ldl cholesterol

LDL Cholesterol: Understanding the Bad Cholesterol

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Did you know that 95 million adults in the U.S. have high cholesterol levels1? This fact shows how crucial it is to know about LDL cholesterol, also called the “bad” cholesterol. LDL cholesterol plays a big part in making plaque in your arteries. This increases your risk of heart disease and stroke1. We’ll cover how LDL cholesterol affects your body, the dangers it brings, and how to manage it well.

Key Takeaways

  • LDL cholesterol is the “bad” cholesterol that can contribute to plaque buildup in your arteries
  • High LDL cholesterol levels are a major risk factor for heart disease and stroke
  • Regular cholesterol testing is important, starting as early as 9-11 years old2
  • Lifestyle changes, such as a healthy diet and regular exercise, can help manage LDL cholesterol levels
  • Medications like statins may be necessary for individuals with very high LDL cholesterol levels

What is Cholesterol?

The Role of Cholesterol in the Body

Cholesterol is a waxy substance found in all body cells3. Your liver makes it, and it’s also in foods like meat and dairy4. It moves through the blood with lipoproteins, including LDL and HDL3.

Your body needs cholesterol, but too much can increase heart disease risk4. The U.S. recommends keeping LDL levels under 100 mg/dL for good health4. For those with heart disease or diabetes, it should be 70 mg/dL or less4.

LDL, or “bad” cholesterol, raises heart disease and stroke risk3. HDL, or “good” cholesterol, lowers this risk3. High triglycerides, another blood fat, can be dangerous with high LDL or low HDL, leading to heart attacks3.

Keeping cholesterol levels healthy is key for heart health. Regular checks help manage levels well3. Eating less saturated fat and exercising can lower LDL and improve cholesterol levels5.

LDL Cholesterol Levels Guideline
Less than 100 mg/dL Optimal
100-129 mg/dL Near or above optimal
130-159 mg/dL Borderline high
160-189 mg/dL High
190 mg/dL and above Very high

4 This table shows the U.S. guidelines for LDL cholesterol levels in adults. It helps understand the different ranges.

“Maintaining healthy cholesterol levels is essential for overall cardiovascular health.”

Understanding LDL and HDL Cholesterol

Cholesterol is a vital substance in our bodies, crucial for many functions. But, an imbalance can cause serious health issues. LDL (low-density lipoprotein) cholesterol, known as the “bad” cholesterol, can lead to plaque buildup in arteries6. This can narrow and harden them.

HDL (high-density lipoprotein) cholesterol, on the other hand, is the “good” cholesterol. It helps remove excess cholesterol from the bloodstream and sends it to the liver for removal6.

Keeping a balance between LDL and HDL cholesterol is key for heart health. LDL levels should be under 130 mg/dL for those without heart disease or diabetes, and even lower for those with these conditions7. HDL levels should be above 50 mg/dL for women and 40 mg/dL for men7. Total blood cholesterol should also be within a normal range7.

Many factors can affect cholesterol levels, like diet, exercise, weight, and genetics6. A healthy lifestyle, eating a balanced diet low in saturated fats, exercising regularly, and keeping a healthy weight, can improve cholesterol levels and lower heart disease risk7. Doctors may also prescribe medication for high cholesterol, especially for those at high risk of heart disease7.

Knowing the difference between LDL and HDL cholesterol and keeping a healthy balance is key for heart health. Regularly checking cholesterol levels and managing them can help reduce the risk of heart disease and stroke678.

ldl cholesterol and Atherosclerosis

High levels of LDL cholesterol and apoB 100 increase the risk of heart and blood vessel problems9. This can cause plaque to form in your arteries, a condition called atherosclerosis. This plaque can make your arteries narrow or block them, slowing blood flow to your heart, brain, and other organs9.

Using statins to lower LDL cholesterol can reduce the risk of heart and blood vessel problems9. Triglyceride-rich lipoproteins and Lp(a) also play a part in these issues9. Non-HDL cholesterol is a good way to check your risk if you have high triglycerides9.

ApoB and LDL-P are better at predicting heart and blood vessel risks than LDL-C and LDL-P alone9. HDL-C levels are linked to a lower risk of these problems9.

Screening found 1 in 217 people have a genetic condition causing high cholesterol10. In this condition, high LDL cholesterol is a key factor in artery blockages10.

