The “bad” cholesterol: LDL

Low-Density Lipoprotein (LDL) is the infamous “bad” cholesterol linked to arteriosclerosis, heart diseases, strokes and peripheral arterial disease. Many good scientific studies have strongly linked high LDL levels with these diseases.


The mechanisms behind the link

The body needs cholesterol to build cells, produce hormones and many other processes, but there is one problem:

Cholesterol is not soluble in blood.

In order to transport cholesterol to different sites in the body where it is needed, lipoproteins are created. LDL is one such lipoprotein. LDL wraps cholesterol in its centre and transports cholesterol from the intestines where food is digested or the liver where cholesterol is produced to sites where it is needed.

Wait, a minute! If it is useful, it should not be bad then? Excessive amounts of LDL will result in atherosclerosis whereby cholesterol is deposited in arteries to form plagues which clog them up.

These clogged arteries may progressively become narrower and limit blood flow to vital organs such as the heart or brain. Sometimes, these plaques may also rupture due to their unstable nature. This causes the formation of blood clots that can completely hinder blood flow. When blood flow is obstructed, the surrounding cells will be deprived of oxygen and nutrients which eventually lead to tissue death. If this happens in the heart, it is termed a heart attack, in the brain then it is called a stroke, while it is called peripheral arterial disease when it occurs in limbs.


Why me?

There are multiple causes to high LDL levels. Poor lifestyle choices such as lack of exercise or over-eating play an important role.  Furthermore, genetics play an important role in high cholesterol levels. People with immediate family members who have high cholesterol levels are more likely to have the same problem.


My LDL cholesterol level is high! What can I do?

Since high LDL levels increase the risk of heart diseases and stroke, then focus should be placed on reducing LDL levels and other factors that increase all these risks.

Risk factors may be classified as modifiable (which means that it’s something we can try to change) or non-modifiable (which is something that cannot be changed, such as gender).

Modifiable risk factors are:

  • Cigarette smoking
  • High blood pressure
  • Diabetes
  • Lifestyle
  • Low HDL

Non-modifiable risk factors include:

  • Gender: Higher risk in males and lower in females. However, the risk for females will become the same as males once they attain menopause.
  • Age: The older one becomes, the higher the risk.
  • Family history: Immediate family members with high cholesterol and/or heart diseases at a young age (<55 for male relative, <65 for female relative)


Things you can do to change the modifiable risk factors.

For smokers, it is advisable to stop smoking. You may seek help from pharmacists who provide smoking cessation counselling. By quitting the habit, you also gain various health benefits compared to those who smoke.

In patients who have high blood pressure, diabetes or both, they should be under follow up with their doctor and make sure they stick to the treatment prescribed.

Lifestyle modifications include frequent exercise, eating well and losing weight. Cardiovascular exercises such as jogging, swimming or aerobics are recommended. Even though cholesterol-rich food has been shown NOT to cause cholesterol levels to rise, a balance and healthy diet is still beneficial. A good diet with ample fruits and vegetables, high fibre, and rich in healthy fats such as fish oil reduces LDL, raises HDL and is good for the heart. More details in our infographic here. Lastly, with a good diet and exercise, one should lose weight which not only makes you feel better, but also good for your heart.


Do I have to take medicines?

There are a few types of medications that are useful in reducing cholesterol. The most well-known of all is a group of drugs called statins. It is a largely misunderstood group of medications where its safety is a concern to many patients. It is safe and effective when taken properly with regular follow-ups.

Cholesterol reducing medications may be started by your doctor if you have the following conditions:

  • Heart attack or stroke
  • Certain heart disease but not heart attack
  • Diabetes
  • Peripheral arterial disease
  • High risk for heart attacks or stroke

Even though you make not feel any difference when taking a statin, do not stop taking it without discussing with your doctor first.


How do I know if I have high risk for a heart attack?

It’s easy. Read our article here. It even comes with a calculator for you to calculate your risk.

If your risk is high, you should consult your doctor on what to do next.


What level of LDL is desirable?

The cut-off levels for desirable LDL various from person to person. It depends on the risk for heart attack as mentioned previously. Calculate your risk for heart attack and then compare it with the table below to find out which LDL level is ideal for you.


  1. Patient education: High cholesterol (The Basics) [Internet]. 2018 [cited 18 January 2018]. Available from:
  2. Kasper D, Harrison T. Harrison’s Principles of internal medicine. New York: McGraw-Hill Education; 2015.
  3. Barr N. Cholesterol Is Finally Officially Removed From ‘Naughty’ List [Internet]. 2018 [cited 18 January 2018]. Available from:–naughty–list-122559246.html
Pou Wee Gan
Pou Wee Gan

M.Pharm, MBBS, BCPS, R.Ph

A pharmacist first, then a medical doctor. An avid tea drinker and an occasional poet.

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