Cholesterol Tests Explained: Importance, Treatments, Heart Disease Risk Factors

Medically Reviewed by Dr. K. Updated as of May 20, 2021.

What Is Cholesterol?

Cholesterol is a form of fat that we need. It aids in the stability of our cells’ outer membranes. Doctors have understood for decades that people with high total cholesterol are more prone to develop heart failure. They also discovered that various types of cholesterol (both “good" and “bad") play a part. Your odds can be increased whether you have high total cholesterol, high bad cholesterol, or low good cholesterol.

Low-density lipoprotein (LDL), or “bad" cholesterol, for example, may cling to blood vessel walls. It may contribute to the clogging of arteries over time, a condition known as atherosclerosis. Heart arteries that are narrowed may form sudden blood clots, resulting in heart attacks.

Doctors use cholesterol tests to assess triglycerides, which are another kind of fat. High levels may increase the risk of a heart attack or stroke. This is particularly true if you have a low amount of HDL (high-density lipoprotein) cholesterol (HDL). Diabetes is therefore more common if the triglyceride levels are high.

Everyone above the age of 20 should get a cholesterol screening, according to the American Heart Association, so you know what the levels are and can take action if necessary.

Cholesterol Tests: The Good, the Bad, and the Fatty

Lipids are the different kinds of cholesterol and other fats found in the blood. A basic blood test is used for doctors to assess and diagnose lipid issues. You’ll also need to fast for 9 to 12 hours before it to ensure it’s not influenced by something you’ve eaten previously.

A lipid profile usually yields four forms of results:

  • Total cholesterol
  • LDL (low-density lipoprotein), the “bad cholesterol"
  • HDL (high-density lipoprotein), the “good cholesterol"
  • Triglycerides, the most common type of fat in your body

Some lipid panels may provide even more accurate information, such as the presence and sizes of different fat particles in your blood. Researchers are investigating whether or not these characteristics have an effect on heart disease. When this type of advanced testing is needed, there are no specific guidelines.

Your Cholesterol Test Results

For total cholesterol:

  • 200 milligrams per deciliter (mg/dL) or less is normal.
  • 201 to 240 mg/dL is borderline.
  • More than 240 mg/dL is high.

For HDL (“good cholesterol"), more is better:

  • 60 mg/dL or higher is good – it protects against heart disease.
  • 40 to 59 mg/dL is OK.
  • Less than 40 mg/dL is low, raising your chance of heart disease.

For LDL (“bad cholesterol"), lower is better:

  • Less than 100 mg/dL is ideal.
  • 100 to 129 mg/dL can be good, depending on your health.
  • 130 to 159 mg/dL is borderline high.
  • 160 to 189 mg/dL is high.
  • 190 mg/dL or more is very high.

For triglycerides, lower is better:

  • 150 mg/dL or less may be the goal your doctor recommends, though the American Heart
  • Association recently suggested that a lower level is best for health.
  • 151 to 200 mg/dL means you’re on your way to a higher risk for heart disease.
  • More than 200 mg/dL means you have a higher risk of heart disease.

To determine your personal LDL target, your doctor may assess your overall risk of heart disease. LDL cholesterol levels should be fewer than 100 mg/dL in individuals who are at higher risk of heart disease or who already have it. (If your risk of heart disease is very high, your heart doctor may recommend an even lower LDL, less than 70 mg/dL.)

If you have a relatively elevated risk of heart disease, you should aim for an LDL level of less than 130 mg/dL. Less than 160 mg/dL is fine if the chance of heart problems is low.

Treatment Options

The first step in lowering your risk of heart disease is to make lifestyle improvements. Your doctor may also advise you to begin taking prescribed medications to lower your cholesterol.

Lifestyle Changes

Bad cholesterol can be reduced by up to 30% with a cholesterol-lowering diet. LDL cholesterol can be reduced by eating a diet low in saturated fat and simple carbohydrates, with no more than 200 mg of cholesterol per day. Plant sterols (found in unique margarines and other foods) and fibre also help.

Keep the following dietary suggestions in mind:

  • Reduce saturated fat consumption to less than 7% of total calories.
  • Trans fat should be avoided at all costs. Look for “partially hydrogenated” oils on the ingredients list. Trans fats are what they’re called. And if a product says “0 grammes trans fat," it can have a tiny amount (less than half a gramme per serving), which adds up.
  • Read the labelling on the foods you buy. Products labelled as “low cholesterol" or “no cholesterol" may contain excessive amounts of saturated fats or sugar.

Regular aerobic exercise can help to reduce bad cholesterol (LDL) while increasing good cholesterol (HDL) . Quit smoking if you’re a smoker.

Diet, exercise, and weight reduction are also good strategies to improve your triglyceride levels. Consult the doctor on a healthy eating plan. If you smoke, you should get advice on how to stop.

Medications and Procedures

If lifestyle changes aren’t enough to reduce cholesterol, drugs or a combination of treatments may be used. If you adhere to your new lifestyle habits, you may be able to work with your doctor to lessen or reduce the number of medications you’re taking.

