stroke.
Although HDL levels are driven by family genetics, you can improve HDL levels in three key ways:
Lastly, although primarily used to decrease high LDL, some statin medications may potentially increase HDL levels moderately. Any medical treatment option should be discussed with your doctor. Importantly, high HDL does not protect you from the untoward effects of high LDL.
LDL is considered the “bad” cholesterol. It carries cholesterol to your arteries, where it may collect in the vessel walls and contribute to plaque formation, known as atherosclerosis. This can lead to decreased blood flow to the heart muscle (coronary artery disease), leg muscles peripheral artery disease or abrupt closure of an artery in the heart or brain, leading to a heart attack or stroke. Over a third of the US population has high LDL cholesterol. Diagnosis is made via blood testing, so if you don’t check, you won’t know.
For LDL, the lower the number the better. A good goal to keep in mind is less than 130 mg/dL if you don’t have atherosclerotic disease or diabetes. It should be no more than 100 mg/dL, or even 70mg/dL, if you have any of those conditions or high total cholesterol. It’s very important to set your own target cholesterol levels with your doctor. Obesity, a large waist circumference, a sedentary lifestyle, or a diet rich in red meat, full-fat dairy, saturated fat, trans fats, and processed foods can lead to high LDL cholesterol.
Lifestyle and diet changes are the main ways to prevent or lower high LDL. A trial of eating a low-fat diet, regular aerobic activity, maintaining a healthy weight, and smaller waist circumference is an appropriate first step. It is best to set a timeline to achieve your goals with your doctor. In some cases, if those lifestyle changes are not enough, your physician may suggest a cholesterol lowering medication, such as a statin. If you are considering over-the-counter herbal or ayurvedic medications for cholesterol, please discuss those with your physician first as well.
Rarely, very high LDL is genetic and passed down in families. This is called familial hypercholesterolemia and is caused by a genetic mutation that decreases the liver’s ability to clear excess cholesterol. This condition can lead to very high LDL levels, and heart attack or stroke at a young age in multiple generations. Those individuals may require special medical treatment for prevention and treatment of atherosclerotic cardiovascular disease.
Remember, knowledge is the first step. If you don’t know your cholesterol levels, get tested. That will give you and your physician a starting point for lifestyle changes and medications if needed. In the meantime, adopt a heart-healthy lifestyle and do it with friends and family no matter their ages. There’s no time like the present to prevent heart disease.
Despite major advances in drugs and medical treatments, maintaining a healthy diet, being physically active, and not smoking are still the best approaches to preventing heart disease. Improving your diet lowers your risk for heart disease in many ways, including helping to lower high cholesterol, blood pressure, and blood sugar and insulin levels, as well as preventing obesity and improving the function of your heart and blood vessels.
Consider the types of foods that you eat and your overall dietary pattern, rather than focusing on individual nutrients such as fat, dietary cholesterol, or specific vitamins. There are no single nutrients or vitamins that can make you healthy. Rather, there is a short list of key foods that together can dramatically reduce your risk for heart disease.
FAQ about Cholesterol
What is cholesterol?
Cholesterol is a fat-like, waxy substance that can be found in all parts of your body. It helps your body make cell membranes, many hormones, and vitamin D. The cholesterol in your blood comes from two sources: the foods you eat and your liver. Your liver makes all the cholesterol your body needs.
What causes cholesterol?
Poor diet. Eating saturated fat, found in animal products, and trans fats, found in some commercially baked cookies and crackers, can raise your cholesterol level. Foods that are high in cholesterol, such as red meat and full-fat dairy products, will also increase your total cholesterol
What foods are high in cholesterol?
This is why it is best to limit the amount of foods we eat that are high in saturated fats such as:
Some food that block body from absorbing cholesterol:
Are eggs good or bad for cholesterol?
Chicken eggs are high in cholesterol, but the effect of egg consumption on blood cholesterol is minimal when compared with the effect of transfat and saturated fats. Most healthy people can eat up to two eggs a day with no increase in their risk of heart disease.
Contributor: Ami B. Bhatt, MD, FACC is the Director of the Adult Congenital Heart Disease Program at the Massachusetts General Hospital and an active clinical cardiologist, investigator, and educator
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