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Cholesterol Blood Testing: Why We Do It

Cholesterol Blood Testing: Why We Do It

Screening for high cholesterol is often included in our annual blood work. Monitoring the cholesterol level helps us to identify and correct changes before an event occurs, such as a heart attack or stroke.

Cholesterol, a waxy, fat-like substance, is found in all the cells in our bodies. It is used to make hormones, vitamin D, and substances that help digest foods. Cholesterol comes from two sources:

  • Our liver makes all the cholesterol we need

  • The remainder of cholesterol comes from our diet

If we have too much cholesterol in our blood, plaque can form:

· Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood

· Over time, plaque hardens and narrows our arteries, causing atherosclerosis

· This limits the flow of oxygen-rich blood to the heart, brain, and other parts of our body

Blood Testing

HDL, triglycerides, LDL, and VLDL are a combination of fat (lipid) and protein, called lipoproteins:

  • Total cholesterol: total measurement of '“good” and “bad” cholesterol

  • HDL: high-density lipoprotein. It’s often called the “good” or “healthy” cholesterol. It carries cholesterol from other parts of the body back to the liver, which then removes it from our bodies. (HDL begins with an H = Healthy)

  • Triglycerides: the most common type of fat in our bodies. These are the calories that we eat but the body does not need right away. Our bodies changes them into triglycerides and stores them in fat cells. When the body needs energy, it releases the triglycerides

  • LDL: low-density lipoprotein. It is a "bad" cholesterol because a high LDL level leads to the buildup of plaque in our arteries

  • VLDL: very low-density lipoprotein. It is another “bad" cholesterol because it too contributes to the buildup of plaque in our arteries

  • Chol/HDL ratio: Total cholesterol divided by HDL. The higher the ratio, the higher the risk

  • non-HDL: Total cholesterol minus HDL. Number containing the “bad” types of cholesterol


Heart-healthy lifestyle changes

  • Diet

    Soluble fiber binds to cholesterol and removes it before it gets into the bloodstream: oats, barley and whole grains, beans, fruits, and vegetables

    LDL-lowering foods: nuts, vegetable oils, soy

    Triglyceride-lowering foods contain high levels of omega-3 fatty acids: Fatty fish (mackerel, herring, tuna, salmon, trout)

    Foods fortified with sterols and stanols: blocks the body from absorbing cholesterol (found naturally in plants)

    (Unhealthy fats: trans and saturated; Healthy fats: monounsaturated and polyunsaturated)

The Food and Drug Administration has banned the use of partially hydrogenated vegetable oils by January 1, 2021.

  • Being physically active can lower LDL cholesterol and triglycerides and increase good HDL cholesterol. The higher the HDL, the better

  • Managing stress. Chronic stress can sometimes increase LDL cholesterol levels and decrease HDL cholesterol levels

  • Quitting smoking


In previous years, the decision to start medication and medication management was primarily based on the lab result numbers. A Cardiovascular Risk Assessment tool is now used to assess our 10-year risk of having an event, such as a heart attack or stroke. Healthcare providers use the risk percentage in combination with our overall health to determine the need for medication to lower cholesterol.

There are several risk assessment tools online. You will need the following information to assess your risk percentage, depending on which tool you use:

  • Gender: male or female

  • Age

  • Race

  • Total cholesterol

  • LDL cholesterol

  • HDL cholesterol

  • Treatment with a statin? (Medications used to treat high cholesterol)

  • Systolic blood pressure (top number)

  • Diastolic blood pressure (bottom number)

  • Treatment for hypertension? (high blood pressure medication)

  • History of diabetes?

  • Current smoker?

  • Aspirin therapy?

Cardiovascular Risk Assessment tool examples:

Low-risk (<5%)

Borderline risk (5% to 7.4%)

Intermediate risk (7.5% to 19.9%)

High risk (≥20%)

According to the American College of Cardiology: “These estimates may underestimate the 10-year and lifetime risk for persons from some race/ethnic groups, especially American Indians, some Asian Americans (e.g., of south Asian ancestry), and some Hispanics (e.g., Puerto Ricans), and may overestimate the risk for others, including some Asian Americans (e.g., of east Asian ancestry) and some Hispanics (e.g., Mexican Americans).

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