Cholesterol Clarity - Dispelling Misconceptions About LDL-C
I went in for my yearly physical last week. For the most part, I was feeling okay besides a few minor aches and pains. Having just reached the mid-40’s range, my primary concern was heart health. The leading cause of death for men in the United States is heart disease. I am in decent shape, workout regularly and refrain from drinking alcohol and smoking, but my diet, can be problematic – I eat healthy during the day, but have a terrible habit of late-night snacking on foods with sugars and saturated fats – the usual suspect are chips, cookies, cakes. My doctor took note and said he would check my cholesterol. This is embarrassing to admit, but I never ever paid much attention to cholesterol and knew almost nothing about it. I have received lipid panel tests in the past, but never looked at the results – there was no reason to.
My blood test results came back. I reviewed my lipid panel and the results fell within normal range except for my low-density lipoprotein-cholesterol (LDL-C), which was high – 140 mg/dL (milligrams per deciliter). An LDL-C level of 140 mg/dL falls within the borderline high range. The results were accompanied by a note from my doctor stating that my cholesterol was higher than the last time we checked and he recommended I moderate my intake of saturated fats while continuing to exercise. I quickly googled LDL cholesterol to find out it was the “bad” kind and worried that I was either going to have heart disease or a heart attack. After calming down and doing further research I realized – as is usually the case – it’s not so simple.
What is Cholesterol
Cholesterol is a waxy substance found in your blood that is essential for building healthy cells. However, having high levels of certain types of cholesterol, specifically LDL cholesterol, often referred to as “bad” cholesterol, can increase your risk of heart disease and stroke.
What is Bad Cholesterol?
At first, everywhere I looked, I kept reading that LDL-C is the “bad” cholesterol and too much can cause coronary artery disease.
LDL-C is considered “bad” because it can build up on the walls of your arteries, forming plaque. Over time, this plaque can narrow your arteries, reducing blood flow and increasing your risk of heart disease. High levels of LDL-C can be caused by factors such as genetics, diet, and lifestyle choices.
Here are the general LDL-C ranges commonly used:
- Optimal: Less than 100 mg/dL (2.59 mmol/L)
- Near optimal/above optimal: 100-129 mg/dL (2.59-3.34 mmol/L)
- Borderline high: 130-159 mg/dL (3.37-4.12 mmol/L)
- High: 160-189 mg/dL (4.15-4.90 mmol/L)
- Very high: 190 mg/dL (4.90 mmol/L) and above
Evolving Debate On LDL
Over the last 20 years, there have been some changes in the optimal LDL cholesterol levels recommended by guidelines and experts. These changes are often based on evolving scientific evidence and a better understanding of cardiovascular risk.
Traditional Guidelines
In the past, the optimal LDL cholesterol level was generally considered to be less than 100 mg/dL for most individuals, with higher levels considered borderline or high.
Evolving Guidelines
Focus on Risk Reduction: The emphasis has shifted from achieving specific LDL-C targets to reducing overall cardiovascular risk. This means that even if LDL-C levels are within the “normal” range, individuals may still be recommended lifestyle changes or medications to reduce their risk of heart disease based on their overall risk profile.
More recent guidelines, such as those from the American College of Cardiology/American Heart Association (ACC/AHA), have shifted towards a more personalized approach to assessing cardiovascular risk. Instead of focusing solely on LDL-C levels, these guidelines emphasize overall risk assessment based on a variety of factors, including age, sex, race, cholesterol levels, blood pressure, smoking status, and diabetes. This makes sense because focusing solely on LDL-C levels may not be appropriate for all individuals, particularly those with lower cardiovascular risk.
Here is an explanation as to why just focusing on just at LDL may not be appropriate. And you can listen to Dr. Paul Saladino discuss why LDL cholesterol is not bad.
Beyond the Numbers
While I initially felt concerned about my LDL cholesterol levels and their potential impact on my heart health, I have come to realize that the situation is more nuanced than I initially thought. Although my LDL levels are higher than ideal, I am not overly worried about them causing heart disease or a heart attack, especially given my overall health and lifestyle choices. However, I understand the importance of taking proactive steps to lower my LDL cholesterol levels and improve my heart health. I plan to moderate my intake of saturated fats and continue exercising regularly, as recommended by my doctor. By making these changes, I hope to lower my LDL cholesterol levels and reduce my risk of heart disease, while also maintaining a balanced and healthy lifestyle.