High cholesterol is a major cause of artery disease11. Lowering LDL cholesterol has been shown to reduce artery disease risk and improve heart health11.

LDL cholesterol levels are closely tied to the risk of heart disease11. Aggressive treatment has been more effective in stopping disease progression11.

High-dose atorvastatin treatment led to fewer heart and blood vessel events11. The NCEP ATP III updated guidelines to suggest aiming for LDL cholesterol under 70mg/dL for high-risk patients11.

Many patients don’t meet LDL cholesterol goals despite treatment11. Studies like EUROASPIRE I and II showed many heart patients don’t hit cholesterol targets11910.

Risk Factors for High LDL Cholesterol

Lifestyle and Genetic Factors

Many things can affect your LDL (low-density lipoprotein) cholesterol levels. This includes both what you do and your genes. Knowing what affects your cholesterol is key to keeping it healthy.

What you do every day can change your LDL cholesterol. Eating too much saturated and trans fats can raise your levels12. Not moving enough and being overweight or obese also link to higher LDL cholesterol12. Smoking can lower your HDL (high-density lipoprotein) and raise your LDL cholesterol, especially for women12. Drinking too much alcohol, more than two drinks a day for men or one for women, can also up your total cholesterol13.

Your genes can also play a big part in your cholesterol levels. If your family has high cholesterol, you might too12. Some genetic changes, like those in familial hypercholesterolemia, can really boost your LDL cholesterol121413.

Other things like certain medicines, your age, gender, race, and ethnicity can also change your LDL cholesterol1213. Knowing what affects your LDL cholesterol helps you prevent and manage it better.

risk factors high ldl cholesterol

Risk Factor Impact on LDL Cholesterol
Saturated and Trans Fats Increased LDL levels12
Lack of Physical Activity Increased LDL levels12
Overweight and Obesity Increased LDL levels12
Smoking Decreased HDL and increased LDL, especially in women12
Alcohol Consumption Increased total cholesterol levels13
Family History Increased LDL levels due to genetic factors1214
Familial Hypercholesterolemia Significantly elevated LDL levels due to genetic mutations121413
Certain Medications Can impact LDL and HDL cholesterol levels13
Age and Gender LDL levels tend to increase with age, and men have higher LDL levels than women until menopause14
Race and Ethnicity Can influence cholesterol levels, with disparities among different groups12

“Maintaining a healthy lifestyle, including a balanced diet and regular exercise, is crucial in managing LDL cholesterol levels and reducing the risk of heart disease and stroke.”

Knowing what affects your LDL cholesterol lets you take steps to keep your heart healthy121413.

Diagnosing High LDL Cholesterol

Knowing if you have high LDL (low-density lipoprotein) cholesterol is key to keeping your heart healthy. Your doctor can check this with a simple blood test called a lipid panel or lipid profile15.

This test looks at the different types of cholesterol in your blood, like LDL, HDL (high-density lipoprotein), and triglycerides. It shows your LDL level. Your doctor will then see if it’s in a healthy range or if it’s high15.

In the U.S., having a total cholesterol below 200 mg/dL is good. LDL levels below 70 mg/dL are best for those with coronary artery disease15. But, the criteria for high LDL can change based on your risk factors and heart health16.

Getting your cholesterol checked regularly is a good idea, especially as you get older. Heart disease risk goes up17. Kids should have one test between ages 9 and 11, and then every five years15.

Cholesterol Level Desirable Range Borderline High High
Total Cholesterol 200-239 mg/dL >=240 mg/dL
LDL (Bad) Cholesterol 130-159 mg/dL >=160 mg/dL
HDL (Good) Cholesterol >=40 mg/dL (men)
>=50 mg/dL (women)
N/A
Triglycerides 150-199 mg/dL >=200 mg/dL

If your LDL levels are high, your doctor can help you make a plan to lower them and reduce heart disease risk16. This might mean eating right, exercising regularly, or taking medicine if needed17.

Managing LDL Cholesterol Levels

Keeping LDL cholesterol levels healthy is key for a strong heart. There are two main ways to do this: changing your lifestyle and using medications18.

Lifestyle Changes

Living a heart-healthy life can really help lower LDL cholesterol. This means eating less saturated and trans fats, exercising often, and keeping a healthy weight18. Foods like monounsaturated fats, polyunsaturated fats, and soluble fiber can also help lower LDL and cut heart disease risk1819.

