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The Good, Bad And Ugly About Cholesterol

About two in three adults have a cholesterol level that is higher than recommended. Having high cholesterol affects your heart and blood vessels and increases your risk of developing cardiovascular disease (CVD). High cholesterol causes fatty deposits (known as plaques) to build up inside your blood vessels.

When people mention their cholesterol level, they are usually speaking of total cholesterol. Your total cholesterol is a combination of all the different types of cholesterol, the good, the bad, and the ugly.

Lipoproteins, or blood fats, take several forms. The main substances are:

(1) Chylomicrons

(2) HDL (high-density lipoprotein) cholesterol

(3) VLDL (very low density lipoprotein), and

(4) LDL (low-density lipoprotein) cholesterol.


Chylomicrons (pronounced ky-low-my-krons) come from the fats we eat. Because fats are not well absorbed in their natural state, they need to be converted (or morphed) into a ore absorbable substance. As fat passes from the stomach into our small intestines, the enzymatic action of our pancreatic juices and bile from our liver and gall bladder create chylomicrons by rearranging these fat molecules and improving digestion.

Chylomicrons contain mostly triglycerides. There are some people with abnormal chylomicron production, based on genetic problems. They are able to produce chylomicrons but are unable to also break them down. However, for most of us, the enzyme lipoprotein lipase breaks down chylomicrons. This enzyme slices off the fatty acids from the glycerol molecule; then we can use the fatty acids for energy or store them in our fat cells.

HDL Cholesterol

There are two major forms of HDL cholesterol, referred to as HDL 2 and HDL3. Both forms protect us against cardiovascular disease. Most laboratories combine HDL2 and HDL3 counts and refer to the total as just HDL cholesterol.

HDL travels around in your bloodstream, sucking up cholesterol, much like a biological vacuum cleaner. HDL carries waxy cholesterol away from fatty deposits on your arteries, to be broken down in the liver. The higher your HDL cholesterol level, the better the cleaning job and the lower your risk of heart and blood vessel disease. To help you remember what is good for you, just remember that you want your high-density lipoprotein cholesterol to be high. The higher, the better.

VLDL Cholesterol

VLDL cholesterol contains mainly triglycerides, just like chylomicrons. VLDL can be formed by breaking up chylomicrons or can be manufactured by your liver. Then these triglyceride-loaded particles can be either transported to the rest of the body and used as energy, or stored in your thighs, waist, derriere, and other fat depots. Although high VLDL levels are related to coronary heart disease, they are not as damaging as LDL cholesterol. When VLDL (or chylomicron) levels increase, high triglyceride levels result and your HDL cholesterol level drops. This can compound the harm of a high VLDL cholesterol level.

LDL Cholesterol

LDL cholesterol is known as the “bad” cholesterol. Picture a molecule wearing a black cowboy hat, squeezing your arteries with black gloves, and depositing globs of yellow fat plaques. LDL cholesterol is a powerful risk factor for cardiovascular disease. For those without diseased blood vessels, reducing LDL cholesterol levels below 110 mg /dL will probably improve your ability to avoid heart disease. However, if you have coronary heart disease, it is recommended that your LDL cholesterol be lower than 100 mg /dL. At this level, cholesterol plaques begin to dissolve, and arteries become unobstructed. You want your low-density lipoprotein cholesterol level to be low. The lower, the better.

Classification of LDL, HDL, and Total Cholesterol (in mg/dL)
LDL Cholesterol 100
Near optimal/above optimal
130-159 Borderline high 160-189 High >190
Very high
HDL Cholesterol <40 Low >60 High
Total Cholesterol <200 Desirable 200-239
Borderline high
>240 High
Triglycerides <150 Normal 150-199
Borderline high
Very high

*Optimal LDL goal if you have heart disease, diabetes, or multiple risk factors.

Excess triglycerides in the blood stream are linked to coronary heart disease. High levels can be caused by genetic abnormalities, excessive fat intake, or uncontrolled metabolic problems such as diabetes.

Why Is My Cholesterol Different From Yours?

Our blood fat levels are controlled by many factors:

Breaking Down Cholesterol and Triglycerides

For greater health, we want our body to break down LDL cholesterol, chylomicrons, and VLDL (our main triglyceride particles) and create more HDL cholesterol “vacuum cleaners.” Although we often blame our shortcomings on heredity, we can take the bull by the horns (rather than eat the steer) and lower LDL cholesterol and triglyceride levels by making wise dietary choices (especially how much and what kind of fat we eat) and supercharging our fat-busting enzymes by losing excess body fat and getting regular exercise. The level of fat-metabolizing enzymes in your body depends, in part, on the amount and type of exercise you do.

Small amounts of alcohol (one to two drinks a day) may raise HDL cholesterol levels; however, higher amounts will increase triglyceride levels.

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