LDL, the Bad Cholesterol: Levels, Risks and How to Lower It

Cholesterol, LDL and HDL

Cholesterol is a waxy, fat-like substance found in every cell in your body. Your liver makes it, and it is also in some foods, such as meat and dairy products. Your body needs some to work properly — but too much in your blood raises your risk of coronary artery disease.

LDL and HDL are two kinds of lipoproteins: a combination of fat (lipid) and protein. Lipids must be attached to proteins to move through the blood.

How high LDL leads to heart disease

A high LDL level means too much LDL cholesterol in your blood. The extra LDL, with other substances, forms plaque, which builds up in your arteries — a condition called atherosclerosis. When the buildup is in the arteries of your heart, it is coronary artery disease: the arteries harden and narrow, slowing or blocking blood flow to your heart. Since blood carries oxygen to the heart, it may not get enough — causing angina (chest pain) or, if the flow is completely blocked, a heart attack.

When to get tested

A blood test measures your cholesterol levels, including LDL. When and how often depends on your age, risk factors and family history. The general recommendations:

You may need checks more often if you have heart disease, diabetes or a family history of high cholesterol.

What affects your LDL

• Diet: saturated fat and cholesterol in your food raise LDL.
• Weight: being overweight tends to raise LDL, lower HDL and raise total cholesterol.
• Physical activity: too little can lead to weight gain, which can raise LDL.
• Smoking: cigarettes lower HDL. Since HDL helps remove LDL from your arteries, less HDL can mean higher LDL.
• Age and sex: cholesterol rises as people get older. Before menopause, women have lower total cholesterol than men of the same age; after it, women's LDL tends to rise.
• Genetics: your genes partly decide how much cholesterol your body makes, and high cholesterol can run in families — familial hypercholesterolemia (FH) is an inherited form.
• Medicines: some, including steroids, some blood pressure medicines and HIV medicines, can raise LDL.
• Other conditions: chronic kidney disease, diabetes and HIV can raise LDL.
• Race or ethnicity: some groups have a higher risk. African Americans typically have higher HDL and LDL than White Americans, and Asian Americans are more likely than other groups to have higher LDL.

What your LDL should be

For LDL, lower is better. General ranges for healthy adults:

If you have coronary artery disease or are at high risk for it, your provider may set different goals.

How to lower it

Heart-healthy lifestyle changes:

• Heart-healthy eating that limits saturated and trans fats — the Therapeutic Lifestyle Changes diet and the DASH eating plan are two examples.
• Weight management: if you are overweight, losing weight can lower LDL.
• Physical activity: everyone should get it regularly.

Medicines, if lifestyle changes alone don't lower LDL enough. There are several types, including statins; they work in different ways and can have different side effects, so ask your provider which is right for you — and keep up the lifestyle changes while you take them.

Some people with FH may have lipoprotein apheresis, in which a filtering machine removes LDL cholesterol from the blood and returns the rest of the blood to the person.

Sources

Based on "LDL: The Bad Cholesterol," MedlinePlus, U.S. National Library of Medicine, from the National Heart, Lung, and Blood Institute, NIH; a work of the United States government in the public domain.