You may have heard the terms lipids and cholesterol used interchangeably, and assumed they meant the same thing. The truth is a little more complicated than that. Lipids are fat-like molecules that circulate in your bloodstream. They can also be found in tissue throughout your body.
There are several types of lipids. Cholesterol is the best-known lipid. Cholesterol is actually part lipid, part protein. This is why the different kinds of cholesterol are called lipoproteins. Another type of lipid is a triglyceride.
Function of lipids in your body
Your body needs some lipids to remain healthy. Cholesterol, for instance, is in all your cells. Your body makes cholesterol, which in turn helps your body produce:
- certain hormones
- vitamin D
- enzymes that help you digest food
You also get some cholesterol from animal-based foods, such as:
- egg yolks
- red meat
Moderate levels of cholesterol in your body are okay. High levels of lipids, a condition known as hyperlipidemia, or dyslipidemia, raise your risk of heart disease.
Low-density lipoproteins vs. high-density lipoproteins
The two main types of cholesterol are low-density lipoproteins (LDL) and high-density lipoproteins (HDL).
LDL is considered the “bad” cholesterol because it can form waxy deposits called plaques in your arteries. Plaque makes your arteries stiffer. It also clogs your arteries, creating less room for blood to circulate. This process is called atherosclerosis. You may have also heard it referred to as “hardening of the arteries.”
Plaques can also rupture, spilling cholesterol and other fats and waste products into your arteries. In response to a rupture, blood cells called platelets rush to the site and form blood clots to contain the foreign objects now in the bloodstream.
If the blood clot is big enough, it can completely block the blood flow. When this happens in one of the heart’s arteries, called coronary arteries, the result is a heart attack. When a blood clot blocks an artery in the brain or an artery carrying blood to the brain, it can cause a stroke.
HDL is known as the “good” cholesterol because its main job is to sweep LDL out of your bloodstream and back to the liver. More cholesterol is then produced in your liver, restarting the whole process.
When LDL returns to the liver, the cholesterol is broken down and passed from the body. HDL represents only about one-fourth to one-third of cholesterol in the blood.
High levels of LDL are associated with a higher risk of heart attack and stroke. High levels of HDL, on the other hand, are associated with lower risks.
Triglycerides help store fat in your cells that you can use for energy. If you overeat and don’t exercise, your triglyceride levels can rise. Excessive alcohol consumption is also a risk factor for high triglycerides. Like LDL, high triglyceride levels are also linked to atherosclerosis. That means they also raise your risk of heart attack and stroke.
Measuring lipid levels
A simple blood test can reveal your levels of HDL, LDL, and triglycerides. The results are measured in milligrams per deciliter (mg/dL). Here are the measurements of normal lipid levels:
An important lipid measurement, called total cholesterol, is calculated by adding your LDL and HDL levels, and 20 percent of your triglycerides. Your total cholesterol may help your doctor determine your risk for a future heart attack. In a healthy adult, total cholesterol should be less than 200 mg/dL.
It’s a good idea to have your cholesterol levels checked every few years, unless your doctor recommends annual checks. If you have heart attack risk factors such as high blood pressure, a history of smoking, or a family history of heart disease, you may be advised to have your cholesterol checked yearly or even more frequently.
Your doctor may also want to do a regular cholesterol check if you’ve recently started a medication to help lower your LDL, just to see if the drug is working.
Your LDL levels tend to rise as you age. The same isn’t true for HDL levels. A sedentary lifestyle can also cause your cholesterol numbers to increase.
Dyslipidemia is a serious risk factor for heart disease, but it’s treatable for most people. People with high LDL levels often need medication to help keep LDL levels within a healthy range.
Statins are among the most widely-used medications to help control cholesterol. These drugs are usually well tolerated and very effective. There are several different types of statins on the market. Each one works a little differently, but they’re all designed to lower LDL levels in the bloodstream.
Some statins can help lower triglycerides, too. To have a significant effect, the statin often needs to be taken in a very high dose. Some statins may also help raise HDL levels slightly, but lowering LDL cholesterol is still the main job of a statin.
If you’re prescribed a statin, but have side effects such as muscle aches, tell your doctor. A lower dose or a different type of statin may be effective without causing any side effects.
You may need to use statins or another cholesterol-lowering drug for life. You shouldn’t stop taking the medication unless instructed by your doctor, even if you’ve reached your cholesterol goals.
Other medications that help lower LDL levels include:
- bile acid binding resins
- cholesterol absorption inhibitors
- combination cholesterol absorption inhibitor and statin
- combination statin and niacin
- PCSK9 inhibitors
With medication and a healthy lifestyle, most people can achieve cholesterol control.
Tips for managing cholesterol
In addition to statins or other cholesterol-lowering medications, you may be able to improve your lipid profile with some of the following lifestyle changes:
- Eat a diet low in dietary cholesterol and saturated fats, such as a diet low in red meat and whole-fat dairy. Work with a dietitian if you need help developing this type of diet.
- Exercise most, if not all, days of the week. The American Heart Association recommends at least 150 minutes of moderate-intensity exercise, such as brisk walking, every week. More physical activity is associated with lower LDL levels.
- Follow your doctor’s recommendations for regular blood work and pay attention to your lipid levels. These can change significantly from one year to another. Keeping track of your numbers will let you know you need to talk with your doctor about your cholesterol and triglycerides.