Cholesterol levels • This is what the LDL-HDL quotient & co. say

It is an important component of cell membranes and a starting material for the synthesis of many hormones: cholesterol is needed to produce bile acids, vitamins and hormones.

Article content at a glance:

What is cholesterol?

The body forms three quarters of all cholesterol as part of cholesterol synthesis in the liver and in the intestinal mucosa itself. The rest enters the body through food. Too much cholesterol is ingested in industrialized countries through the consumption of too much and too fatty food, especially animal fat.

Cholesterol is a blood fat. If the concentration in the blood is too high, cholesterol is deposited in the blood vessels: This can gradually clog them and the blood can no longer flow freely. Elevated blood lipid levels are therefore a risk factor for diseases such as arteriosclerosis, high blood pressure, heart attacks and strokes.

The blood test differentiates between HDL cholesterol and LDL cholesterol.

HDL – “good” cholesterol

HDL (high-density lipoprotein) cholesterol consists of half protein and half fat. It is formed in the intestinal mucosa and in the liver and is used to transport excess cholesterol back to the liver. Dangerous fat deposits are “collected” along the way. Cholesterol can be broken down in the liver and then excreted in the bile.

This is why HDL cholesterol is also called good cholesterol. It accounts for about 25 percent of all cholesterol in the body. Women have a hormonal advantage here: estrogens ensure that they form a particularly large amount of the “good” cholesterol, which largely prevents dangerous vascular deposits. This benefit gradually diminishes after menopause.

LDL – “bad” cholesterol

LDL (low density lipoprotein) cholesterol is the antagonist and is often referred to as bad cholesterol. LDL cholesterol is a protein with a high fat content produced in the liver. It transports cholesterol from the liver to the cells.

If too much of it circulates in the blood, this increases the risk of so-called plaques forming and calcifying the vessels. If this calcification is severe, the risk of high blood pressure, heart attacks and strokes increases. The healthy HDL helps prevent the harmful vascular deposits.

When and how is blood cholesterol determined?

The total cholesterol in the blood is also determined during preventive medical check-ups (health check-ups). The values ​​of HDL and LDL plus triglycerides, the third blood fat group, are output together. The values ​​obtained are used to estimate the risk of cardiovascular disease, diabetes mellitus or thyroid dysfunction.

If the corresponding diseases have already been diagnosed or if there is excess weight that needs to be reduced, the blood lipids can be used to monitor therapy and progress. Important to know: A high cholesterol level in the blood is often detected too late because it does not cause any symptoms. It is therefore important to have your cholesterol levels checked early and regularly.

The proportion of cholesterol is determined from the blood serum. The blood should be taken on an empty stomach, so the patient must not have eaten anything in the past twelve hours.

Cholesterol levels: which guide values ​​are healthy?

The standard values ​​for cholesterol in the blood depend on age and gender. The concentration of blood lipids generally increases with age, and the cholesterol level in women is then higher than in men. It is also significantly increased during pregnancy. A total cholesterol level of less than 200 milligrams per deciliter (mg/dl) is considered a healthy normal level.

Millimoles per liter (mmol/l) is also a common unit of measurement for cholesterol levels. 200 mg/dl corresponds to 5.17 mmol/l.

The LDL value in the blood should always be as low as possible. In the assessment, the doctor will use existing risk factors. These factors are:

• Smoking
• high blood pressure
• Diabetes mellitus
• overweight
• diagnosed cardiovascular diseases
• low HDL cholesterol
• heart disease in the family
• Age (men over 45 years, women over 55 years)

Cholesterol levels table

Depending on how many risk factors someone has, the target limits for LDL cholesterol and total cholesterol are as follows:

Risk	LDL cholesterol	total cholesterol
low risk (fewer than two risk factors)	below 116 mg/dl	below 200 mg/dl
moderate risk (two or more risk factors)	below 100 mg/dl	below 200 mg/dl
high risk (e.g. very high blood pressure)	below 70 mg/dl	below 180 mg/dl
very high risk (already diagnosed disease such as diabetes, arteriosclerosis, CHD, heart attack, stroke)	Aim below 55 mg/dl	below 180 mg/dl

If your own LDL cholesterol levels are above the recommended ones, you should seek medical advice and discuss whether the LDL value should be lowered below the upper limit of normal by changing your diet or using medication.

The proportion of HDL cholesterol in the blood should always be as high as possible, in men greater than 40 milligrams per deciliter and in women higher than 50 milligrams per deciliter.

What does the LDL-HDL ratio mean?

The ratio of LDL to HDL cholesterol is important for assessing the risk of arteriosclerosis and other cardiovascular diseases. This LDL-HDL quotient may be around 3.5 in a healthy person. Lower values ​​apply to people who are predisposed by certain risk factors, and it should be below 2.5 in patients with already manifested cardiovascular diseases.

Causes of high cholesterol

An unhealthy lifestyle that includes high-fat, animal-based foods and little exercise can increase blood levels of LDL cholesterol. In addition, a number of diseases have an influence on the blood lipid level. Kidney diseases, diabetes mellitus, obesity or hypothyroidism can be causes of elevated levels.

If the total cholesterol is increased, this usually correlates with an excessively high LDL cholesterol. Excessively high LDL values ​​can indicate bile stasis or urinary poisoning (uremia). The value is also affected by the intake of medication. These include steroid hormones or corpus luteum hormones (gestagens).

On the other hand, high HDL cholesterol levels are very rare. It has therefore not yet been clarified whether too high a value can reduce or even increase the risk of arteriosclerosis.

Causes of low cholesterol levels

In general, low total cholesterol and low LDL are considered desirable. Even if LDL cholesterol is very low, unlike when LDL is too high, there is no need for treatment.

A low level of the good HDL cholesterol is usually not associated with a disease. However, it has an unfavorable effect on the LDL-HDL quotient, i.e. the ratio of LDL to HDL. This can increase the risk of cardiovascular diseases such as arteriosclerosis or stroke.

In addition, noticeably low values ​​​​should be examined, as these can occur, among other things, with:

Lowering cholesterol reduces risk for blood vessels

The composition of blood lipids can be influenced above all by a conscious diet – and thus reduce the risk of vascular diseases. The general recommendation to use no visible fat at all, if possible, is no longer supported today. What type of fat is eaten is much more important for a healthy diet. In order to increase the HDL cholesterol value, one should avoid animal fat and instead consume vegetable fat with unsaturated fatty acids. So-called trans fats are also dangerous and should be avoided. These are mainly found in products with hydrogenated vegetable fats (margarine, frying fat, shortening). In addition, excess weight should be reduced, and regular exercise can also contribute to lowering cholesterol.

In the case of vascular diseases that have already been diagnosed (CHD, heart attack, stroke, arteriosclerosis), medication (cholesterol-lowering drugs, statins) can help to reduce cholesterol to less dangerous levels.