Cholesterol HDL:LDL

Cholesterol HDL: LDL

Cholesterol travels in the blood attached to lipoproteins. Low-density lipoprotein (LDL) carries cholesterol to tissues and can deposit it in artery walls, so clinicians call it “bad” cholesterol. High-density lipoprotein (HDL) picks up excess cholesterol and returns it to the liver for disposal, so it’s considered “good.” High LDL and low HDL raise the risk of atherosclerosis, heart attack and stroke.

Know your numbers: how tests read

A standard lipid panel reports total cholesterol, LDL-C, HDL-C and triglycerides. For most adults, clinicians view LDL under about 100 mg/dL as desirable and HDL above about 40 mg/dL for men and 50 mg/dL for women as protective; an HDL above 60 mg/dL is often considered optimal.

Targets are individualised by overall cardiovascular risk—people with prior heart disease or very high risk usually have lower LDL targets (often <70 mg/dL or a ≥50% LDL reduction). Always discuss your specific goal with your clinician.

Calculate simple, helpful metrics

You can quickly compute non-HDL cholesterol (total minus HDL) to capture all “bad” particles. Some clinicians also look at the LDL: HDL ratio or total cholesterol: HDL ratio to help risk assessment, but risk calculators and clinical context matter more than any single ratio. If your fasting lipid panel is abnormal, your clinician may repeat it or order advanced testing.

Step-by-step lifestyle changes that move numbers

A. Diet: replace saturated fats (butter, fatty red meat) with unsaturated fats (olive oil, nuts, fatty fish). Increase soluble fiber (oats, beans, fruits) and plant sterols; these lower LDL. Reduce refined carbs and added sugars, which can raise triglycerides.

B. Activity: aim for at least 150 minutes of moderate aerobic exercise or 75 minutes of vigorous activity weekly; exercise raises HDL modestly and helps lower LDL and triglycerides.

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C. Weight: lose excess weight—losing 5–10% of body weight typically improves LDL, HDL and triglycerides.

D. Quit smoking: Stopping smoking raises HDL and improves cardiovascular risk quickly.

E. Alcohol: Moderate alcohol can raise HDL, but raises other risks; don’t start drinking for cholesterol benefits.

When lifestyle isn’t enough: medications

If your risk is moderate or high, or LDL remains high despite lifestyle change, clinicians commonly prescribe statins, which robustly lower LDL and reduce heart attacks and strokes. Other options include ezetimibe, bile acid sequestrants and newer agents (PCSK9 inhibitors) for very high-risk or statin-intolerant patients. Medication decisions depend on risk calculators, previous heart disease, and tolerance.

Practical testing and follow-up steps

A. Get a baseline fasting lipid panel as recommended by your clinician.

B. If abnormal, repeat the test (after 4–12 weeks of lifestyle change or after starting medication).

C. Use cardiovascular risk calculators (ASCVD risk) with your clinician to decide treatment intensity.

D. Once on therapy, check lipids to confirm response (typically 4–12 weeks after medication start, then periodically).

How to prioritise actions (simple triage)

If you have established heart disease, diabetes, or multiple risk factors (high blood pressure, smoking, strong family history), prioritise a medical review for LDL targets and possible medication. If you’re low risk, start with diet, exercise and weight loss and recheck lipids in a few months.

Common misconceptions

Raising HDL with supplements alone rarely offsets high LDL—focusing on overall risk and lowering LDL usually matters more. Dietary cholesterol (eggs) has less impact on most people than saturated and trans fats, but individuals vary. If early heart disease runs in your family, ask about genetic testing for familial hypercholesterolemia because it changes targets and treatment urgency. Regular checks and a clear plan with your clinician are the most effective way to lower risk.

Simple action plan: book a lipid panel if you haven’t had one in the last year; start one concrete habit (swap butter for olive oil, add a 20–30 minute brisk walk most days, or choose oats for breakfast); talk to your clinician about your personal LDL target if you have risk factors.