LDL Cholesterol

"'Bad' cholesterol — high values raise heart-disease and stroke risk."

What it is

Cholesterol is a fatty substance that your body needs to build healthy cells. It travels around your body in your blood, carried by proteins. Together, these form lipoproteins. There are different types of lipoproteins, and two of the main ones are LDL and HDL.

LDL stands for Low-Density Lipoprotein. Think of it as a delivery truck for cholesterol. It picks up cholesterol from the liver and delivers it to cells throughout your body that need it. This is a normal and essential process. However, the term "bad cholesterol" is often used because if there's too much LDL cholesterol circulating in your blood, it can start to cause problems.

Why it matters

When there's an excess of LDL cholesterol, it can build up inside the walls of your arteries. Arteries are the blood vessels that carry oxygen-rich blood from your heart to the rest of your body. This buildup is called plaque. Over time, plaque can harden and narrow your arteries, making it harder for blood to flow through them. This process is known as atherosclerosis.

If the arteries supplying your heart become narrowed or blocked, it can lead to angina (chest pain) or a heart attack. If the arteries supplying your brain become narrowed or blocked, it can lead to a stroke. Therefore, keeping your LDL cholesterol levels within a healthy range is an important part of looking after your heart and circulatory health. The target level for LDL cholesterol can vary depending on your individual risk factors for heart disease and stroke, so it's something to discuss with your doctor. For many people, a level below 3 mmol/l is considered desirable.

What can cause it to be high or low

Several factors can influence your LDL cholesterol levels.

Factors that can contribute to higher LDL cholesterol:

• Diet: Eating a diet high in saturated and trans fats can raise LDL cholesterol. These fats are often found in processed foods, fatty meats, butter, cheese, and fried foods.
• Genetics: Some people inherit a tendency to have higher cholesterol levels. This is known as familial hypercholesterolaemia.
• Weight: Being overweight or obese can increase LDL cholesterol levels.
• Lack of physical activity: Not being physically active can contribute to higher LDL cholesterol.
• Age and Sex: Cholesterol levels tend to rise with age. Before the menopause, women generally have lower LDL cholesterol than men of the same age. After the menopause, women's LDL cholesterol levels tend to rise.
• Certain medical conditions: Conditions like an underactive thyroid (hypothyroidism), kidney disease, and diabetes can sometimes be associated with higher LDL cholesterol.
• Certain medications: Some medications can affect cholesterol levels.

Factors that can contribute to lower LDL cholesterol:

While high LDL cholesterol is more commonly discussed, very low levels are less common and usually not a cause for concern unless they are extremely low or associated with other symptoms. In some rare genetic conditions, LDL cholesterol can be very low. Sometimes, very low levels might be seen in individuals who have had significant weight loss or are severely malnourished, but this is not typical.

Lifestyle factors that may help

Making certain lifestyle changes can be beneficial in managing your LDL cholesterol levels. These are often things that are good for your overall health too.

• Dietary choices: Focusing on a diet rich in fruits, vegetables, whole grains, and lean proteins can be helpful. Limiting foods high in saturated and trans fats, and choosing healthier fats like those found in olive oil, nuts, and oily fish, is often recommended.
• Regular physical activity: Engaging in regular moderate-intensity exercise, such as brisk walking, swimming, or cycling, can help improve your cholesterol profile. Aiming for at least 150 minutes of moderate-intensity activity per week is a common guideline.
• Maintaining a healthy weight: If you are overweight, losing even a small amount of weight can have a positive impact on your LDL cholesterol levels.
• Stopping smoking: Smoking can negatively affect your cholesterol levels and increase your risk of heart disease. Quitting smoking can lead to improvements.
• Limiting alcohol intake: Excessive alcohol consumption can affect your health in various ways, including potentially impacting cholesterol levels.

Questions to discuss with your GP

It's always a good idea to have a conversation with your GP about your cholesterol levels and what they mean for you. Here are some questions you might consider discussing:

• What is my current LDL cholesterol level, and what is the target range for me?
• What are the main factors contributing to my LDL cholesterol level?
• Are there any specific dietary changes you would recommend for me?
• What type and amount of physical activity would be most beneficial for my heart health?
• Are there any other health conditions or lifestyle factors that I should be aware of in relation to my cholesterol?
• How often should I have my cholesterol levels checked?