"The groundwork of all happiness is health." - Leigh Hunt

How low should LDL cholesterol be?

Good and bad

Cholesterol is a fatty substance that happens naturally within the body. The body uses it to make cell membranes and certain hormones. The fat you eat from food is absorbed within the intestine and travels to the liver, which converts it into cholesterol after which releases it into the blood.

Eating high-cholesterol foods often has a modest effect on blood cholesterol, but many such foods are also high in saturated fats, which have a greater impact on levels of cholesterol. “Much of your cholesterol level is determined genetically,” Dr. Cannon says.

There are two principal varieties of cholesterol: LDL and high-density lipoprotein (HDL). LDL is named “bad” because an excessive amount of of it within the bloodstream can remain contained in the partitions of the arteries. These deposits, called plaques, can rupture and trigger clots that block blood flow to the guts or brain, resulting in heart attack or stroke.

In contrast, HDL has historically been considered “good” because some types of HDL cause excess cholesterol to build up within the bloodstream and artery partitions. Still, notes Dr. Cannon, “Many clinical trials have found that raising HDL blood levels does not reduce the risk of heart attack or stroke, so the focus is on lowering LDL.” Is.”

From the numbers

Current guidelines from the American Heart Association and the American College of Cardiology set the perfect LDL level for the overall population at lower than 100 milligrams per deciliter (mg/dL). 100 to 159 mg/dL is taken into account high, and 160 mg/dL and better is taken into account dangerous.

People with known heart disease should aim for an LDL level below 70 mg/dL. “Thus, in all patients, high-risk individuals have a lower LDL goal,” says Dr. Cannon.

In addition to high LDL levels, having a number of other aspects may additionally contribute to your cardiovascular risk, reminiscent of

  • A family history of premature heart disease (a father or brother diagnosed at age 55 or younger, or a mother or sister diagnosed before age 65)
  • smoking
  • obesity
  • Diabetes
  • High blood pressure
  • Low HDL levels (below 40 mg/dL).

Why the deal with 70 mg/dL? “Studies show that when LDL drops below this number, plaque in the arteries becomes smaller and more stable, reducing the risk of heart attack and stroke,” says Dr. Cannon. ” says Dr. Cannon.

But how far below 70 mg/dL must you go? Clinical trials have shown and European guidelines recommend that individuals with the best risk of heart disease should keep LDL levels below 55 mg/dL. Dr. Cannon notes that the U.S. guidelines haven't been updated since 2018, and he believes they are going to eventually follow Europe's lead and make 55 mg/dL the brand new goal for high-risk individuals. .

What about those that usually are not at high risk? In most individuals on this group, LDL levels between 100 and 130 mg/dL could also be acceptable. “However, we still generally want to keep LDL levels below 100, as benefits have been seen in trials looking at ways to prevent heart disease,” says Dr. Cannon. “Ultimately, your doctor can prescribe an ideal target LDL based on your heart risk factors and history.”

Lifestyle and medications

The first step to lowering high LDL levels is to make dietary changes—reducing saturated fat by adopting a heart-healthy food plan like Mediterranean, DASH, or the same plant-based food plan— Lose weight, and increase exercise.

But medication is commonly needed to assist lower LDL levels which are too high and keep them low. This often starts with a sort of medicine called a statin.

Statins work to lower LDL by blocking an enzyme within the liver that helps make cholesterol. The drug also has anti-inflammatory properties, and inflammation is a known contributor to plaque buildup. Another profit: Statins help prevent plaques from breaking open and releasing chemicals that trigger the formation of blood clots, which result in blocked arteries and heart attacks. Depending in your LDL level, your doctor will prescribe one of the best statin and dosage in your situation.

The downside of statins is the potential negative effects. The most typical sore muscles are. If this happens to you, your doctor may temporarily lower the dose or switch to a unique statin.

While statins are the first-line drug of selection, three other classes of medicine also can help lower LDL—ezetimibe (Zetia), bempedoic acid (Nexletol), and PCSK9 inhibitors (Repatha, Praluent, or Leqvio). “Any of these three can be added to or substituted for statin therapy if people don't reach their LDL goal, or if they can't tolerate statin side effects,” says Dr. Cannon. are

Ezetimibe inhibits the absorption of cholesterol within the intestine. Bempedoic acid and PCSK9 inhibitors act on liver cell receptors to extend the uptake and destruction of LDL cholesterol, thereby lowering LDL blood levels.

Could your LDL be too low? Not really, says Dr. Cannon. “Getting LDL to a really low level can increase the risk of drug side effects, but very low LDL levels are not directly problematic.”

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