What is cholesterol and and where does cholesterol comes from?

Cholesterol is a waxy substance which is made in the body by the liver but is also found in some foods. It plays a vital role in how every cell works and is also needed to make Vitamin D, some hormones and bile for digestion. However, too much cholesterol in the blood can increase your risk of getting heart and circulatory diseases.  Cholesterol isn’t just something that sits in your body like fat around your waist. It’s carried through your bloodstream by carriers made of fat (lipid) and proteins.

Two types of lipoproteins carry cholesterol to and from cells and the amount of each type of cholesterol in your blood can be measured by a blood test.  Lipoproteins are basically a core full of fat and cholesterol, along with a lipid membrane that contains proteins called apolipoproteins.  These are commonly referred to as the “bad” and “good” cholesterol, but this is actually inaccurate. All cholesterol is the same, it’s the lipoproteins that are different.

Heart disease really is NOT a cholesterol disease, it is a lipoprotein disease.

  • Low-Density Lipoprotein, or LDL
  • High-Density Lipoprotein, or HDL

Low Density Lipoprotein (LDL) Cholesterol

LDL is the ‘bad’ cholesterol. ‘L’ is for lousy and we want these levels to be low, as LDL is the main cause of fatty build up in the arteries

Blood levels of LDL cholesterol (LDL-C) are often assessed when evaluating the risk of future heart disease.

Cholesterol is a fatty substance. Fats are insoluble in water and can therefore not be transported in blood on its own.

The body’s solution to this problem is to bind cholesterol to certain proteins that function as transport vehicles carrying different types of fats such as cholesterol, triglycerides (TG) and phospholipids. These combinations of fats and protein are termed lipoproteins. Low-density lipoprotein (LDL) is one of the body’s lipoproteins and an important carrier of cholesterol.

The amount of cholesterol carried by different lipoproteins can provide valuable information about the risk of developing cardiovascular disease (CVD). LDL-C reflects the amount of cholesterol carried by LDL.

Low-density lipoprotein cholesterol (LDL-C) is an important marker for the risk of developing heart disease.

Many studies have shown a strong and graded correlation between Low-density lipoprotein cholesterol (LDL-C) and the risk of cardiovascular disease (CVD), both in women and men. However, this association appears to become less prominent with increasing age, and some studies have suggested that low LDL-C may be associated with increased mortality in older adults.

Available evidence suggests that lowering blood levels of LDL-C reduces the risk of CVD.  If you do not have heart or blood vessel disease and are not at high risk for developing heart disease, the following guidelines apply.

Your LDL cholesterol number is:

  • Optimal if it is less than 100
  • Near optimal/above optimal if it is 100-129
  • Borderline high if it is 130-159
  • High if it is 160-189
  • Very high if it is 190 or above

The treatment goal for individuals with heart disease or blood vessel disease is to reach an LDL of less than 70. The treatment goal for high-risk individuals (those with diabetes or other multiple risk factors for heart disease) is to reach an LDL of at least less than 100.

High Density Lipoprotein (HDL) Cholesterol

HDL is the ‘good’ cholesterol. ‘H’ is for healthy and we want these levels to be high, as HDL has a protective effect on our heart, because it sweeps excess cholesterol out of the bloodstream.  HDL cholesterol actually acts to reduce the buildup of LDL cholesterol within the arteries, carrying it back through the blood to the liver.  Experts believe HDL acts as a scavenger, carrying LDL cholesterol away from the arteries and back to the liver. There it’s broken down and passed from the body.

A healthy HDL cholesterol level may protect against heart attack and stroke. Studies show low levels of HDL cholesterol increase the risk of heart disease. HDL cholesterol does not completely eliminate LDL cholesterol. Only one-fourth to one-third of blood cholesterol is carried by HDL.

Sometimes, your doctor may prescribe drugs, known as a statin, to help give you HDL levels a significant boost. Otherwise, increased physical activity can have a positive impact on your HDL levels, which will give your body what it needs to fight bad cholesterol rises.

Your HDL cholesterol number is:

  • Low (and considered a risk factor) if it is less than 40
  • Good (and able to help lower your risk of heart disease) if it is 60 or more

How do people develop high cholesterol?

While there are a number of factors, genetics seems to be the largest single contributing factor in determining which people develop high cholesterol.  Studies have shown a high correlation between family history and high levels of cholesterol in humans.

Diets high in saturated and trans fats, high rates of alcohol consumption, under active thyroid issues and kidney issues can also be significant contributing factors to cholesterol levels. Interestingly, refined carbs and sugar appear to be the primary culprits here.

Lowering Your Cholesterol

The first thing doctors usually recommend to lower LDL cholesterol is dietary changes.  Reducing the consumption of foods high in trans and saturated fats can have a marked impact on cholesterol levels in the blood.

Replacing problem foods such as fatty red meat with leaner meats like poultry and fish, and replacing full fat dairy products with skim can have serious health benefits to people with high LDL cholesterol levels.

Also, high fiber foods such as leafy greens and other vegetables have been shown to reduce LDL levels.

Lastly, unsaturated fats coming from sources like seeds, nuts, and natural oils can also have a positive impact on your cholesterol levels.

Beyond changing your diet, using commonly prescribed medications or more revolutionary treatments like PCSK9 Inhibitors can drastically reduce your LDL levels.

How often should cholesterol levels be checked?

It is generally recommended that everyone over 45 years, has their cholesterol measured. The frequency of testing will depend on your results.

If you’re under 45, have your cholesterol checked if you have one other risk factor for heart disease. These include a family history, if you’re a smoker, if you’re overweight or if you have high blood pressure.

Everyone should ‘know their numbers’ and take control of their own health. A lot of people are scared of what they might discover, but prevention is better than cure.

The test that is performed is a blood test called a lipoprotein profile. That includes:

  • Total cholesterol level
  • HDL
  • Triglycerides

LDL level is calculated from the above 3 values.