How lipids (HDL and LDL) affect your heart health

Dr. James Underberg M.D. Clinical Assistent Professor Medicine and Clinical Lipidologist at New York University Medical School

If you’re even moderately interested in your cardiovascular system, you have probably encountered the term “lipid” before. Many people do not understand this term or know how it translates into real life complications, such as heart attack and stroke. Did you know that “lipid” is simply a medical term for fat found in the bloodstream? There are different types of lipids; the two major types of lipids are cholesterol and triglycerides. Here are some other basic facts you should know about lipids; keep this information in mind as you are preparing for your next appointment with your healthcare provider.

HDL cholesterol (HDL-C) is the measure of the cholesterol (lipid) carried in particles called high-density lipoproteins (HDL). HDL is known as the “good” cholesterol because the high-density lipoproteins usually carry harmful cholesterol molecules away from the vessel walls and return them to the liver where they are metabolized. This healthy process is called “reverse cholesterol transport.” Optimal HDL levels should be greater than 40 for males and greater than 50 for females. While HDL is thought of as good, the cholesterol contained inside these particles is no different from any other cholesterol.

On the other hand, LDL cholesterol is the measure of the cholesterol (lipid) carried in particles called low-density lipoproteins. These particles travel in the bloodstream and transport cholesterol from one cell to another. Too much LDL cholesterol in the bloodstream can lead to excess cholesterol being deposited in the walls of blood vessels making them narrower and causing the onset of heart disease. High levels of LDL cholesterol can put patients at risk for cardiovascular disease. However, having normal or elevated levels of HDL cholesterol does not necessarily protect one from the impact of elevated LDL cholesterol levels.

The most basic, fundamental thing you can do to protect your heart health is to have a frank discussion with your healthcare provider regarding your risk of developing heart disease. You should be clear on whether you can be treated through diet and exercise or, if risk is high enough, whether you should consider an appropriate level of drug treatment. This conversation should include discussion of your individual risk factors, which are conditions or habits that make one more likely to develop heart disease. The risk factors for heart disease and/or stroke include smoking, diabetes, family history, poor diet and lack of exercise.

It is essential for healthcare providers and patients to establish a treatment goal for LDL-C and another more important target called the non-HDL cholesterol—which, along with more exercise and better diet, are known to further prevent heart disease. You should discuss a lifestyle strategy that includes you own personal level of intensity of physical activity. Depending on the risk level, your doctor may also discuss the benefits and the risks of taking a drug (like statins) to control cholesterol level.

Every patient is unique and your healthcare provider should focus on the particular risk factors that you or your family members have—mainly high levels of cholesterol. Individual goals are necessary to assure high quality of care and provide patients opportunities for face-to-face discussion with their healthcare providers to increase the chances of success in reducing cardiovascular risk. Speak to your healthcare provider and become educated about what you can do to understand and manage your lipids best!

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Dr. James Underberg M.D.Clinical Assistent Professor

Dr. James Underberg, M.D., is a clinical assistant professor of medicine and clinical lipidologist at New York University Medical School and the NYU Center for Prevention of Cardiovascular Disease. He is the Director of the Lipid Clinic at Belle...

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