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Low-density lipoprotein (LDL) cholesterol is often labeled the “bad” cholesterol because of its purported role in arterial plaque buildup. While keeping LDL cholesterol lower can mean a reduced risk of developing heart disease down the line, it’s important to talk about cholesterol in context.
Managing cardiovascular risk factors goes beyond targeting cholesterol, but to understand why, we need a solid understanding of LDL and its role in heart health.
LDL Versus HDL
There are different types of lipoproteins that carry cholesterol and fats in the bloodstream. The 2 relevant here regulate cholesterol: low-density lipoprotein (LDL) and high-density lipoprotein (HDL).
Let’s start with the preferred type. HDL is the good cholesterol most doctors want to see in your labs. HDL helps remove excess cholesterol from the bloodstream by transporting it from the arteries and tissues back to the liver, where it can be processed and excreted. This process is known as reverse cholesterol transport.
Generally, higher HDL levels are good news for heart health, but very high levels might not be cardioprotective. In fact, some studies show that extremely high levels of HDL may increase your risk of arterial dysfunction that could lead to heart disease. (1)
Let’s get to the ‘villain’ now. LDL cholesterol is known as the bad cholesterol because high levels can lead to plaque buildup along arterial walls. This means narrowed blood vessels and, potentially, an increased risk of coronary artery disease, peripheral artery disease, and aneurysms.
LDL cholesterol (LDL-C) can be affected by what you eat, such as a diet high in trans fats. Tobacco use and certain medications, especially drugs that manage blood pressure, can also play a role in high blood cholesterol.
There are also things that impact LDL levels beyond your control. Health conditions like kidney disease and diabetes can affect how much LDL cholesterol shows up on your panels. Your genes also matter. If high cholesterol runs in your family or you have a history of familial hypercholesterolemia, you’re more likely to have trouble balancing cholesterol.
Finally, age and gender matter, too. LDL levels tend to go up for women during hormonal changes like menopause. Both genders tend to see cholesterol go up as they age, though.
Studies show keeping levels of LDL low can potentially slow the progression of atherosclerosis and delay the age at which arterial plaques begin to develop. (2) This can mean a lower lifetime risk of heart disease, especially for high-risk populations or aging adults.
HDL can play a protective role by counteracting LDL’s harmful effects, but we’ve already suggested how important it is to keep a healthy balance between the two. You don’t want to go overboard by focusing on one over the other.
Beyond LDL-C
It’s essential to clarify that simply measuring levels of LDL-C in the blood alone is not a sufficient predictor of cardiovascular disease (CVD) risk. What really matters is the size of LDL particles.
Smaller, denser LDL particles are more likely to contribute to plaque buildup and arterial damage. Larger, fluffy LDL particles are generally harmless and not a cause for concern.
To assess whether your LDL particles are small and dense or large and fluffy, you need to look at ApoB, a biomarker that approximates the count of LDL particles (and, therefore, their size).
Another key factor to consider is Lp(a), a genetically influenced lipid that shares a similar molecular shape to LDL-C. Lp(a) is thought to be highly atherosclerotic and plays a crucial role in blood clotting.
There are growing arguments that much of what was traditionally considered LDL-C in plaque buildup may actually be Lp(a). (3) This is due to its structural similarity to LDL and how it was originally thought to be a variant of LDL-C, not an individual biomarker and genetic factor.
To ensure a more comprehensive and accurate prediction of CVD risk, consider a Vertical Auto Profile (VAP) panel over traditional cholesterol testing. The VAP is much more detailed and measures:
Total cholesterol
LDL cholesterol
HDL cholesterol
Triglycerides
Total number of very-low-density lipoprotein (VLDL) particles
LDL pattern density (small-dense LDL, also called sdLDL or LDL-P)
LDL bound to C-reactive protein (LDL-RC)
ApoB levels
Lipoprotein (a) or Lp(a) cholesterol levels
Lipoprotein subclasses like HDL-2, HDL-3, and intermediate-density lipoprotein (IDL)
Want to learn a better predictor of heart disease? Check out our Toku Health article on Apolipoprotein B: A Key Heart Health Marker You Shouldn’t Ignore.
What Classifies as Healthy Levels
Before we get into the common wisdom on ideal levels of LDL cholesterol, it’s important to note here that low levels of LDL don’t necessarily mean you’re heart-healthy. LDL is just one biomarker out of many (e.g. Lp(a), ApoB) that may or may not mean you develop heart disease down the line.
Levels of inflammation, family history, and your history of blood clots matter just as much, if not more, than the numbers on your blood cholesterol tests.
Now that you have more context on cholesterol as just a piece of your overall heart health, here is how the Centers for Disease Control and Prevention (CDC) defines optimal cholesterol levels:
Total cholesterol: About 150 mg/dL
LDL cholesterol: About 100 mg/dL
HDL cholesterol: About 40 mg/dL or more in men and about 50 mg/dL or more in women
Triglycerides: Less than 150 mg/dL
Total cholesterol levels measure the combined levels of LDL, HDL, and other lipid components in the blood.
The American Heart Association suggests that when it comes to LDL, lower cholesterol is better, especially if you have a history of heart disease. In that case, your doctor may want you to aim for LDL-C levels at 70 mg/dL or lower on blood tests.
Lipid panels from your healthcare provider also measure triglycerides, a type of fat found in your blood that stores energy. High triglyceride levels can accelerate plaque buildup in blood vessels, increasing your risk of heart disease.
