December 22nd, 2018
By Natan Schleider, M.D.
So you had a physical and your doctor told you you have ‘high cholesterol’ but what does this really mean?
Historically, labs could only test ‘Total Cholesterol’ so alevel above 200 was considered high and below 200 was considered normal. This is a vast oversimplification to the point that in the 21st Century, Total Cholesterol tells doctors very little as it includes both Good (HDL) and Bad (LDL) cholesterol. So, for example, if your LDL cholesterol in 90 (which is quite low) and your HDL cholesterol is 120 (which is quite high but that’s good, the higher the better) your Total Cholesterol would be above 200 and you would have enviable cholesterol.
I included my own cholesterol test results above. This is a fancier panel which some insurance companies will not cover but it is detailed and a good teaching tool.
The common cholesterol test (aka lipid test panel) your doctor performs includes the following which I will help you to interpret (so you can decide whether to skip the bacon cheeseburger and/or exercise more and/or add a medicine for cholesterol.
- LDL (Low Densiy Lipoprotein)–If you remeber anything, the LDL is THE MOST IMPORTANT NUMBER ON YOUR CHOLESTEROL TESTING. Commonly called bad cholesterol, LDL is the stuff that sticks to and clogs arteries anywhere in the body cauisng heart attacks and strokes and peripheral vascular disease. [Note different sub-types of cholesterol are sometimes called ‘particles’ and the smaller the particle the more likely it is to clog arteries. You will note my test has a ‘Lipoprotein Particle Evaluation’ which for our purposes is too complex to review and not that relevant for most patients]. As a general rule, if your LDL is above 160 treatment is immediately indicated, generally with a medicine. This does not mean you are committed to Lipitor for life but if your cannot keep you cholesterol below 160 you may need medicine indefinitely. Note I take Lipitor 40 mg daily for prevention reasons as current USPTF guidelines show that artifically lowering your cholesterol from normal to low reduces risk of artery clogging, heart attack, and stroke. If LDL is below 100 you are in the clear (unless you have high risk factors for artery clogging like diabetes, tobacco smoking, or perosnal history of heart attack or stroke) in which case LDL should be below 70. If your LDL is between 100 and 160 there is some debate but as a general rule, if you have zero risk factors for artery clogging try to get LDL to 130 or less without medicine. If you have some risk factors for artery clogging like obesity or high blood pressure try to get LDL to 100 or lower.
- HDL or Good Cholesterol–This should be above 40 ideally but the higher the better. While some new injectable medicines can raise HDL, as of 2018 these are not commonly used in primary care. Only regular exercise brings up good cholesterol although statin medicines like Lipitor may help a bit.
- Triglycerides–These are a type of fat that do not stick to arteris very well so I won’t say they are not important but will say try to keep levels below 150 with diet and exercise and consider a medicine if they run above 150.
- Total Cholesterol–As mentioned before, no real information here, the devil is in the details of the other tests.
So that covers the basics on cholesterol. I know I am seeing an educated intelligent patient when they say “Tell me about my LDL and HDL, the total cholesterol doesn’t matter much.’
Thanks for reading,
Natan Schleider, M.D.