LDL cholesterol

Low-density lipoproteins (LDL) are the "bad" cholesterol; the cholesterol that can clog up arteries. They carry most of the cholesterol in the blood. Think of LDL as "lousy," so the level should be "low." LDL cholesterol builds up on the walls of arteries, forming plaque. The plaque narrows the inside of the artery, resulting in less blood flow through the artery, sometimes occluding flow completely. Plaque can also rupture, allowing a blood clot to form. This clot can partially or completely occlude the artery. When an artery in the heart is occluded, a heart attack results; when an artery in the brain is occluded, a stroke results. LDL cholesterol levels are a better predictor of heart disease risk than total cholesterol. High LDL is often associated with high total cholesterol levels.

For those with zero to one risk factor, LDL should be below 160mg/dl, and lower is better. For those with two or more risk factors, LDL should be below 130mg/dl; less than 100 is optimal. For persons with known heart disease, LDL should be less than 100mg/dl. For those with known heart disease and very high risks for heart attack or stroke, it may be recommended to keep LDL below 70mg/dl.

LDL cholesterol level LDL category
Less than 70 mg/dl Optimal, especially if very high risk
Less than 100mg/dl Optimal
100 – 129 mg/dl Above optimal
130 – 159 mg/dl Borderline high
160 – 189 mg/dl High
190 mg/dl and higher Very high

A number of things can contribute to elevated LDL levels:

  • A diet high in saturated fat, cholesterol, and trans-fats (hydrogenated or partially hydrogenated oils) will increase LDL. Diet changes to reduce LDL include substituting polyunsaturated and monounsaturated fats for the saturated fats, cholesterol, and trans-fats.
  • Diabetes, hypothyroidism, renal disease, and liver disease can contribute to elevated LDL levels. Appropriate management of these problems can help minimize their affect on LDL.
  • Obesity also can contribute to high LDL levels. Losing weight will help lower LDL levels.
  • Reduced estrogen levels contribute to higher LDL. Hormone replacement therapy (HRT) is rarely used to help lower LDL because of other medical risks associated with HRT.
  • LDL, total cholesterol and triglycerides increase and HDL decreases during the perimenopausal period, especially in women who gain weight. Therefore, it is important to maintain a healthy diet and exercise regularly during this time.