Cholesterol belongs to the group of fats (lipids) and is essential for the human body. Cholesterol takes on various functions there. For example, cholesterol plays a role in metabolism, more precisely: in fat metabolism, and is involved in the construction of cell membranes. In addition, without cholesterol, the body cannot produce hormones such as glucocorticoids, estrogen, testosterone.
Cholesterol also helps with the build-up of bile acids during fat digestion, and vitamin D is also produced with its support (from the precursor dehydrocholesterol). Another word for cholesterol is cholesterol.
However, too much blood fat – above all the “bad cholesterol” or LDL cholesterol – can increase the risk of vascular calcification (arteriosclerosis) and thus cardiovascular diseases. Elevated cholesterol levels can lead to a heart attack or stroke in the long term.
The body makes most of its cholesterol in the liver. From there it travels through the bloodstream to other organs and tissues. If there is too much of the “blood fat” it transports it back to the liver.
In order for cholesterol to be able to be transported in the blood at all, it is packed into small packets in the liver together with proteins, fats (lipids) and other components, the lipoproteins.
According to the density of the lipoproteins, physicians differentiate between two main types of cholesterol:
Total cholesterol tells you how much cholesterol is circulating in the blood. Essentially, this value is made up of HDL and LDL. It is unfavorable if this value is high, because increased total cholesterol, especially increased LDL cholesterol, increases the risk of hardening of the arteries (arteriosclerosis).
Humans only get a small portion of cholesterol from food.
Source: German Green Cross e.V.
But there are also foods with little cholesterol or those that are considered to be practically cholesterol-free. Some examples:
Doctors can use cholesterol levels to estimate the risk of cardiovascular disease. For example, high LDL cholesterol and low HDL cholesterol are considered unfavorable for the blood vessels because they promote vascular calcification (arteriosclerosis). However, an elevated cholesterol level alone is not meaningful, there are other risk factors at play. Physicians must always consider all factors together to assess an individual’s cardiovascular risk. These include, for example:
Doctors determine cholesterol based on blood values. The following cholesterol table shows what is generally considered to be good normal cholesterol values. The units of measurement for cholesterol are milligrams per deciliter (mg/dl) or millimoles per liter (mmol/liter).
Depending on the number of risk factors, the LDL cholesterol levels can be broken down as follows:
Source: German Society for Nutrition e.V.
In general it can be said: A high HDL and a low LDL and total cholesterol are considered favorable. The ratio of HD L to LDL cholesterol (it should be less than 4) and the values for triglycerides (also important blood fats) also play a role.
Whether total cholesterol, HDL or LDL. Doctors no longer favor rigid cholesterol limits. Because many people would be considered “sick” and therefore in need of treatment if they were even slightly different. Also, an elevated cholesterol level alone says nothing about the cardiovascular risk.
Whether treatment is necessary always depends on the LDL value and how many other risk factors a person has. The more risk factors there are, the lower the normal LDL cholesterol levels should be. Doctors determine the risk of a heart attack or stroke in a person with high cholesterol levels in the next ten years. The so-called PROCAM score is used here, for example. This queries various parameters and then calculates the individual risk of cardiovascular diseases based on data that the University of Münster determined in the study of the same name.
There are cholesterol tolerance values that are not yet considered risky and that doctors initially only monitor and observe. Treatment with medication is only necessary if they are not reduced by measures such as diet or exercise or even increase further.
In general, nutrition experts recommend consuming no more than 300 mg of cholesterol per day. You can calculate the amount of cholesterol you take in using various food tables and overviews.
Each 300 mg cholesterol is z. Am:
Some people have high cholesterol. There are many reasons for this. If certain levels in the blood are exceeded, doctors refer to this as hypercholesterolemia, i.e. an elevated cholesterol level. On the other hand, they speak of hyperlipoproteinemia or hyperlipidemia when certain lipoproteins and the transported lipids such as cholesterol or triglycerides in the blood are elevated. There are two variants of hypercholesterolemia – a primary and a secondary form.
This form of lipid metabolism disorder is congenital and those affected have elevated LDL cholesterol levels. LDL cholesterol is not broken down properly and the fat stays in the blood. If the LDL cholesterol is too high, the risk of vascular calcification (arteriosclerosis) increases – and thus of a heart attack and stroke.
There are several hereditary forms of primary hypercholesterolaemia. If the LDL cholesterol is too high, the causes are usually changes (mutations) in the gene for the LDL docking site (LDL receptor). High cholesterol is already evident in early childhood. In addition to the coronary arteries, cholesterol is also deposited in the eyes, skin and tendons.
The disease is also called familial hypercholesterolemia because it tends to run more frequently in some families. It is more likely – and often at a young age – that the increased cholesterol will result in a heart attack due to vascular calcification (arteriosclerosis). If the LDL cholesterol is increased, it can also block the vessels in the brain – and under certain circumstances the cholesterol can provoke a stroke. Familial hypercholesterolemia accounts for about 15 percent of cases.
Secondary hypercholesterolaemia is much more common than the primary form. Other diseases and certain risk factors are to blame when LDL cholesterol is elevated. Some examples:
When the “good” HDL cholesterol is elevated, it is usually considered good. Because it offers a certain protection against arteriosclerosis, heart attack and stroke. The high-density lipoproteins transport fats from the blood and the cell walls of the blood vessels and thus help to prevent harmful deposits (plaques) from forming. However, recent study data suggest that it can also have an adverse effect if HDL cholesterol is too high (more than 60 mg/dl or 1.5 mmol/l). Even then there can be an increased cardiovascular risk. The simplified classification into “good” and “bad”, which has been the standard up to now, may have to be checked by researchers.
