HDL Cholesterol vs. LDL Cholesterol

Cholesterol is a non-water soluble fat-like waxy substance, essential to body function in small amounts, which is introduced into the body by dietary fat and produced in the body by digestive processes of the liver. Cholesterol is transported through the body in the bloodstream as lipoproteins. There are two types of cholesterol: Low-density lipoprotein, LDL, called "bad" cholesterol, and High-density lipoprotein, HDL, called "good" cholesterol. Density of lipoproteins is classified by the ratio of fat to protein in the lipoprotein body, with lower density associated with higher fat content. Levels of HDL cholesterol and LDL cholesterol can be measured to determine the ratio of "good" and "bad" cholesterol with a blood test.

Along with HDL cholesterol and LDL cholesterol, triglycerides and Lp(a) cholesterol are included in total cholesterol count. Lp(a) is a genetic variant of LDL, also a type of "bad" cholesterol believed to be a risk factor in the premature development of arterial plaque. Triglycerides are associated with higher levels of LDL cholesterol, and lower levels of HDL cholesterol, as well as higher total cholesterol levels, and an increased risk of heart disease. Triglycerides are also used to measure the presence of very low density lipoproteins (VLDL) in the blood.

Elevated levels of LDL, "bad" cholesterol, are associated with an increased risk of heart disease due to its less efficient movement through the bloodstream to the liver, which results in the formation of deposits called plaque on the arterial walls. Heavy deposits can narrow the arterial walls and decrease the flexibility of the arteries, resulting in a condition called atherosclerosis, or hardened arteries. If blood clots form, they can lodge in the narrowed arteries, causing strokes or a heart attack. Insufficient blood flow to the heart due to narrowed arteries can result in chest pains, called as angina. Complete blockage of coronary arteries can result in heart attacks.

Higher levels of HDL, "good" cholesterol, are associated with a lowered risk of heart disease. It is believed that HDL cholesterol assists in lowering cholesterol levels by helping to carry LDL cholesterol through the bloodstream to be flushed from the system through the liver. A lower level of HDL "good" cholesterol is associated with a higher risk of heart disease. It is considered desirable for heart health to have a higher ratio of HDL "good" cholesterol to LDL "bad" cholesterol, which helps to keep total levels of cholesterol lower, reducing the risks associated with LDL cholesterol plaque build up in arteries.

Diet and heredity are both factors in individual levels of HDL cholesterol and LDL cholesterol, which can be controlled to some extent through a diet low in saturated fats, exercise, and medication, in order to increase levels of HDL "good" cholesterol, and reduce levels of LDL, "bad" cholesterol. Most current therapies are oriented to increasing HDL cholesterol, which is thought to decrease LDL cholesterol, which can be helpful in reducing the risk of accumulation of arterial plaque, which leads to a reduction in the risk of strokes and heart attack.

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