Lowering Cholesterol and the Difference between HDL and LDL

1. How can I lower my cholesterol?

Cholesterol can be lowered by a variety of means which traditionally begins with therapeutic lifestyle changes (diet, weight loss, exercise) followed by drug therapy. Diet alone may be able to lower total cholesterol and LDL (bad) cholesterol from 7-30% depending on how restrictive the dietary plan. Most diets recommend limiting fat and cholesterol intake, specifically saturated fats and trans fatty acids, and increasing the intake of plant steroids and fiber. A variety of specific foods such as walnuts and soy proteins and dietary supplements such green tea and cholesterol lowering margarines have been shown to have a modest effect in reducing cholesterol. Weight loss and the amount of weight lost parallel improvements in triglyceride and cholesterol levels. The duration and level of exercise also parallel improvement in all aspects of cholesterol profile. Even low amounts of exercise such as walking 30minutes/day 5-7days/wk has been shown to have a positive impact on cholesterol levels. Smoking cessation is another lifestyle change that can improve cholesterol.

Drug therapy is generally started after therapeutic lifestyle changes have failed to meet target cholesterol reduction or concomitantly when it is anticipated that therapeutic lifestyle changes will not solely be sufficient to minimize heart disease risk. Numerous classes of drugs including statins, fibric acid derivatives, bile acid sequestrants, nicotinic acid, and cholesterol absorption inhibitors are available to not only reduce cholesterol but also improve overall cholesterol profile. Certain drugs may lower bad cholesterol up to 60% and raise good cholesterol by as much as 25%. Although each drug class and drug has their own specific risk, in general drugs are well tolerated and have proven to be very effective. Lastly, given that only 1/3 of patients being treated for high cholesterol are meeting target goals and only ~1/2 of persons prescribed a lipid lowering drug are still taking the medication 6 months later, compliance and a constructive physician-patient relationship are vital to any cholesterol lowering treatment plan.

2. What is the difference between HDL and LDL?

HDL stands for high density lipoprotein and is considered good cholesterol. HDL accounts for ~1/3 of all blood circulating cholesterol and serves as a protective mechanism from the development of heart disease by carrying away cholesterol from vessel walls and plaque to the liver for disposal. Higher levels of HDL have been shown to reduce the risk of heart attack and stroke.

LDL stands for low density lipoprotein and is considered bad cholesterol. LDL is a necessary protein in the body for it transports substances vital to cell function and development. When there is an excess of LDL in the blood or when it undergoes structural changes from certain body stresses, LDL can become harmful by accumulating in blood vessels walls. This can lead to blockages in arteries or unstable plaque build-up which is prone to rupture and the formation of blood clots. Levels of LDL and its subtypes are directly related to the risk of heart attack and stroke.