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It is not cholesterol as such that counts, but which particles act on the vessel wall for how long.
Also known as: dyslipidemia · LDL / HDL / triglycerides
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Fat is not freely soluble in blood; it travels in carriers. Two are named most often: LDL brings cholesterol from the liver to the tissues, HDL brings it back. If too much LDL stays on the road too long, it deposits in vessel walls — that is where atherosclerosis begins, silently and over years. So a lipid disorder does not hurt and is almost always found through a blood test. For the assessment it is not the single value that counts but the whole picture: how high is the LDL, how high the triglycerides, is there blood pressure, smoking, diabetes, excess weight, family cases? One important point is often missed — there is an inherited form in which LDL is already strongly raised at a young age; it is more common than assumed and is worth asking about if early heart attacks ran in the family. High triglycerides, by contrast, depend strongly on alcohol, sugar and weight and often move clearly with lifestyle. Measured expectation helps: diet and exercise shift LDL by a few per cent, not by half — that is not failure, that is the order of magnitude.
The strongest dietary lever for LDL: replace saturated fats (fatty meat, butter, palm oil) and trans fats with unsaturated ones (olive oil, nuts, fish).
Soluble fibre binds bile acids in the gut; the body pulls LDL from the blood to replace them. Well established and dose-dependent.
They block cholesterol absorption in the gut and lower LDL by about 10 %. In fortified products or as a supplement.
Not LDL alone decides, but age, blood pressure, smoking and sugar together.
They respond distinctly faster and more strongly than LDL.
With high LDL when young or early family cases, assessment is worthwhile.
For most questions a non-fasting sample is fine — for triglycerides fasting helps.
Statins inhibit an enzyme in the liver so that liver cells pull more LDL from the blood; ezetimibe slows uptake in the gut, PCSK9 inhibitors extend the life of the LDL receptors on the liver cell. All lower the value for as long as they are taken. What counts is not the value itself but how long it stays low.
On a statin, cholesterol reaches its new level after four to six weeks — so a check is not done before then. A moderate statin lowers LDL by about thirty to fifty per cent; doubling the dose adds only another six per cent, a second drug considerably more. A fasting sample is today usually unnecessary; only triglycerides depend strongly on the last meal and need twelve hours.
The usual case — found through blood, not through a feeling.
Visible fat deposits suggest a marked or inherited form.
Young, it is a pointer; in old age it is common and without meaning.
Before 55 in men, 65 in women — that belongs in the conversation.
Very high values can irritate the pancreas — the exception, but important.
Soluble fibre from oats and psyllium binds bile acids and measurably lowers LDL.
Traditionally used for the vessels; the effects in studies are small and inconsistent.