Read Next: LDL Particle Size: What It Is and Why It Matters
If Levels Are Too High
High LDL cholesterol is linked to plaque buildup in the arteries, or atherosclerosis. As the plaque builds up, your arteries narrow. These blockages restrict blood flow and can contribute to health problems like heart attack and stroke.
Elevated LDL is also linked to inflammation in blood vessels, further compounding your risk of bad cardiovascular outcomes. (4) Inflammation can contribute to plaque rupture and trigger blood clots, further blocking arteries.
While cholesterol is just one piece of a healthy lifestyle and heart health, lower LDL cholesterol is often at the top of the list of doctors’ orders for those with a history of heart disease.
Statins, or cholesterol-lowering medications, are a common approach to keep cholesterol in check, but there are lifestyle changes and statin alternatives available:
Regular exercise: Aim for a regular habit of about 150 minutes of moderate aerobic exercise weekly for better cholesterol balance. (5) Regular physical activity is good for reducing inflammation, too, a key predictor of heart disease.
Weight management: Obesity is a risk factor for higher LDL cholesterol and metabolic conditions like type 2 diabetes. Losing even 5-10% of your body weight can improve cholesterol levels. (6)
Smoking cessation: Smoking, vaping, and any kind of tobacco use lowers levels of HDL cholesterol, the type of cholesterol that helps your body reduce excess plaque. (7) Chemicals in tobacco also damage blood vessel walls, causing endothelial dysfunction. (8)
Stress management: Chronic stress is linked to higher levels of LDL cholesterol and inflammation, an immune response trigger that’s also bad for your heart health. (9) Finding ways to manage stress on a regular basis is essential to overall wellness.
Dietary changes: Healthy eating plans that include foods rich in soluble fiber and healthy fats can help your body block or reduce cholesterol absorption. Plant sterols and stanols found in whole grains, fruits, and vegetables are also linked to better lipid profiles. (10) Additionally, if you follow or are considering a low-carb diet, keep in mind that LDL-C levels may rise, but this does not inherently equate to an increased risk of plaque buildup or a greater plaque burden. (11)
Natural supplements: Omega-3 fatty acids, turmeric, and nattokinase supplement (learn more about nattokinase here) a natural enzyme from fermented soybeans, are all known for supporting balanced cholesterol.
Toku Flow is a daily natto supplement that combines nattokinase with vitamin K2 and beta-glucan to support reduced coronary plaque and balanced cholesterol with fewer side effects.If They’re Too Low
Your body needs cholesterol for healthy cell membranes, hormone production, and nutrient absorption. Extremely low levels of cholesterol may disrupt hormonal balance, although this is more likely with low levels of HDL.
For most, low LDL levels aren’t associated with serious health concerns. (12) One study found a link between very low LDL cholesterol and a higher risk of hemorrhagic stroke, but that same study suggests more research is needed to understand the connection. (13)
Context matters. If you’re worried about a low amount of cholesterol contributing to health concerns, you may want to get evaluated to get to the root cause of your symptoms. It’s more likely that there are other things at play beyond your cholesterol levels, like inflammation or metabolic dysfunction.
For healthier cholesterol balance overall, increasing your intake of healthy fats from sources like nuts, avocadoes, and full-fat dairy products can have a positive impact. You can also boost your consumption of fat-soluble vitamins, like vitamins E and K, that depend on cholesterol for proper absorption.
The New Truth About Cholesterol
We’ve hinted at this already, but LDL cholesterol shouldn’t be the sole focus of your efforts to improve your heart health. Oxidized LDL cholesterol can impact arterial plaque buildup, but it’s more likely a result of inflammation.
Targeting inflammation and the formation of blood clots, the remnants of which are much more damaging to blood vessel health than LDL, is essential to heart health. The “new truth about cholesterol” is that it may not be as important as we think in the big heart health picture.
Arterial plaque isn’t caused by LDL alone, either. High levels of LDL trigger immune responses that can make it more likely for arterial plaque to rupture. Any arterial damage, like a history of blood clots or chronic inflammation, can have the same effect.
A Natural Solution for Great Heart Health
Low levels of LDL cholesterol are generally preferable to high levels, but it’s also important to keep things in perspective as you make lifestyle changes for better heart health. Cardiovascular disease can — and does — affect people without a history of high LDL cholesterol.
Unfortunately, cholesterol is one of those health markers that is seemingly easy to control with prescribed statins.
This doesn’t get to the real, preventative measures that matter more to overall heart health over time. Managing LDL levels can be part of your strategy to reduce your risk of developing heart disease, but it shouldn’t be your sole focus.
Read Next:
Signs You May Be Experiencing Poor Circulation
Potential Degradative Effects of Natto on COVID Spike Protein
Sources
The LDL cumulative exposure hypothesis: evidence and practical applications
The effects of exercise training on lipid metabolism and coronary heart disease
Weight Loss and Serum Lipids in Overweight and Obese Adults: A Systematic Review and Meta-Analysis
Effects of cigarette smoking on HDL quantity and function: implications for atherosclerosis
Tobacco smoking and vascular biology and function: evidence from human studies
Plant Sterols and Plant Stanols in Cholesterol Management and Cardiovascular Prevention
Carbohydrate Restriction-Induced Elevations in LDL-Cholesterol and Atherosclerosis
