LDL (low-density lipoprotein) is the bad cholesterol. It is the Lousy cholesterol and you want that number as Low as possible. If HDL particles are the garbage trucks, LDL particles are the bags of garbage piling up in the streets.
LDL is the cholesterol that gums up your arteries and causes the buildup of blockages. It’s also the cholesterol that is toxic to the lining of your arteries, increasing the risk of a heart attack or stroke. It’s not surprising then that LDL cholesterol most often becomes the target for treatment in patients with coronary artery disease or those patients at high risk for developing coronary artery or vascular disease.
Most cardiologists agree that 130 mg/dL represents the upper limit of normal for LDL levels, and otherwise healthy individuals should try to attain a number close to or below that. As we accumulate other risk factors (older age, high blood pressure, family history of heart disease, or tobacco use), the LDL level should optimally fall closer to or below 100. Once heart disease is known to be present, or there is evidence of vascular disease elsewhere, a history of stroke, or the patient has diabetes, the LDL cholesterol level should fall close to or below 70. Achieving an LDL level below 70 is very difficult if you depend on lifestyle changes alone; it usually requires the use of cholesterol-lowering medications. The reason that we want to attain extremely low LDL levels in this latter group of patients, is that studies have shown that with very aggressive LDL lowering, we can actually see some regression in the blockages which have accumulated over time.
How can you lower your LDL cholesterol? By consuming a healthy diet (rich in fruits and vegetables, whole grains, but low in saturated fat), by getting regular exercise, and by attaining and maintaining a normal weight. LDL levels can change dramatically with lifestyle changes. You can see 30- or 40-point drops — especially if your lifestyle is particularly unhealthy to begin with.
LDL levels that start very high — well over 160 — tend to be at least partially genetically determined. Although adherence to a healthy lifestyle is still critical for these individuals, many will end up on cholesterol-lowering medications to attain goal LDL levels.
Medications for lowering LDL are plentiful and effective. From a treatment perspective, of the three cholesterol particles that make up the cholesterol profile, LDL is the easiest to control with medications. Nevertheless, these medications are not a substitute for good eating habits or healthy lifestyle choices. Medications will also be much more effective (meaning you will need lower doses) if you do your part and live healthfully.