  • Eat 25 grams of soy-based foods daily to cut cholesterol by 5-6%19.
  • Have 4.5 ounces of beans a day to lower LDL by 5%19.
  • Use olive oil instead of animal fats to help lower LDL cholesterol19.
  • Add foods high in soluble fiber like barley, oatmeal, and legumes to stop cholesterol from being absorbed19.
  • Enjoy dark chocolate, avocados, fruits, and berries for their antioxidants and flavonoids that lower cholesterol19.

Being active, managing your weight, and reducing stress are also key to controlling LDL cholesterol20.

Medications

If changing your lifestyle isn’t enough, doctors might suggest cholesterol-lowering drugs, like statins20. For some, treatments like lipoprotein apheresis might be needed to remove LDL cholesterol from the blood20.

Some people take supplements like red yeast rice, flaxseed, and garlic to try to lower cholesterol. But, we’re not sure if they really work. Always talk to a doctor before trying new supplements20.

By making lifestyle changes and possibly using medications, you can manage your LDL cholesterol levels. This can help lower the risk of heart disease182019.

The Importance of Monitoring LDL Levels

Checking your LDL (low-density lipoprotein) cholesterol levels often is key for your heart health21. By tracking these levels, you and your doctor can spot any changes or trends. This helps you take steps to keep your cholesterol in check. This can prevent heart disease and other health issues.

The National Health and Nutrition Examination Survey (NHANES) from 1999 to 2006 found 20% of teens had high cholesterol21. But only a small number, 0.8%, needed medicine for it21. The NHLBI in 2011 said all kids should be checked for high cholesterol to find those at high risk21.

Adults can use the 2008 Framingham score or JBS3 risk score to predict heart disease risk21. The ATP III set standards for lipid levels, including LDL-C and triglycerides21. It also defined metabolic syndrome, which includes high cholesterol and obesity21.

Research by Neaton et al. linked high cholesterol with death in men22. The Cholesterol Treatment Trialists’ study showed lowering LDL cholesterol is safe and effective22.

Everyone should get their cholesterol checked regularly23. The NHLBI suggests starting at age 9 to 11, then every five years23. People over 65 should get tested yearly23. Treatment plans should be tailored to your health and risk factors23.

By keeping an eye on your LDL levels and acting on them, you can manage your cholesterol. This lowers your risk of heart disease. Regular check-ups and proactive steps are key for a healthy heart.

Cholesterol Level Desirable Range Borderline Range High Range
Total Cholesterol Below 200 mg/dL 200-239 mg/dL 240 mg/dL and above
LDL Cholesterol Below 100 mg/dL (Optimal)
Below 70 mg/dL (for those with coronary artery disease and other forms of atherosclerosis)
100-129 mg/dL (Near Optimal) Not Applicable
HDL Cholesterol 60 mg/dL and above Not Applicable Below 40 mg/dL in men, Below 50 mg/dL in women
Triglycerides Below 150 mg/dL 150-199 mg/dL 200-499 mg/dL (High), 500 mg/dL and above (Very High)

“Regularly monitoring your LDL cholesterol levels is crucial for managing your heart health and preventing the development of heart disease.”

Monitoring LDL cholesterol levels is very important. By knowing your levels and working with your doctor, you can keep your heart healthy. This reduces the risk of heart problems212223.

The Role of Genetics in LDL Cholesterol

Genetics can greatly affect an individual’s LDL cholesterol levels. Conditions like familial hypercholesterolemia (FH) are inherited and lead to very high LDL levels24. Knowing how genetics affects high LDL cholesterol is key for treatment and early action.

FH is a genetic disorder that messes with cholesterol metabolism, causing high LDL levels for life25. Sadly, over 90% of people with FH haven’t been diagnosed yet, showing a big gap in finding those with this condition25. FH is found more often in certain groups like French Canadians and Ashkenazi Jews, showing different genetic risks25.

Genetic changes in genes like the LDL receptor and apolipoprotein B cause most FH cases24. But, in 40-60% of suspected FH cases, no gene changes are found, pointing to other genetic factors24. The Global Lipid Genetic Consortium found 95 genetic spots linked to LDL cholesterol, showing how complex cholesterol control is24.

