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Cholesterol: The good, the bad and the ugly

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How to keep yours in check for long-term health

LDL, HDL, triglycerides. The world of cholesterol is full of acronyms and moving pieces that mean and do different things for your health — for better or worse. If you visit your doctor regularly, chances are you have your cholesterol checked annually. But do you know what the numbers really mean?

Having a working understanding of what cholesterol is and does can help you avoid serious complications, including coronary heart disease (the leading cause of death in the United States), heart attack and stroke.

What is cholesterol?

“Because too much cholesterol can cause major problems, a lot of the attention cholesterol gets is negative. People often forget that cholesterol is something we need for our bodies to function properly,” said Cynthia Jamison, MD, of Novant Health Lakeside Primary Care.

Cholesterol plays important roles in the body. It’s a necessary component of all animal cell membranes; it’s used to create vital hormones; it helps make vitamin D; and it’s used to make and use bile acids in the body to digest fatty foods and absorb vitamins A, D, E and K. Cholesterol comes from your body and the food you eat. The normal, healthy human body produces all the cholesterol it needs, usually in the liver, and circulates it through the blood. High levels of saturated and trans fats in your diet can cause your liver to produce excess cholesterol. Eating animal products, such as meat, eggs and full-fat dairy products, also add extra cholesterol.

“Cholesterol is a natural part of being human. It isn’t a concern until it gets out of hand. When you have more cholesterol in your system than your body can process and use properly, it begins to take a toll on your health and puts you at risk for heart attack and stroke,” Dr. Jamison said.

Good vs. bad cholesterol

There are two types of cholesterol: low-density lipoprotein (LDL) and high-density lipoprotein (HDL). A third type of fat, triglyceride, combines with LDL and HDL to make up your total cholesterol count.

“While both LDL and HDL occur naturally in your body and in the food you eat, they are not necessarily equal,” Dr. Jamison said. “LDL is what we call ‘bad’ cholesterol. It contributes to plaque buildup in your arteries. HDL is the ‘good’ cholesterol; it helps remove LDL from your arteries, delivering it back to the liver to be broken down.”

Artery plaque buildup causes a condition called atherosclerosis, which is when arteries are less flexible than normal. Atherosclerosis puts you at greater risk of blood clots blocking circulation. Depending on where a clot occurs, it can result in heart attack or stroke.

According to the American Heart Association, people with high triglycerides often have a high total cholesterol level, including a high LDL cholesterol (bad) level and a low HDL cholesterol (good) level. LDL cholesterol can also have a genetic mutation, called Lp(a) cholesterol. Lp(a) is a significant risk factor for premature development of fatty deposits in arteries.

Risk factors and screening

The AHA recommends all adults age 20 or older have their cholesterol, and other traditional risk factors, checked every four to six years. Those with a family history of high cholesterol or triglycerides may need to be checked more often and should discuss prevention methods with their doctor.

“I can’t express enough how important getting screened is,” Dr. Jamison said. “It’s a quick, simple blood test. Since high cholesterol doesn’t have noticeable symptoms, having your levels checked is the only way to know if you’re in danger or not.”

Cholesterol screenings can be done with or without fasting, but a non-fasting test can only measure your total cholesterol and HDL because LDL and triglycerides are affected by what you eat. Your doctor will help decide which test is right for you.

A complete fasting lipoprotein profile includes HDL and LDL cholesterols and triglycerides. Your total cholesterol level is a calculation of HDL + LDL + 20 percent of your total triglyceride level. A total score of less than 180 mg/dL is considered good.

Prevention and management

The good news is that you can lower your cholesterol if it is too high,” said Dr. Jamison. She added that adopting a heart-healthy diet, committing to regular exercise, and quitting smoking were all great first steps to lower high cholesterol.
Knowing which fats to avoid is key to reaching heart-healthy diet goals. The AHA recommends limiting saturated fat intake to no more than 5 to 6 percent of your daily total calories, or 11 to 13 saturated fat grams in a 2,000-calorie diet. Trans fats should also be avoided and limited to 1 percent of your daily calories.

Saturated fats come from animal products, like meats and full-fat dairy products, and from plant products like coconut oils and cocoa butter. Trans fats, also called “partially hydrogenated oils”, are created during processing by adding hydrogen to liquid vegetable oils to make them more solid. Trans fats most commonly appear in fried foods and baked goods.

“Everyone should be conscious of what they’re putting in their bodies, especially when it comes to fats that can affect cholesterol. Whether you’re naturally slender or overweight, you simply can’t consume high levels of these fats without raising your cholesterol,” Dr. Jamison said. “That’s why it’s so important for everyone to be aware of their numbers and know what to watch for in their diets.”