LDL Cholesterol

Medically Reviewed by James Beckerman, MD, FACC on May 23, 2024
3 min read

LDL cholesterol is often called the “bad” cholesterol because it collects in the walls of your blood vessels, raising your chances of health problems like a heart attack or stroke.

But cholesterol isn't all dangerous. Your body needs it to protect its nerves and make healthy cells and hormones.

Some cholesterol comes from the food you eat, and your liver makes more. It won’t dissolve in blood, so proteins carry it where it needs to go. These carriers are called lipoproteins.

LDL is a tiny blob made up of an outer rim of lipoprotein with a cholesterol center. Its full name is "low-density lipoprotein."

Most of the cholesterol in your body is LDL. The rest is high-density lipoprotein (HDL) or “good” cholesterol. HDL takes LDL to your liver, where it’s flushed out of your body. High HDL levels might protect against heart attacks and strokes.

A blood test can check your LDL, HDL, and total cholesterol levels. It also measures triglycerides, a type of fat that stores extra energy from your diet. High triglyceride levels can make you more likely to have heart problems.

Experts recommend testing every 4 to 6 years. You’ll probably need it more often if you have heart disease or diabetes, or if high cholesterol runs in your family.

Lower numbers are better when it comes to LDL cholesterol test results. The general guidelines for adults in the United States are:

  • Less than 100 milligrams per deciliter (mg/dL): Optimal
  • 100-129 mg/dL: Near or above optimal
  • 130-159 mg/dL: Borderline high
  • 160-189 mg/dL: High
  • 190 mg/dL and above: Very high

If you have a condition like heart disease or diabetes, your doctor might recommend an LDL target of 70 mg/dL or below.

High LDL cholesterol levels can make you more likely to have problems including:

Guidelines used to focus on lowering "bad" cholesterol to a specific number. Now, you and your doctor will probably work together to come up with a way to lower it by a certain percentage. It's based on how likely it is that you’ll have heart disease or a stroke.

Doctors use a calculator to estimate your odds of those problems in the next 10 years. The calculator considers several things, including:

  • Your cholesterol level
  • Your age
  • Your blood pressure
  • Whether you smoke
  • Whether you take blood pressure medicine

All of these things affect your chance of having a heart problem. Other risks include:

  • Diabetes
  • A history of heart disease in your family

Your doctor will set up a plan of lifestyle changes and/or medication that can lower your cholesterol levels and your overall odds of a heart problem. Your plan might include:

  • A healthy diet. Try not to eat things that are high in saturated fat, cholesterol, or simple carbs such as sugar and white flour. Eat more fiber and plant sterols such as margarine or nuts.
  • Regular exercise. The kind that gets your heart pumping is best.
  • Weight loss. Losing even 5 to 10 pounds can improve your cholesterol levels.
  • Quitting tobacco. If you have a hard time giving up smoking, your doctor can help you find the program that’s best for you.
  • Medication. Some drugs, like statins, help keep your body from making cholesterol. Another, ezetimibe (Zetia), lowers the amount of cholesterol your body gets from food you eat. If you can’t take statins or have a severe form of high cholesterol, you might get shots of PCSK9 inhibitors. These meds help your liver remove more LDL from your blood.