There are good treatments for high LDL cholesterol in those with genetic risks. Statin drugs can cut LDL levels by half or more, helping FH patients25. New drugs like PCSK9 inhibitors also help lower LDL, with some studies showing over 70% reduction with statins24.

Spotting and managing genetic high cholesterol early is key to avoiding heart disease. Testing family members of those with FH helps find those at risk26. By understanding genetic factors, doctors can tailor treatments and help patients lower their heart disease risk.

Genetic factors LDL cholesterol

The Link Between LDL Cholesterol and Other Health Conditions

High levels of LDL cholesterol, known as the “bad” cholesterol, are linked to serious health issues. High LDL levels can cause plaque to build up in arteries, a condition called atherosclerosis. This buildup can reduce blood flow and lead to severe diseases.

Coronary artery disease (CAD) is a major health issue linked to high LDL cholesterol. CAD is the most common heart disease in the U.S., affecting many people. LDL cholesterol buildup can cause arteries to narrow, leading to chest pain, heart attacks, and other heart problems.

High LDL cholesterol also raises the risk of stroke. Cholesterol plaque can narrow brain arteries, causing a stroke. High LDL levels can also lead to peripheral artery disease, reducing blood flow to the legs and arms, and sometimes requiring amputation.

People with diabetes and chronic kidney disease (CKD) face a higher risk of high LDL cholesterol and related health issues. Factors like being inactive, obese, or eating poorly can raise harmful cholesterol and triglyceride levels27. CKD patients are more likely to get coronary artery disease due to faster plaque buildup in their arteries28.

To stay healthy and lower the risk of these conditions, it’s key to keep an eye on and manage LDL cholesterol. This can be done through a healthy diet, regular exercise, and managing weight, along with medication if needed272829.

The Role of Diet in Managing LDL Cholesterol

Eating right is key to keeping LDL, or “bad,” cholesterol levels in check. By choosing foods low in saturated and trans fats and high in fiber, you can lower your LDL cholesterol. This helps reduce the risk of heart disease30.

Healthy Eating Habits

Changing what you eat is a powerful way to manage LDL cholesterol. Experts say to get no more than 25 to 35% of your daily calories from fats, with less than 7% from saturated fats30. Also, eating less than 200 mg of cholesterol daily can help lower your levels30. To keep your heart healthy, try to limit sodium to 2,300 milligrams a day30.

The Mediterranean diet is great for lowering LDL cholesterol. It focuses on whole grains, fruits, veggies, and healthy fats like those in nuts, seeds, and olive oil31. The Therapeutic Lifestyle Changes (TLC) diet also helps by cutting down on saturated and trans fats31.

  • Try to get 10 to 25 grams of soluble fiber each day to help lower LDL cholesterol31.
  • Keep saturated fat intake to 5% to 6% of your daily calories31.
  • Add 8 ounces of fish to your diet each week for heart health31.
  • Avoid trans fat by staying away from fast food, fried foods, and some baked goods31.
  • Choose healthy snacks like nuts, seeds, fruits, veggies with hummus or cheese, and Greek yogurt with whole grain cereal31.
  • Use baking instead of frying when cooking and flavor your food with herbs and spices31.

By making these changes and following a balanced diet, you can manage your LDL cholesterol levels. This reduces the risk of heart disease31.

“Dietary changes can have a significant impact on managing LDL cholesterol levels, which in turn can reduce the risk of heart disease and other related health conditions.” – Registered Dietitian

Remember, diet is just part of the picture. Managing LDL cholesterol might also mean exercising regularly and possibly taking medication as advised by a doctor32.

Exercise and LDL Cholesterol

Regular exercise is a great way to keep LDL cholesterol levels in check. Activities like brisk walking, jogging, or swimming help by boosting HDL cholesterol and improving heart health33. Also, staying at a healthy weight is key to managing LDL cholesterol33.

The American Heart Association suggests doing at least 150 minutes of moderate exercise each week to lower LDL cholesterol33. Sadly, about 1 in 4 adults worldwide don’t meet the recommended physical activity levels, says the World Health Organization33.

Studies show that certain exercises can really help with cholesterol. For example, a 2013 study found that daily walking for an hour, five days a week, for 24 weeks raised HDL cholesterol33. Another study in 2015 showed that regular strength training increased HDL cholesterol levels33.

