Step 1: What is cholesterol and why is it important?

Cholesterol is a white waxy substance used in building cell walls and producing hormones. Every cell in your body can make cholesterol, but most of it is made in our live. It can also be found in some of the foods we eat.

You’ve probably heard HDL called the “good” cholesterol and LDL is the “bad” cholesterol. HDL and LDL both carry cholesterol but have different jobs. LDL takes cholesterol to other parts of the body where cholesterol is needed to work properly. HDL collects extra cholesterol in the body and returns it to the liver for recycling.

When there is too much LDL cholesterol in the bloodstream, it penetrates and irritates the walls of the arteries. This causes inflammation, plaque buildup, and blockages. If your LDL cholesterol levels stay high, it can lead to cardiovascular disease or even death.

We know LDL plays a key role in these processes, and the evidence is clear that high LDL is a key risk factor for heart disease.

Many people live with LDL cholesterol levels that are too high for too long, and the consequences can literally be deadly. In fact, research from the Family Heart Foundation shows that 7 out of 10 of Americans at high risk for cardiovascular disease are not reaching recommended LDL levels, leaving them in the Danger Zone.

When there is too much LDL cholesterol in the bloodstream, it penetrates and irritates the walls of the arteries. This causes inflammation, plaque buildup, and blockages. If your LDL cholesterol levels stay high, it can lead to cardiovascular disease or death.

The good news is that there are many ways to lower your LDL and lower your risk.

Step 2: What is being tested when I get a cholesterol test?

A cholesterol test, otherwise known as a lipid panel, is a simple blood test that can be ordered by your healthcare provider. It’s important to understand the results of your lipid panel. Don’t count on the doctor’s office to call you with results. In fact, it is best to get your cholesterol test done before a visit with your healthcare provider so you can discuss the results. The lab report may be available from your doctor or through your online patient portal, like MyChart.

These test results can be overwhelming and confusing. Here are key things to look for:

Total Cholesterol

Your total cholesterol can be calculated by adding together your HDL, LDL, and 20% of your triglycerides. It is possible to have “normal” total cholesterol and still have very high LDL. This is why it’s important to look at each number to know if you are in the Safe Zone.

HDL Cholesterol (High Density Lipoprotein Cholesterol)

This is sometimes called the “good” cholesterol because higher levels are associated with lower risk for cardiovascular events. HDL brings excess cholesterol from other areas of the body and return it to the liver for recycling.

However, having high HDL is not enough to outweigh the harmful effects of high LDL.

LDL Cholesterol (Low Density Lipoprotein Cholesterol)

This number is key. This “bad” cholesterol is what can build up in the arteries and causes heart attacks and strokes.

LDL is a lipoprotein that carries cholesterol in the blood. It is not actually cholesterol, but it carries cholesterol through the body. When LDL’s job is done, it returns to the liver for recycling. If that recycling process is impaired, LDL can build up in our artery walls.

Higher LDL levels are known to cause cardiovascular disease. If your LDL is very high, it is likely due to or at least influenced by genetics. Changing your diet can lower LDL, but on average by 10-15%. If you have very high LDL, you may need one or more medications to lower it to the Safe Zone. Don’t wait to get there – you can always start medication and work on your diet at the same time.

Triglycerides

This is another type of fat in the bloodstream that’s linked to heart disease and stroke. Basically, triglycerides store unused calories and deliver energy to your cells when they need them.

Triglyceride levels change throughout the day and respond quickly to what you eat or drink. That’s why you need to fast before you have your cholesterol panel done. A high triglyceride number can make your total cholesterol level high, even if your LDL is low. If your triglyceride level is too high, your test results may say your LDL could not be calculated. Very high triglycerides (over 500 mg/dL) can cause pancreatitis and should be treated urgently. Diet and medications for triglyceride reduction are different from those used to lower LDL. It is also important to point out that exercise can play a key role in lowering triglycerides and alcohol can raise triglycerides. In fact, a single alcoholic beverage in some people can significantly raise triglycerides.

Lipoprotein(a), also known as Lp(a)

High lipoprotein(a), also known as Lp(a) is another important risk factor for developing cardiovascular disease. It’s different from LDL and can lead to blockages in the arteries, inflammation, and blood clotting. Some people have both high LDL and high lipoprotein(a), increasing their risk.

A lipoprotein(a) test is not included in a regular lipid panel and most people have never had their Lp(a) tested. To understand your risk for cardiovascular disease, you should ask to have your Lp(a) tested. Most people do not need regular Lp(a) testing – it is either high or it is not high and it does not generally change very much. If it is high, the recommended course of action is to manage all of your other cardiovascular risk factors, including lowering your LDL.

