Your cholesterol reading on your blood test is made up of:
- good cholesterol (HDL)
- bad cholesterol (LDL)
- some other minor lipid particles that are not routinely measured on pathology testing
LDL – bad cholesterol
Vascular risk is mainly concerned with your bad cholesterol (LDL). And for most people, your LDL should be around 3.0 mmols/Litre.
If you have had previous coronary heart disease e.g. heart bypass surgery or stenting, your target LDL should be around 1.7 – 1 .8 mmols/Litre.
In addition, other high-risk scenarios such as Diabetes Mellitus warrant an LDL under 2.5 mmols/Litre.
Your LDL should go down by reducing your saturated fat intake, which mainly comes from red meats, full-fat dairy products, and unseen fats in restaurant and take-away foods, in particular.
HDL – good cholesterol
Your good cholesterol (HDL) is also important. Generally, the higher the HDL, the better. Therefore, if your HDL is above 1.5 mmol/Litre (more common in women), one can often tolerate a slightly higher LDL, than that mentioned in the paragraph above.
Another possible scenario is a very low HDL of under 1.0 mmol/Litre. This is potentially a risk factor because your protective HDL (which tends to mop up the bad LDL from your arterial walls) cannot therefore buffer any LDL available.
An isolated high triglyceride level is something that is not commonly seen — while it probably can pose some added risk to heart attack and stroke, currently we don’t know exactly how much risk, if not accompanied by a high LDL or low HDL.
We occasionally see a person with a profile of a high triglyceride (more than 1.7 mmols/Litre) combined with the low HDL, which is also a risk pattern seen.
Triglycerides seemed to be quite responsive in most people to reducing, particularly white carbohydrates, e.g. white rice, white bread, pasta and potatoes – swapping these food groups to low GI carbohydrates such as wholegrain or multigrain bread, brown rice, sweet potatoes etc.
Generally speaking, reducing your LDL by 1 mmol/Litre reduces your risk of heart attack by up to 30% – hence its significance.
The risk of coronary heart disease or stroke interplay between multiple risk factors, which include:
- family history
- your age (older is higher risk)
- your gender (male is worse)
- how your body handles sugar (Diabetes Mellitus being worse than impaired fasting glucose)
- smoking history (current smoker is worse than ex-smoker is worse than never smoked)
- other minor risk factors
The main points to remember
- The target for LDL, your bad cholesterol, ought to be around 3 mmols/Litre – unless you have added risk factors such as Diabetes Mellitus or a previous cardiovascular event.
- For your HDL (your good cholesterol), the higher the better. Occasionally we see people with HDL above 2.0 mmol/Litre ( e.g. 2.7 – 3.0 mmol/Litre). Generally, this is genetically determined. Women tend to run at a higher HDL than men. Factors that can increase your HDL can include a lot of exercise, and possibly fish oil supplementation. Generally regarding improving cholesterol readings, most of the leverage is in dropping LDL.
- Triglycerides have some importance, although they are not as important as LDL and HDL. Generally triglycerides go down with reducing carbohydrates and alcohol.