To manage LDL cholesterol with exercise, the CDC recommends aiming for total cholesterol under 200 mg/dl, LDL under 100 mg/dl, and HDL over 60 mg/dl33. Regular exercise can also lower LDL cholesterol and blood pressure, which are good for the heart33.

A 2014 review found that resistance training in premenopausal people lowered total and LDL cholesterol levels after 14 weeks33. The AHA advises tracking heart rate during workouts, aiming for 50–85% of the max heart rate33.

In summary, combining cardio and resistance training is a great way to manage LDL cholesterol and boost heart health. By following guidelines and tailoring your workouts, you can keep your cholesterol levels healthy and reduce heart disease risk33.

“Regular exercise can raise HDL cholesterol, the ‘good’ cholesterol, with recommendations of at least 30 minutes of exercise five times a week or 20 minutes of vigorous aerobic activity three times a week.”34

Exercise isn’t the only way to manage LDL cholesterol. What you eat also matters. Foods high in saturated fats, like red meat and full-fat dairy, can increase total cholesterol34. On the other hand, foods rich in omega-3 fatty acids, such as salmon and flaxseeds, can help lower blood pressure34. Soluble fiber in oatmeal and apples can also reduce cholesterol absorption34.

Whey protein, found in dairy products, has been shown to lower LDL and total cholesterol levels34. Quitting smoking can also boost HDL cholesterol levels, cutting the risk of heart disease in half within a year34. Staying at a healthy weight through diet and exercise can also help lower cholesterol levels34.

Sometimes, medication may be needed along with lifestyle changes to control cholesterol levels34. By combining regular exercise, a heart-healthy diet, and possibly medication, you can take steps to keep LDL cholesterol levels in check and reduce heart disease risk34.

  1. Medical research indicates that weight training can have a positive impact on cholesterol levels by reducing LDL cholesterol and triglycerides while increasing HDL cholesterol35.
  2. Aerobic exercise is recommended by the American Heart Association to reduce triglycerides and raise HDL cholesterol levels35.
  3. The American Heart Association suggests getting at least 150 minutes per week of moderate-intensity aerobic exercise or 75 minutes of vigorous aerobic activity, combined with at least two sessions per week of moderate- to high-intensity weight or resistance workouts35.
  4. Research suggests that low- to moderate-intensity resistance training can help reduce total cholesterol levels, while high-intensity weight training is needed to boost HDL cholesterol35.
  5. Individuals who substitute weight training for cardio workouts can still lower LDL cholesterol levels35.
  6. Resistance training should be started slowly, with short workouts at lower intensity before gradually increasing effort levels35.
  7. Effort levels of 75%-85% of maximum intensity are recommended for resistance training aimed at managing raised cholesterol levels35.
  8. Doing more sets with more repetitions can have a greater effect on cholesterol levels than lifting heavier weights35.
  9. Combining cardio with resistance training through circuit training can provide both cardiovascular and resistance benefits35.
  10. Varying workout routines, mixing weight training with body-resistance exercises, and focusing on high intensity in workouts can optimize the impact on cholesterol levels35.

By adding a mix of cardio and resistance training to your routine, you can effectively manage LDL cholesterol and improve your heart health. Remember, being consistent and gradually increasing your efforts is key. Talk to a healthcare professional to create a personalized exercise plan that fits your needs and goals333435.

Emerging Treatments for High LDL Cholesterol

Lifestyle changes and traditional medications like statins are still key for managing high LDL cholesterol. But, new treatments are coming. PCSK9 inhibitors and lipoprotein apheresis are two examples. They can help people with high LDL cholesterol levels.

PCSK9 inhibitors have shown great promise in lowering LDL cholesterol by up to 60%36. They work by blocking a protein that affects LDL cholesterol levels. This means the body can clear out more LDL cholesterol. These drugs also cut the risk of heart disease by 15%36.

Lipoprotein apheresis is another new option. It uses a machine to remove LDL cholesterol from the blood. This is especially helpful for people with a genetic condition that causes very high LDL cholesterol36.

Researchers are also looking into gene-based therapies for high LDL cholesterol. For example, a drug called lepodisiran can lower lipoprotein(a) levels by 94% with just one dose37. Another therapy aims to be a one-time fix that targets the PCSK9 gene37. These are still being tested, but they could be big advances.