It’s better to have higher HDL and lower LDL, triglycerides, and lipoprotein(a).

A note about ratios

Lab reports often include the HDL/LDL ratio. This was once thought to be more important than experts think it is today. If your LDL is high, a good ratio is not considered protective.

Other numbers

A lipid panel may also include other results, including Apolipoprotein B (ApoB) and non-HDL. Essentially, they are different ways of looking at the same numbers. Again, if your LDL is too high, these numbers will be affected. Your overall goal should be reaching the LDL Safe Zone.

If you have any questions, contact the Family Heart Foundation Care Navigation Center or call your doctor.

Step 4: What can I do next?

A heart-healthy diet is key to everyone’s good health, and it’s a great first step. Some people can get to their LDL Safe Zone through a healthy diet.

But on average, most diet changes will lower LDL cholesterol levels by approximately 10-15%. Many people need more than that – especially if their LDL is very high and especially if they already have cardiovascular disease.

When diet and exercise are not enough, there are many effective LDL-lowering medications that can get you to the LDL Safe Zone and keep you there. Some people will only need one, while others may need more than one in combination.

Don’t wait to start medication if your LDL is in the Danger Zone. Cardiovascular disease develops over time and cannot be reversed once the damage is done. The sooner you get your LDL to the Safe Zone, the sooner you start lowering your risk for a heart attack, or for another heart attack, stent, or bypass surgery if you already have cardiovascular disease. You can always incorporate heart-healthy dietary and lifestyle changes alongside the medication, but the sooner you get to the Safe Zone, and the longer you stay there, the lower your risk for heart disease and stroke will be.

If you have any questions, contact the Family Heart Foundation Care Navigation Center or call your doctor.

Step 3: What do the results mean for me and my future?

If your cholesterol test comes back with high levels of LDL, your healthcare provider may prescribe lipid-lowering therapies. For decades, statins have been the first line of defense for most people. Today, there are many therapies that work to significantly lower LDL cholesterol.

This is good news as many people need more than one treatment to get to their LDL Safe Zone.

There are usually no symptoms for high cholesterol. Don’t let the first symptom of your high cholesterol be a heart attack or stroke.

Medical guidelines from the American College of Cardiology and the American Heart Association in 2018 give clear recommendations for your LDL Safe Zone based on your risk factors.

These guidelines recommend an LDL level below 100 mg/dL for everyone with the exception of those with cardiovascular disease (see below).
For someone who already has cardiovascular disease, no matter their untreated LDL level, the recommendation is to get LDL below 70 mg/dL.

*LDL over 190 mg/dL is considered “severe hypercholesterolemia” and might be an indication that you have familial hypercholesterolemia (FH), especially if you also have a family history of high cholesterol or premature heart disease. FH is a serious and common genetic cholesterol disorder affecting 1 in 250 people. If you suspect you may have FH, contact our Care Navigation Center for help.

If your LDL cholesterol is high, that leaves you at risk for cardiovascular disease.

Cardiovascular disease includes:

Heart Attack (also known as Myocardial Infarction or MI)
Stroke
Transient Ischemic Attack (TIA)
Angina (Chest Pain)
Coronary Artery Bypass Surgery (Bypass or Open-Heart Surgery)
Stents

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September 24 is FH Awareness Day - Join us in raising awareness!

Journey to the LDL Safe Zone

STEP 1

STEP 2

STEP 3

STEP 4

Family Heart Foundation research shows us that people who live with high levels of LDL cholesterol, not in their Safe Zone, are significantly more likely to have heart attacks, strokes, or other cardiovascular events.

High risk patients mostly NOT AT GOAL (>70% of time) had

than high risk patients mostly AT GOAL (>70% of time)

Unfortunately, we also know that most Americans who are already at high-risk of cardiovascular disease have never reached their LDL Safe Zone.

And even that small number of Americans who reach their LDL Safe Zone don’t stay there for very long. On average people keep their LDL at goal for less than 6 months at a time.

Take action now to get your LDL cholesterol to the Safe Zone and save yourself from a heart attack or stroke.

The Family Heart Foundation gratefully acknowledges our Family Heart Campaign Partner Sponsors, Amgen and Regeneron.

Step 1: What is cholesterol and why is it important?

Step 2: What is being tested when I get a cholesterol test?

Step 4: What can I do next?

Step 3: What do the results mean for me and my future?

Join us in the fight