Cholesterol Levels: Understanding HDL, LDL and Triglyceride Numbers

Cholesterol levels are one of the first things your doctor will ask for if you are suspected to be suffering from heart disease or stroke – two leading and high profile killers worldwide. You should not, therefore, underestimate the importance of these levels.

Having said that and its importance established, it is essential that you check for your cholesterol values at regular periods. High blood levels carry a potential threat.

Keeping your values within the normal range should be your goal because it is good for you and highly recommended; the reason being that high or elevated levels invite killer complications.

Here, it is important to note that all types of cholesterol are not bad. There is one type, HDL or the good cholesterol, whose higher number denotes a healthy figure.

The higher numbers of the other two types, LDL, and triglycerides, denote an undesirable profile and they significantly increase the risk of coronary heart disease (CHD).

How often should you test for cholesterol levels?

How often should you test for cholesterol levels and the values of each type depend on your current values.

High levels usually do not cause any symptoms. They are detected when you undergo a routine checkup or if any complications set in such as a heart attack.

According to the second report of the NCEP Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults:

After the age of 20 years, you should test every five years because that is the age when cholesterol can start to rise. After the age of 35 years, you should check your cholesterol levels every year because as you age, levels tend to rise.

This will help in detecting abnormal levels and you can take prompt measures to correct any abnormal levels.

There is now strong evidence that coronary atherosclerosis begins in late adolescence and young adulthood.

You may be able to bring down your levels even without medications by simply following the recommendations:

  • If you are a smoker, quit the habit
  • Men should limit alcohol intake to two pegs (60 ml each) and women not to exceed one peg
  • Follow a healthy lifestyle with compulsory physical activity (exercise) at least five times a week
  • Stick to an ideal diet of low saturated fats

If your values are elevated and the doctor has advised you measures with or without medication, he will ask you to check your blood again after three months to see how well the treatment is working and whether any change in the medication or dose is needed.

Cholesterol Test

The blood tests for cholesterol comprises of a lipoprotein profile wherein your blood is checked for:

1. Total cholesterol levels

2. Low-Density Lipoprotein or LDL cholesterol levels

3. High-Density Lipoprotein or HDL cholesterol levels

4. Triglycerides levels

This test is also referred to as lipid profile or lipid panel and is carried out with the patient fasting for 9 to 12 hours. All foods, smoking, and alcohol are not recommended during this fasting period. Drinking water, however, is permitted.

Doing the test in the morning, therefore, is most convenient after an overnight fasting. Blood is drawn from a vein in the arm and sent to the laboratory for testing.

If you have done your test in the morning, the report typically will be available on the evening of the same day.

Results of the test may be wrong in rare cases. If your report indicates elevated levels, it is advisable to repeat the test after a couple of days at another laboratory. This is because cholesterol medication is a lifelong commitment.

Why fast before testing for cholesterol?

Fasting is advised to get accurate tests, especially for LDL and triglycerides levels. The reason for this is that if you eat, the digested food will raise your lipid levels and interfere with the accuracy of the results.

The results of LDL and triglycerides especially will not show the true values. If you do not fast, your doctor will consider using only the total cholesterol and HDL levels.

Again, some or rather most doctors will ask you to stay off alcohol, including wine for at least 48 hours before going for the test. The reason being that alcohol will boost the levels of HDL, the good cholesterol and give a false picture.

You should avoid foods and drinks that contain an excessive amount of sugar, fats, and cholesterol for a week before the test. Eat what you normally eat the previous night and go for the test in the morning.

Nowadays, however, some experts have put forward a very strong viewpoint that does allow you to do the test without the fasting. They feel that fasting is not necessary because the test results do not show much of a difference. However, whatever the difference, it does exist and most experts advise staying fasting. Accurate results will ensure a proper treatment and dose.

Here is a breakdown of cholesterol levels from normal to borderline to high as per the guidelines laid down by the National Cholesterol Education Program (NCEP).

Cholesterol is measured as milligrams per deciliter or mg/dl, which is the standard international form of measuring cholesterol.

1) Total cholesterol blood levels: Desirable, borderline and high

Total cholesterol is the total amount of all cholesterols in the blood and includes the sum of low-density lipoprotein (LDL or the “bad cholesterol”), high-density lipoprotein (HDL or “good cholesterol”) and 20% of your triglycerides.

Total cholesterol values:

Desirable levels  —   less than 200 mg/dl
Borderline high  —  200 to 239 mg/dl
High                      —  above 240 mg/dl

2) LDL cholesterol blood levels: Normal. borderline and elevated

Low-density lipoprotein is transported in the blood from the liver, where it is manufactured, to the various parts of the body to be taken up by the body cells.

Higher levels of LDL mean more amount of this waxy sticky substance floating in the blood stream.

Being waxy and sticky in nature, the extra cholesterol, which the body has not used sticks on the inner surface of the arterial walls in the form of plaques.

This reduces the lumen of the arteries and over time as the plaque increases in size, the plaque can block the artery. This is called atherosclerosis.

Blockage of the coronary arteries of the heart causes coronary artery disease, which includes angina and heart attack.

Heart arteries are particularly vulnerable because they are narrow and can get blocked early leading to loss of supply to the part of the heart muscle the artery supplies blood. This is the basic cause of a heart attack.

LDL values

Optimal               –   Less than 100 mg/dl
Near optimal      —  100 to 129 mg/dl
Borderline high  –  130 to 159 mg/dl
High                      —  150 to 189 mg/dl
Very High            —   above 190 mg/dl

The average LDL (the dangerous cholesterol) levels of Americans is 130 mg/dL when it should be below 100. This shows the wrong dietary habits of the Americans.

3) HDL cholesterol blood levels: Healthy, borderline and 

HDL is the good cholesterol, which carries the excess bad cholesterol (LDL) from the blood to the liver from where it is passed out through the bile into the small intestine for excretion.

HDL may also help decrease the LDL buildup on the walls of arteries that narrow the arterial lumen.

The higher the levels of HDL, the better it is for your health because it removes the excess LDL from the blood and that helps to keep LDL levels within normal limits.

To be specific, the lower your HDL level, the higher is your risk of heart disease. In women, a level less than 50 mg/dL contributes in a potential way of increasing heart disease risk. An HDL level of 60 mg/dL or higher offers significant protection.

HDL values

Optimal               – more than 60 mg/dl – lower risk of heart disease.
Low in men        — less than 40 mg/dl –  higher risk factor for heart disease
Low in women   – less than 50 mg/dl –  higher risk factor for heart

4) Triglycerides levels: Optimal, borderline and high

Triglycerides are the chemical form of cholesterol in which fats exist in the food and your body. With higher levels of blood triglycerides levels, you are at a greater risk of having coronary artery disease because they too, narrow the lumen of the arteries.

Triglyceride values

Normal level        — Less than 150 mg/dl
Borderline High — 150 to 199 mg/dl
High                      — 200 to 499 mg/dl

What should you do if your cholesterol values are high?

High cholesterol (LDL and triglycerides) levels not only increase your risk of heart disease but also significantly increase your risk of stroke and peripheral vascular disease. Prompt action is necessary.

Your doctor will advise you what to do. For instance, he will first try to gauge if he can bring down your levels without taking any medication.  He will recommend:

  • Good lifestyle habits
  • Diet containing least amount of saturated fats and more of omega fatty acids
  • Regular exercise
  • Maintain optimum weight
  • No smoking

If these measures do not work, he will prescribe medicines to lower your LDL and triglycerides levels. He will also advise you to check your cholesterol levels periodically till they come to normal. He will do this to gauge the effect of the medicines on the lipid levels.

 

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