Understanding LDL Cholesterol: The "Bad" Cholesterol Explained

Cholesterol, a waxy substance produced by the liver, is transported in the bloodstream by two types of lipoproteins: low-density lipoprotein (LDL), often labeled as "bad" cholesterol, and high-density lipoprotein (HDL), recognized as "good" cholesterol. Elevated levels of LDL can lead to plaque accumulation in arteries, narrowing them and subsequently impairing blood flow to vital organs like the heart.

While our liver generates all the cholesterol our body requires—essential for functions such as hormone production and fat digestion—dietary cholesterol predominantly comes from animal foods, including meat, dairy, and eggs.

Cholesterol travels in the bloodstream attached to proteins known as lipoproteins. LDL is often called “bad” cholesterol because excess amounts can lead to health complications, whereas HDL helps collect cholesterol and transports it back to the liver for elimination. This piece examines everything you need to know about LDL cholesterol and its implications for your health, backed by the latest research.

While cholesterol is necessary for maintaining good health, excessive LDL can lead to adverse effects. An overload of LDL cholesterol can cause a build-up of plaque in the arterial walls, gradually narrowing the blood vessels. Narrower vessels can impede blood flow, potentially resulting in serious conditions such as angina and heart attacks. In contrast, HDL cholesterol plays a crucial role in transporting cholesterol back to the liver for disposal.

What is a Healthy LDL Level?

Most adults are advised to maintain their LDL cholesterol levels within a specific range. It’s essential to consult a healthcare provider to determine what is ideal for you.

High levels of LDL cholesterol can often go unnoticed, as there may be no symptoms. Regular blood testing is crucial to identify high cholesterol levels early on. In cases of significantly elevated LDL, physical signs such as xanthomas (small skin bumps) or corneal arcus (gray-white rings around the corneas) may appear.

Potential Complications of High LDL

If left untreated, high LDL can lead to several serious health issues, including:

• Atherosclerosis (widespread plaque accumulation)
• Carotid artery disease
• Coronary artery disease
• Peripheral artery disease
• Stroke
• Sudden cardiac arrest

The most reliable method to check your LDL levels is through a lipid panel blood test, often ordered by your doctor. They will also review your family history, as genetic factors can influence cholesterol levels. A diagnosis of "high cholesterol" occurs when your non-HDL cholesterol level exceeds the personalized goal set by your healthcare provider.

According to the Centers for Disease Control and Prevention (CDC), over 12% of adults aged 20 and older had total cholesterol levels above 240 mg/dL between 2015 and 2016. Additionally, around 7% of children ages 6 to 19 also presented with high cholesterol levels. Emerging studies suggest that moderate high cholesterol levels exacerbated by factors like hypertension can pose risks similar to those associated with chronically high cholesterol.

It is recommended that everyone begin cholesterol screenings at age 20, repeating every 4 to 6 years if low-risk. After age 40, more frequent check-ups may be necessary. Men should consider annual tests between ages 45-65, while women should do so between ages 55-65.

Age is a significant factor in the risk for high cholesterol, as the body's efficacy in filtering cholesterol declines over time. A family history of high cholesterol can also elevate your risk. While these factors are uncontrollable, certain lifestyle choices can be modified to decrease your risk:

• Obesity and type 2 diabetes increase the likelihood of elevated LDL.
• Smoking harms blood vessels and may decrease HDL levels.
• A diet high in saturated and trans fats can increase LDL levels.
• Inadequate physical activity (aim for 2.5 hours of moderate exercise weekly).
• Excessive alcohol consumption can raise triglycerides.

Research suggests that not all LDL is created equal. It includes subclasses (A, B, and I), with subclass B found to be particularly detrimental and a better predictor of heart disease risk than total LDL levels. Discuss your LDL numbers and potential complications with your healthcare provider for a deeper understanding.

If diagnosed with high LDL levels, there are effective strategies to reduce them. Your doctor may propose medication options, such as:

• Statins: Commonly prescribed, statins lower the risk of heart attacks and strokes.
• Ezetimibe: These are options when statins aren’t effective.
• Bile Acid Sequestrants: Used if statins are unsuitable or need to be supplemented.
• PCSK9 Inhibitors: Injected biweekly for those at high risk.
• Lomitapide and Mipomersen: Given for familial cholesterol conditions.

Discuss potential side effects and the reasons for specific prescriptions with your physician.

Implementing Lifestyle Changes

Regular cholesterol checks are vital, especially for those with a familial predisposition to high cholesterol levels. If you're under 40, you might only need testing every few years; however, your physician will help determine the frequency based on your unique situation.

If your results show high LDL levels, rest assured that you're not alone, as over 93 million Americans face similar challenges. There are numerous ways to address elevated LDL—from medication to lifestyle changes—allowing you to take proactive measures toward achieving better overall health.