Your doctor may advise you to take:

Statins: These are the most common and powerful cholesterol medicines. They stop the liver from producing cholesterol. They normally don’t cause any issues, but they can cause liver and muscle damage in rare cases. As a result, once you begin treatment, the doctor will perform blood tests to monitor your liver function to see whether there are any symptoms of complications. Memory loss and a slight increase in the risk of type 2 diabetes have also been recorded. The benefits may outweigh the risks, so discuss them with your doctor.

Statins available are:

  • Atorvastatin (Lipitor)
  • Fluvastatin (Lescol)
  • Lovastatin (altoprev, Mevacor)
  • Pitavastatin (Livalo)
  • Pravastatin (Flolipid, Pravachol)
  • Rosuvastatin calcium (Crestor)
  • Simvastatin (Zocor)

Niacin: This is a medication that doctors may recommend to help increase HDL (“good") cholesterol levels. Large doses are required for it to be successful. Skin flushing and an upset stomach are common side effects in these doses. It may be better to take newer formulations of niacin that have been designed to reduce these side effects. Despite its cholesterol-lowering efficacy, a new clinical review showed that adding statin medicine with niacin did not reduce the risk of heart disease.

Fibrates: Fibric acid derivatives, called fibrates, are sometimes prescribed by doctors to increase HDL cholesterol and lower triglyceride amounts. They also have a minor effect on lowering LDL cholesterol.

Ezetimibe (Zetia): This medication reduces the volume of cholesterol absorbed by the small intestine. It is normally combined with a statin, which may decrease cholesterol by another 25%. Zetia, on the other hand, is controversial due to a lack of proof that it reduces the risk of cardiac failure or death from heart disease.

Bile acid sequestrants: These substances, also known as cholestyramine and colestipol, can help some people lower their total and LDL cholesterol. Bloating, gas, and constipation are some of the side effects. If medicine alone isn’t controlling your cholesterol, your doctor may try combining a bile acid sequestrant and a statin.

Proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors: This is a newer type of cholesterol-lowering drug and is used to treat people of heterozygous hereditary hypercholesterolemia that are unable to regulate their cholesterol with diet and statin treatment. It’s even provided to those who have atherosclerotic heart disease. The medications alirocumab (Praluent) and evolocumab (Repatha) inhibit the liver protein PCSK9 from removing LDL-cholesterol from the bloodstream. The level of bad cholesterol in the body is reduced as a result of this. Evolocumab, in fact, has been shown to help people with cardiovascular disease reduce their likelihood of heart attacks and strokes.

Triglyceride medications: If your triglyceride level is higher than 500 mg/dL, your doctor may prescribe medication. To maintain the triglyceride levels out of the trouble zone, you may continue to take these medications for a prolonged period.

LDL apheresis: This isn’t a drug. It’s a blood-cleansing method that could aid in the treatment of serious genetic cholesterol conditions. Blood is extracted from the bloodstream for several hours, chemically cleansed of LDL cholesterol, and eventually pumped back into the body. Treatments every 2 to 3 weeks will reduce average LDL cholesterol by 50% to 80%, but they are time consuming and very costly.

Treatment Options

The first step in lowering your risk of heart disease is to make lifestyle improvements. Your doctor may also advise you to begin taking prescribed medications to lower your cholesterol.

Lifestyle Changes

Bad cholesterol can be reduced by up to 30% with a cholesterol-lowering diet. LDL cholesterol can be reduced by eating a diet low in saturated fat and simple carbohydrates, with no more than 200 mg of cholesterol per day. Plant sterols (found in unique margarines and other foods) and fibre also help.

Keep the following dietary suggestions in mind:

  • Reduce saturated fat consumption to less than 7% of total calories.
  • Trans fat should be avoided at all costs. Look for “partially hydrogenated” oils on the ingredients list. Trans fats are what they’re called. And if a product says “0 grammes trans fat," it can have a tiny amount (less than half a gramme per serving), which adds up.
  • Read the labelling on the foods you buy. Products labelled as “low cholesterol" or “no cholesterol" may contain excessive amounts of saturated fats or sugar.

Regular aerobic exercise can help to reduce bad cholesterol (LDL) while increasing good cholesterol (HDL) . Quit smoking if you’re a smoker.

Diet, exercise, and weight reduction are also good strategies to improve your triglyceride levels. Consult the doctor on a healthy eating plan. If you smoke, you should get advice on how to stop.

Medications and Procedures

If lifestyle changes aren’t enough to reduce cholesterol, drugs or a combination of treatments may be used. If you adhere to your new lifestyle habits, you may be able to work with your doctor to lessen or reduce the number of medications you’re taking.

