If you have crossed the age of 30, it is likely that you would have had your Cholesterol checked, at least once. A blood sample is taken, a report is issued, and you may stare at this report and wonder what it all means.

Many times, patients who visit doctors having had a cholesterol test done notice that their cholesterol is high or out of range, and begin to worry about it. Fortunately, not always is it worrying.

To clear things up, let us look at your cholesterol report and decipher what each of these values mean.

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Why Worry About Cholesterol

Cholesterol is a thick, waxy substance that is synthesised by the liver. The production of cholesterol in the blood is the most at night (which is why your doctor will ask you to take your cholesterol medicines at night).

Cholesterol is not really all bad, especially if the levels are within the normal range. It is required for the synthesis of hormones, and is essential to maintain the integrity of the lining of cells and tissues.

However, excess cholesterol is bad. This is because it can deposit on the inner surface of the blood vessels, leading to a condition called atherosclerosis. Atherosclerosis leads to narrowing of arteries, and this is the main reason for heart attacks and strokes in India and across the globe.

The problem with cholesterol is that you will have no idea that it is elevated unless you get a test done. This is because high cholesterol does not cause any symptoms.

It is simple to get your cholesterol levels checked. All you need is a blood test. As fasting levels are more accurate, an overnight fast of 9 to 12 hours is recommended.

The Cholesterol Parameters

Your cholesterol report may contain the following parameters:

1. Total cholesterol
2. High density lipoprotein cholesterol (HDL)
3. Low density lipoprotein cholesterol (LDL)
4. Triglycerides
5. Very low density lipoprotein cholesterol (VLDL)

Let’s take a brief look at each of these.

1. Total Cholesterol

Your total cholesterol value is an indicator of the total quantity of cholesterol in your blood. It is a combination of both good and bad cholesterols (explained below). A total cholesterol value of below 160 to 170 mg/dL is a good reading. If your cholesterol is higher than this, then you increase your chances of developing heart disease and other similar problems.

2. Low Density Lipoprotein (LDL) Cholesterol

This is sometimes called ‘bad cholesterol’ and for very good reason. LDL carries the cholesterol from the liver into the bloodstream. This cholesterol is carried through the blood and deposited on the blood vessel wall, leading to atherosclerosis.

These days, doctors are more concerned about LDL levels as high levels are linked to heart disease and stroke. The Lipid Association of India has issued specific guidelines for doctors when it comes to managing high LDL levels.

Generally, a good LDL cholesterol level is one that is below 100 mg/dL. However, this can be quite hard to achieve. Therefore, some doctors would not mind the LDL cholesterol being slightly higher than that. That being said, you should do all that you can to reduce this level. I have discussed this later in the article.

Just of note, LDL cholesterol level that is greater than 190 mg/dL is considered to be ‘very high risk’. This means that those with such levels have a very high chance of having heart disease.

In individuals with diabetes or heart disease, the LDL value should be maintained even lower. A level of 70 mg/dL or below is now advised. At this level, it is believed the chances of developing heart disease or other complications is reduced dramatically. Treatment strategies are often aimed towards reducing LDL cholesterol by 30 to 50 % at the least.

3. High Density Lipoprotein (HDL) Cholesterol

High density lipoprotein cholesterol is a good cholesterol. This is because HDL carries cholesterol from the bloodstream back to the liver. This way, the cholesterol does not cause any damage to the blood vessels and instead protects it from getting clogged up.

Previously, there was a great deal of concern regarding HDL cholesterol and how helpful it was. Guidelines were issued regarding how high HDL cholesterol had to be to protect a person from heart disease. These days, the attention that it once used to receive has died down. More attention is being paid to LDL cholesterol.

It is currently advised that HDL cholesterol values are above 40 – 45 mg/dL. This is particularly important for those with diabetes or a family history of abnormal cholesterol levels. Women tend to have better HDL levels compared to men. Those with diabetes have low levels and this is often accompanied by high triglyceride levels.

The higher the HDL (accompanied by low levels of LDL), the better it is at preventing heart disease or stroke.

4. Triglycerides

Triglycerides are a type of blood fat whose levels are often related to total cholesterol levels. They have recently started to gain importance as a few scientific papers have been published recently detailing their role in heart attacks and strokes.

High triglyceride levels are seen in those people who suffer from diabetes. In addition to this, those who eat a lot of sweets and sugary items can also have high triglyceride levels.

Levels that exceed 500 mg/dL are worrying, and require treatment. This is because it does not just affect the heart; it can also affect the pancreas (and this is dangerous).

In India, people tend to have high triglyceride levels that is combined with high LDL and low HDL levels. Those who are overweight, smoke, have poor physical activity and consume excess alcohol have high triglyceride levels. Those who consume a diet that is high in carbohydrates can also have high triglyceride levels.

The recommended level of triglyceride is below 150 mg/dL.

5. Very Low Density Lipoprotein (VLDL) Cholesterol

This is a little know cholesterol that is often ignored in reports. It is considered to be a bad cholesterol and its levels are often related to triglyceride levels. This higher the triglyceride level, the higher the VLDL level.

Non HDL Cholesterol – A New Entity

Recently, a more relevant type of cholesterol has emerged. It is called ‘Non HDL Cholesterol’.

In simple terms, it the cholesterol value you get by deducting the HDL value from the total cholesterol.

For example, if your total cholesterol value was 220 mg/dL and your HDL was 50 mg/dL, then your non HDL cholesterol levels would be 220 – 50 = 170 mg/dl.

Non HDL cholesterol is now considered to be important as it excludes only HDL and includes every other type of cholesterol that is considered to be ‘bad’. This is a good way to determine how much bad cholesterol there is in the blood, as most of the blood tests fail to address a few more bad cholesterol markers.

These other markers include Apo B levels, Lipoprotein (a) levels and small LDL levels. These are not routinely checked, though certain labs do perform the former 2 as a part of their regular panel. There is currently no lab test that can determine small LDL levels, which are probably the worst kind of bad cholesterol there is.

The current recommendation is to keep the non HDL cholesterol levels below 130 mg/dL. In those with diabetes or heart disease, it is better to keep it below 100 mg/dL.

Reducing Your Cholesterol Levels

While most of your high cholesterol levels are genetic, you can always take steps to reduce your levels.

Without going into too much detail, all you need to do is follow a healthy diet, perform plenty of exercise and reduce your weight. Eat more whole grain foods as the soluble fibre in them can reduce your risk of heart disease. Keep fried foods to a minimum. Use olive oil, quality sunflower oil or rice bran oil as these have more unsaturated fats.

Walk regularly, or better even, run or swim. Any exercise is good exercise, so make sure you get your bit in every day.

In A Nutshell

When you glance at your cholesterol report, you want your HDL to be higher than the described range and LDL cholesterol and triglyceride levels to be lower than the given range.

Don’t worry too much about ratios etc. as these are now being discarded slowly.

Closing Remarks

So, there you have it – your cholesterol report explained. If you are looking to reduce your cholesterol levels, make sure you speak to your doctor and embark on an exercise and diet program. Medications may also be needed which you can always buy from Medlife at discounted rates.

References

• Nayor, Matthew, and Ramachandran S. Vasan. “Recent Update to the US Cholesterol Treatment Guidelines.” Circulation 133.18 (2016): 1795-1806.
• Soluble fibre and your heart – http://heartsense.in/soluble-fiber-secret-good-heart/

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