As new treatments come along, it’s important for people with high LDL cholesterol to talk to their doctors. They should look at both old and new options. By staying informed and active, people can better manage their cholesterol and lower heart disease risk.

“Innovative treatments like PCSK9 inhibitors and lipoprotein apheresis offer new hope for individuals with persistently high LDL cholesterol levels.”

Emerging Treatment Mechanism of Action Potential Benefits
PCSK9 Inhibitors Targets the PCSK9 protein, enabling more effective LDL cholesterol clearance Up to 60% reduction in LDL cholesterol36, 15% reduction in cardiovascular risk36
Lipoprotein Apheresis Selectively removes LDL and other harmful lipoproteins from the blood Effective for individuals with familial hypercholesterolemia36
Gene-based Therapies Target the underlying genetic factors contributing to high LDL cholesterol Potential for long-lasting, one-time treatments37, significant reductions in lipoprotein(a) levels37

383637

Conclusion

Understanding and managing LDL cholesterol is key for good heart health and lowering the risk of heart disease and stroke39. High LDL levels in the blood raise the risk of heart disease. Low HDL levels also increase this risk39. A healthy lifestyle, like eating well and exercising, helps protect the heart39. Studies show that exercise lowers the risk of chronic conditions and boosts mood and mental health39.

Working with healthcare providers to manage high LDL cholesterol is vital3940. Experts suggest checking cholesterol every five years for those over 20. A simple blood test can track overall health39. Medications like HMG-CoA Reductase inhibitors and PCSK 9 inhibitors can lower LDL levels and improve heart health40.

By understanding LDL cholesterol and managing it, people can greatly lower their risk of heart disease and other health issues394041. Ongoing monitoring and working with healthcare providers are crucial for keeping LDL levels in check. This leads to a healthier, more fulfilling life.

FAQ

What is LDL cholesterol?

LDL (low-density lipoprotein) cholesterol is often called the “bad” cholesterol. It can lead to plaque buildup in your arteries. This increases your risk of heart disease and stroke.

How does LDL cholesterol impact health?

High LDL cholesterol levels can cause plaque to form in your arteries. This is called atherosclerosis. The plaque can narrow or block arteries, affecting blood flow to your heart, brain, and other organs.

What factors can contribute to high LDL cholesterol levels?

Eating a diet high in saturated and trans fats, not being active, and being overweight or obese can raise your LDL cholesterol. Genetic factors, like a family history of high cholesterol or conditions like familial hypercholesterolemia, can also increase your levels.

How is high LDL cholesterol diagnosed?

A blood test called a lipid panel or lipid profile can diagnose high LDL cholesterol. This test checks the different cholesterol types in your blood, including LDL, HDL, and triglycerides.

How can high LDL cholesterol be managed?

Managing high LDL cholesterol involves lifestyle changes and medications. Eating a heart-healthy diet low in saturated fats and getting more active can help lower your LDL. If needed, your doctor may prescribe cholesterol-lowering drugs like statins.

Why is it important to monitor LDL cholesterol levels?

Keeping an eye on your LDL cholesterol levels is key for your heart health. It helps you and your doctor spot changes or trends. This way, you can take steps to keep or improve your cholesterol levels.

How do genetic factors influence LDL cholesterol levels?

Genetic conditions like familial hypercholesterolemia can cause very high LDL levels. Knowing the genetic link to high LDL cholesterol helps guide treatment and the need for early action and close monitoring.

What other health conditions are linked to high LDL cholesterol?

High LDL cholesterol is linked to an increased risk of many health issues. These include coronary artery disease, stroke, peripheral artery disease, diabetes, and chronic kidney disease.

How can diet help manage LDL cholesterol levels?

Eating a diet that’s low in saturated and trans fats and high in fiber can lower LDL cholesterol. The TLC diet and the Mediterranean diet are good examples of heart-healthy eating plans.

How does exercise affect LDL cholesterol?

Regular exercise, like cardio and strength training, can lower LDL cholesterol by boosting HDL cholesterol and improving heart health. It also helps you maintain a healthy weight, which is key for managing LDL cholesterol.

What new and emerging treatments are available for high LDL cholesterol?

Besides lifestyle changes and traditional medications, new treatments are being developed. These include PCSK9 inhibitors and lipoprotein apheresis. They offer more options for people with high LDL cholesterol that doesn’t respond to other treatments.

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