Your doctor may advise you to take:

Statins: These are the most common and powerful cholesterol medicines. They stop the liver from producing cholesterol. They normally don’t cause any issues, but they can cause liver and muscle damage in rare cases. As a result, once you begin treatment, the doctor will perform blood tests to monitor your liver function to see whether there are any symptoms of complications. Memory loss and a slight increase in the risk of type 2 diabetes have also been recorded. The benefits may outweigh the risks, so discuss them with your doctor.

Statins available are:

  • Atorvastatin (Lipitor)
  • Fluvastatin (Lescol)
  • Lovastatin (altoprev, Mevacor)
  • Pitavastatin (Livalo)
  • Pravastatin (Flolipid, Pravachol)
  • Rosuvastatin calcium (Crestor)
  • Simvastatin (Zocor)

Niacin: This is a medication that doctors may recommend to help increase HDL (“good") cholesterol levels. Large doses are required for it to be successful. Skin flushing and an upset stomach are common side effects in these doses. It may be better to take newer formulations of niacin that have been designed to reduce these side effects. Despite its cholesterol-lowering efficacy, a new clinical review showed that adding statin medicine with niacin did not reduce the risk of heart disease.

Fibrates: Fibric acid derivatives, called fibrates, are sometimes prescribed by doctors to increase HDL cholesterol and lower triglyceride amounts. They also have a minor effect on lowering LDL cholesterol.

Ezetimibe (Zetia): This medication reduces the volume of cholesterol absorbed by the small intestine. It is normally combined with a statin, which may decrease cholesterol by another 25%. Zetia, on the other hand, is controversial due to a lack of proof that it reduces the risk of cardiac failure or death from heart disease.

Bile acid sequestrants: These substances, also known as cholestyramine and colestipol, can help some people lower their total and LDL cholesterol. Bloating, gas, and constipation are some of the side effects. If medicine alone isn’t controlling your cholesterol, your doctor may try combining a bile acid sequestrant and a statin.

Proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors: This is a newer type of cholesterol-lowering drug and is used to treat people of heterozygous hereditary hypercholesterolemia that are unable to regulate their cholesterol with diet and statin treatment. It’s even provided to those who have atherosclerotic heart disease. The medications alirocumab (Praluent) and evolocumab (Repatha) inhibit the liver protein PCSK9 from removing LDL-cholesterol from the bloodstream. The level of bad cholesterol in the body is reduced as a result of this. Evolocumab, in fact, has been shown to help people with cardiovascular disease reduce their likelihood of heart attacks and strokes.

Triglyceride medications: If your triglyceride level is higher than 500 mg/dL, your doctor may prescribe medication. To maintain the triglyceride levels out of the trouble zone, you may continue to take these medications for a prolonged period.

LDL apheresis: This isn’t a drug. It’s a blood-cleansing method that could aid in the treatment of serious genetic cholesterol conditions. Blood is extracted from the bloodstream for several hours, chemically cleansed of LDL cholesterol, and eventually pumped back into the body. Treatments every 2 to 3 weeks will reduce average LDL cholesterol by 50% to 80%, but they are time consuming and very costly.

Risk Factors

Your risk is not solely determined by your cholesterol levels. Keep in mind that heart disease may be caused by a variety of factors other than cholesterol. Diabetes, smoking, hypertension, obesity, exercise, stress and genetics all play a role.

In certain circumstances, even normal cholesterol levels may lead to heart attacks, whereas elevated cholesterol levels may lead to healthy hearts. Overall, though, more patients with abnormal cholesterol levels would have a much higher risk of heart disease.

Follow-up Testing

Most patients should have follow-up cholesterol tests every 5 years, according to experts. You’ll need cholesterol testing more often if your lipid levels aren’t what you and your doctor planned for, or if you have any causes to be worried regarding heart disease.

Source:

Referenced on 22/04/2021

  1. American Heart Association: “How to Get Your Cholesterol Tested," “Triglycerides," “Triglycerides: Frequently Asked Questions," “About Metabolic Syndrome," “What Are High Blood Cholesterol and Triglycerides?” “LDL and HDL Cholesterol: What’s Bad and What’s Good?"
  2. Kontush, A. Arteriosclerosis, Thrombosis, and Vascular Biology, 2003.
  3. Tabas, I. Journal of Clinical Investigation, 2002.
  4. National Heart, Lung, and Blood Institute: “High Blood Cholesterol: What You Need to Know."
  5. Stefanick, M. New England Journal of Medicine, 1998.
  6. Talayero, B. Current Cardiology Reports, December 2011.
  7. Palo Alto Medical Foundation: “Dietary Guidelines for Reducing Triglycerides."
  8. University of Massachusetts Medical School: “What you can do to lower your triglycerides."
  9. CDC: “High Cholesterol: What You Can Do.”
  10. Cleveland Clinic: “Metabolic Syndrome," “Heart and Vascular Health & Prevention."
  11. National Cholesterol Education Program.
  12. FDA: “Trans Fat at-a-Glance," News release.
  13. https://www.webmd.com/cholesterol-management/guide/tests-for-high-cholesterol-lipid-panel 

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