Cholesterol is a fat-like substance found in your blood and is in all the cells of your body.
Your body needs it to make cell membranes, vitamin D, and hormones like estrogen and testosterone.
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Your liver is responsible for producing around 80%¹ of the cholesterol you need.
The remaining 20% of the cholesterol you need comes from the foods you eat. However, plants can’t make it, so you’ll only find it in meat and dairy products. This includes fatty meat, sausages, butter, ghee, and yogurt.
Cholesterol is fat, so it can’t travel around the blood on its own. Instead, it requires a carrier protein. To solve this, tiny particles known as lipoproteins enable cholesterol to move freely throughout the body.
Lipoproteins are composed of a triacylglycerol and cholesterol core with a phospholipid outer shell that contains a particular protein (apolipoprotein) to stabilize the structure. The types of lipoproteins you need to know about are LDL, HDL, and VLDL.
LDL, low-density lipoprotein, is commonly referred to as bad cholesterol. LDL is responsible for transporting cholesterol made in the liver. It’s often described as 'bad' cholesterol because if LDL increases, it can lead to plaque buildup in your arteries. Too much plaque can cause coronary heart disease, and in more severe cases, it can lead to heart attacks.
HDL, high-density lipoprotein, is responsible for absorbing cholesterol and carrying it back to the liver. This allows your liver to then remove it from the body.
If your HDL levels are high, you have a lowered risk of heart disease and stroke. HDL also helps to remove LDL from your arteries.
VLDL, very low-density lipoprotein, is similar to LDL, except it is mainly responsible for carrying triglycerides, rather than cholesterol, to your tissues. It does carry cholesterol, just much less frequently.
Triglycerides are a type of fat and are our main source of energy. The body produces triglycerides, and they also come from the food we eat.
Triglycerides that aren’t required by the body straight away get stored as fat cells. When your body needs energy, they get released. As VLDL delivers triglycerides to your tissues, it gets transformed, eventually becoming LDL.
A normal range of VLDL sits around 2 and 30mg/dl. Higher than this is a strong risk factor for heart disease and stroke.
High VLDL, like LDL, can lead to plaque buildup in your arteries, known as atherosclerosis.²
Plaque comprises fat, cholesterol, calcium, fibrin, and cellular waste. This results in narrowing passages, restricting blood flow. Left untreated, this can lead to cardiovascular disease, a leading cause of death.
Elevated levels of VLDL have additionally been associated with major adverse limb events (MALE).³ Major adverse limb events are defined as severe limb ischemia requiring intervention or major amputation.
Recommendations for VLDL tests depend on a variety of factors. These include your family history of high cholesterol, age, and other risk factors.
Talk to your doctor about whether you could benefit from a test based on your family history and potential risk factors.
There are no symptoms for high VLDL, so you will only be aware if you have a test carried out. The NHLBI⁴ recommends getting tested every one to two years if you’re aged 45–65 for males and 55–65 for females. For over 65s, it’s recommended you get tested annually.
You may be required to fast before the test. This means your doctor may request that you don’t eat or drink anything for 9–12 hours before the test. Testing will usually occur in the morning, meaning you can fast while you sleep.
Currently, there is no precise way to measure your VLDL levels. However, you will get an estimate of your VLDL levels instead. This is achieved by taking a blood sample to measure your triglyceride levels and then using this to calculate what your VLDL is. VLDL is around one-fifth of your triglyceride levels.
However, if your triglyceride level is really high, this method becomes less accurate. In this instance, your doctor will conduct a direct LDL measurement instead. You can then expect to get the test results within a few days.
During the test, you will have a needle inserted into a blood vessel to collect the blood sample. Sometimes, this can be slightly uncomfortable or painful.
There is little risk from a VLDL test. You may experience a small amount of pain or bruising where the blood sample was drawn.
The simplest way to lower your VLDL is to lower your triglycerides. This can be achieved through lifestyle changes or medication if required.
Exercise regularly: Exercise helps increase your HDL levels, thereby removing more cholesterol from your body. It also helps with weight loss, which results in lower VLDL levels in the body.
Eating a healthy diet
Reduce alcohol consumption
Medication (including niacin, fibrates, and statins)
Adopting a healthy diet could include minimizing refined carbohydrates and saturated fats and increasing fruit, vegetable, and whole grain consumption.
As you won’t experience any symptoms of high VLDL, remember to maintain regular check-ups with your doctor to keep an eye on your levels and overall health.
Talk to them about potential risk factors and your family history. If they find that your VLDL levels are high, they can guide you towards various lifestyle changes and medication if necessary.
In summary, we need VLDL to deliver different kinds of fats, predominantly triglycerides, to the cells of our body. However, too much VLDL can lead to plaque buildup in your arteries, putting you at risk of atherosclerosis and cardiovascular events. You can take preventative steps to reduce your VLDL, particularly by eating healthier and exercising regularly.
If you’re concerned about your VLDL levels, talk to your doctor to see if you need to get your levels tested or if medication is the right choice.
How it’s made: Cholesterol production in your body | Harvard Health Publishing
Blood cholesterol diagnosis | National Heart, Lung, and Blood Institute
Blood cholesterol treatment | National Heart, Lung, and Blood Institute
Triglyceride lowering drugs (2021)