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LDL cholesterol
Also known as LDL, Low-density lipoprotein, Bad cholesterol
LDL cholesterol is the particle that carries cholesterol from the liver out to the tissues and deposits it in artery walls along the way. It is the number that treatment aims at, and lowering it reliably lowers the risk of heart attack and stroke.
In Cardiology
Calling it bad cholesterol is a useful shorthand and a slight lie: LDL is doing a necessary delivery job, and the harm comes from having more particles circulating than the body needs. Excess LDL enters the artery wall, is oxidised, and starts the plaque that becomes . The relationship is causal and dose-dependent — lower for longer means less disease — which is what separates LDL from most other numbers on a .
What the numbers mean
| Situation | Commonly used target |
|---|---|
| Low overall risk, no other conditions | Below 116 mg/dL (3.0 mmol/L) |
| Moderate risk | Below 100 mg/dL (2.6 mmol/L) |
| High risk, including most people with | Below 70 mg/dL (1.8 mmol/L) |
| Very high risk, such as established heart disease or previous | Below 55 mg/dL (1.4 mmol/L) |
Most laboratories calculate LDL from the other values rather than measuring it, and that calculation becomes unreliable when are high, which is when a directly measured LDL or a non-HDL cholesterol figure is used instead.
Diet moves LDL modestly — less ghee, butter, fried food, red meat and bakery items made with hydrogenated fat; more soluble fibre, pulses, oats, nuts and fish. The liver sets most of the level, so a is what shifts it substantially, and it is the treatment with the strongest evidence in this whole area. An unusually high LDL in a young person, or a family history of heart attacks in the forties, raises the possibility of familial hypercholesterolaemia, which is inherited and under-diagnosed here.
Where this comes up
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Related terms
- CholesterolBlood lipids, Serum cholesterolCholesterol is a waxy fat the body needs to build cell walls, hormones and vitamin D. Problems come not from its presence but from the balance between the particles that deposit it in artery walls and those that carry it away.
- Lipid profileLipid panel, Cholesterol testA lipid profile is a blood test that measures the fats circulating in blood: total cholesterol, LDL, HDL and triglycerides. It is used to estimate the risk of heart attack and stroke and to decide whether cholesterol-lowering treatment is worthwhile.
- StatinHMG-CoA reductase inhibitor, AtorvastatinStatins are medicines that lower cholesterol by reducing how much the liver makes. They are taken to lower the long-term risk of heart attack and stroke, not to treat a symptom.
- AtherosclerosisHardening of the arteries, Arterial plaqueAtherosclerosis is the build-up of fatty, fibrous plaque inside artery walls, which stiffens them and narrows the channel blood flows through. It develops silently over decades and is the process behind most heart attacks and strokes.