What’s the difference between “good” and “bad” cholesterol?

Cholesterol often gets a bad rep, but our bodies actually require cholesterol. It’s a waxy, fat-like substance that our livers produce, or we get it from the food we eat. Our bodies use it to build our cells, make hormones like estrogen, and it helps digest fatty foods. Cholesterol is not inherently bad, but high cholesterol, especially high levels of the wrong type of cholesterol can be bad for your health. Whether cholesterol is good or bad comes down to how it’s transported in the body.

Lipoproteins are the molecules in our body that transport cholesterol. Low-density lipoproteins (LDLs) are considered “bad” while high-density lipoproteins (HDLs) are considered “good”. Generally, the lower your LDLs and higher your HDLs, the better. Here’s why.

HDLs are considered good because they absorb cholesterol from the body and take it to the liver to be broken down. Too much cholesterol can build up in the arteries forming plaque. Because HDLs take cholesterol away from the arteries, high levels of HDLs can prevent this buildup, thus lowering your risk for heart disease and stroke. LDLs do the opposite.

LDLs are bad because they take cholesterol to the arteries where they can form plaque. When cholesterol and other fatty substances line artery walls, a condition known as atherosclerosis, the arteries become narrower and less flexible, making it harder for blood to flow to the heart, brain, muscles and other organs in your body.

Blocked arteries can cause angina, or chest pain. Even worse, a piece of the plaque can rupture and form a blood clot, disrupting the flow of blood entirely. If a coronary artery is blocked by a clot, the blood supply to your heart is cut off, leading to a heart attack. This is why although LDLs make up most of the body’s cholesterol, you don’t want your level to be too high, since it can be a risk factor for cardiovascular disease.

There are also very low-density lipoproteins (vLDLs) which are different from LDLs in terms of their composition. LDLs have more cholesterol than vLDLs, which have more triglycerides, another fatty substance in the body used for energy. Since triglycerides can also build up in the arteries and form plaque, it’s good to have low vLDL levels, too.

The bottom line is that the more cholesterol there is circulating in your blood, the higher the risk to your health. High LDL levels combined with low HDLs and high triglycerides can increase your risk of cardiovascular disease. These levels are measured in terms of milligrams per deciliter in your blood. Optimal values for evaluating cholesterol levels are: LDLs less than 100 mg/dl; HDLs above 60 mg/dL; and triglycerides below 150 mg/dL.

Now, the American Heart Association (AHA) recommends that doctors treat cholesterol levels as just one indicator which should be considered with other factors to determine overall risk for heart disease. The “optimal” ranges are not a sole determinant of health risk, but must be evaluated in the context of the patient’s age, racial or ethnic heritage, sex assigned at birth, overall health and medical history.

Since high cholesterol has no symptoms, the only way to know your levels is to get them checked. The AHA recommends that adults over age 20 get their cholesterol levels checked every 4 to 6 years, or more often if you have additional risk factors. Cholesterol is not just a problem for men, who tend to have higher cholesterol than premenopausal women. Everyone’s risk of high cholesterol goes up with age. Plus, diet, exercise, weight and even genetics can all affect your cholesterol levels.

If you want to check your cholesterol levels, get started with Alpha today. Your Alpha Provider may ask you to have your blood drawn at our partner lab, Quest Diagnostics, or a lab of your choice. If our medical team determines that your cholesterol is too high, we’ll work out a treatment plan suited to your needs. Consultations are all online, and we ship medication within days of prescribing. With Alpha, you can keep your cholesterol in check from the comfort of your home.