Elevated cholesterol levels usually don’t cause symptoms and most don’t notice it. In contrast to high blood pressure, high cholesterol does not cause symptoms such as tiredness, exhaustion or reduced physical performance.
It is different with familial hypercholesterolemia. Arteriosclerosis (vascular calcification) can develop here at a young age, which in turn can trigger complications. This can be vasoconstriction, a heart attack or a stroke. Sometimes doctors do not diagnose this form of hypercholesterolemia until this point in time.
Externally, increased cholesterol levels in the familial form can often be recognized by the fact that the fat is deposited in the eyes, in the skin or on the tendons, for example on the Achilles tendon or the extensor tendons of the finger joints. People with familial hypercholesterolemia should always seek medical attention early to reduce the risk of cardiovascular disease.
As part of the health check-up from the age of 35 (every three years), you should have your blood cholesterol checked regularly. Otherwise, the general advice applies: Always consult your doctor if you have any health problems. The right doctor for cholesterol is first of all your family doctor. In the case of familial hypercholesterolaemia, other specialists usually come into play, for example cardiologists, neurologists, dermatologists or ophthalmologists.
Healthy total cholesterol levels are below 200 mg/dl (5.2 mmol/l). LDL cholesterol should be less than 130 mg/dl (3.4 mmol/l). Even lower values apply if a person has several cardiovascular risk factors at the same time (see “cholesterol values” above).
An example: A total cholesterol of 250 alone is not dangerous. However, if there are other risk factors such as smoking or high blood pressure, the risk of cardiovascular diseases such as heart attack and stroke increases significantly. Doctors should keep an eye on cholesterol levels and check them regularly. Cholesterol can often be lowered by changing your lifestyle, for example diet (reducing fat), exercising more in everyday life or losing weight. Otherwise, medication is a way to improve blood lipid levels.
Many local pharmacies now offer a cholesterol test. You can also measure your cholesterol yourself. Special quick tests for at home are available in pharmacies, specialist shops or online mail order shops. With a small prick of your finger, you get a small amount of blood that you put on a test strip. After a few minutes you can read the test result. A cholesterol meter may be helpful for people with familial hypercholesterolemia. It displays HDL, LDL, total cholesterol and triglycerides.
It is quite possible to lower your cholesterol through diet or through a cholesterol-conscious choice of food. There are many foods that are low or cholesterol-free, but there are also foods that are very high in cholesterol. You should be economical with the latter.
A healthy, balanced diet not only helps to lower LDL cholesterol, but also helps you lose weight if you are overweight or obese. Because too many kilos also affect the blood vessels and are a risk factor for cardiovascular diseases. And: If you have to take blood-fat-lowering medication, but at the same time eat healthily, you can often save some of the medication. The drugs are then often better tolerated and have fewer side effects.
Some tips for fat-modified diet if you have high LDL cholesterol:
There are cholesterol tables on the internet that you can use to get an overview of the cholesterol content of food. They show which food lowers cholesterol levels. Some examples:
There are now also some apps for a low-cholesterol diet.
You can also lower cholesterol with medication. They aim to reduce the “bad” LDL cholesterol in the blood. They are an option when a lifestyle change has not brought sufficient success. As a rule, you have to take the medication permanently. Cholesterol tablets against excessive blood lipids are also an important part of treatment in the case of familial hypercholesterolemia.
There are several drugs that can effectively lower bad cholesterol, i.e. LDL cholesterol. They are also called “cholesterol lowering agents” or “lipid lowering agents”. The drugs of first choice are so-called statins (CSE inhibitors). They inhibit a specific enzyme called HMG-CoA reductase, thereby preventing cholesterol from building up. Statins lower LDL cholesterol and triglycerides and raise HDL cholesterol. Examples of commonly used drugs that lower LDL cholesterol are simvastatin, lovastatin or pravastatin.
If statins do not lower cholesterol enough, doctors combine them with other medications. This includes:
There is also lipid apheresis. The method can be compared to a kind of blood washing (dialysis) in which doctors “fish” the LDL cholesterol out of the blood. It is an option for patients who have had a heart attack, have poor blood flow to the heart, or when diet and medication are not effective enough. Apheresis is also used in familial hypercholesterolemia.
Some people have low cholesterol. Doctors then speak of hypocholesterolaemia. It is much less common than hypercholesterolemia. Depending on the literature, the values for total cholesterol in hypocholesterolaemia vary between 110 and 160 mg/dl.
If the cholesterol is too low, it could be the symptom of a disease. Some examples related to hypocholesterolemia:
Low cholesterol levels usually do not cause any symptoms themselves and many do not notice it. The complaints in this case depend on the underlying disease associated with hypocholesterolemia.
However, it is relevant for health if the “good” HDL cholesterol is too low. This is because it protects against cardiovascular disease. The guide value is 40 mg/dl (1 mmol/l) for men and > 50 mg/dl (1.3 mmol/l) for women. On the other hand, if the “bad” LDL cholesterol is low, this is considered desirable. Total cholesterol and triglycerides should also not exceed certain values.
When doctors talk about increasing cholesterol, they usually mean “good” cholesterol. However, raising the “good” HDL cholesterol is much more difficult than lowering the “bad” LDL cholesterol. In principle, the same measures that should also help to lower LDL cholesterol (nutrition, exercise, weight control, stopping smoking, etc.) are worth trying, or also:
If these measures do not succeed in letting the HDL cholesterol climb, it only helps to significantly reduce the LDL cholesterol – this brings both back into balance.
Sources guideline:
The original for this article “A healthy cholesterol level: everything you need to know about it” comes from FOCUS doctor search.
