http://labtestsonline.org/understanding/analytes/ldl/tab/test/
https://www.pritikin.com/your-health/health-benefits/lower-cholesterol/1468-7-tips-for-improving-your-ldl-cholesterol.html#.VR9fbObF_9k
The Test
- How is it used?
- When is it ordered?
- What does the test result mean?
- Is there anything else I should know?
How is it used?
The test for low-density lipoprotein cholesterol (LDL-C) is used as part of a lipid profile to predict an individual's risk of developing heart disease. Of all the forms of cholesterol in the blood, the LDL cholesterol is considered the most important form in determining risk of heart disease. Since treatment decisions are often based on LDL values, this test may be used to monitor levels after the start of diet or exercise programs or to determine whether or not prescribing one of the lipid-lowering drugs, such as statins, would be useful.
In addition to measuring the amount of LDL-C in blood, a test that measures the number of LDL particles (LDL-P) and/or their size may be useful in helping to determine risk of heart disease in certain people, according to some recent studies. For more on this, see Common Questions #1 and the article on Lipoprotein Subfraction Testing.
When is it ordered?
LDL-C levels are ordered as part a lipid profile, along with total cholesterol, HDL-C, and triglycerides. This profile may be ordered as a screening profile for a healthy person as part of a routine physical exam. It is recommended that all adults be tested at least once every five years. A fasting lipid profile may be ordered more frequently for those who have one or more major risk factor for heart disease (see below). It may be ordered for someone who has had a high screening cholesterol result to see if the total cholesterol is high because of too much LDL-C.
For children and adolescents, routine lipid testing is recommended by the American Academy of Pediatrics (AAP) once between the ages of 9 and 11 and again between the ages of 17 and 21. Screening with a lipid profile is recommended for children and youth who are at increased risk of developing heart disease as adults. Some of the risk factors are similar to those in adults and include a family history of heart disease or health problems such as diabetes, high blood pressure, or being overweight. High-risk children should have their first lipid profile between 2 and 8 years of age. Children younger than 2 years old are too young to be tested.
LDL-C levels may also be ordered at regular intervals to evaluate the success of lipid-lowering lifestyle changes, such as diet and exercise, or to determine the effectiveness of drug therapy such as statins.
What does the test result mean?
Elevated levels of LDL cholesterol can indicate risk for heart disease, so an LDL-C result is evaluated with respect to the upper limits that are desired based on individual risk factors. According to the National Cholesterol Education Program, if a person has no other risk factors, an LDL-C level can be evaluated as follows:
- Less than 100 mg/dL (2.59 mmol/L) — Optimal
- 100-129 mg/dL (2.59-3.34 mmol/L) — Near optimal, above optimal
- 130-159 mg/dL (3.37-4.12 mmol/L) — Borderline high
- 160-189 mg/dL (4.15-4.90 mmol/L) — High
- Greater than 189 mg/dL (4.90 mmol/L) — Very high
Desired goals for LDL levels change based on individual risk factors (listed below). Lifestyle changes, such as altering diet and exercise, are always recommended as treatment to lower elevated levels of LDL to target LDL cholesterol values. Certain combinations of LDL-C levels and individual risk factors for heart disease may warrant treatment with cholesterol-lowering drugs, such as statins, in addition to lifestyle changes.
Target values based on risk factors are:
- LDL-C less than 100 mg/dL (2.59 mmol/L) with heart disease or diabetes.*
- LDL-C less than 130 mg/dL (3.37 mmol/L) with 2 or more risk factors (intermediate risk for heart disease).
- LDL-C less than 160 mg/dL (4.14 mmol/L) with 0 or 1 risk factor (low risk for heart disease).
*Some organizations recommend that LDL-C be less than 70 mg/dL (1.82 mmol/L) if a person has heart disease or has had a heart attack.
Major risk factors for heart disease include:
- Cigarette smoking
- Age (males 45 years or older or females 55 years or older)
- High blood pressure (blood pressure of 140/90 or higher or taking high blood pressure medications)
- Family history of premature heart disease (heart disease in a first degree male relative under age 55 or a first degree female relative under age 65)
- Pre-existing coronary heart disease
- Diabetes mellitus
[Note: High HDL-C (60 mg/dL or above) is considered a "negative risk factor" and its presence allows the removal of one risk factor from the total.]
According to the American Academy of Pediatrics, the LDL-C level can be evaluated for youth with no other risk factors as follows:
For children and teens:
- Less than 110 mg/dL (2.85 mmol/L) — Acceptable
- 110-129 mg/dL (2.85-3.34 mmol/L) — Borderline high
- Greater than 130 mg/dL (3.36 mmol/L) — High
For young adults:
- Less than 120 mg/dL (3.10 mmol/L) — Acceptable
- 120-159 mg/dL (3.10-4.11 mmol/L) — Borderline high
- Greater than 160 mg/dL (4.12 mmol/L) — High
Low levels of LDL cholesterol are not generally a concern and are not monitored. They may be seen in people with an inherited lipoprotein deficiency and in people with hyperthyroidism, infection, inflammation, or cirrhosis.
Is there anything else I should know?
LDL cholesterol should be measured when a person is not ill. LDL cholesterol is temporarily low during acute illness, immediately following a heart attack, or during stress (like from surgery or an accident). Wait at least six weeks after any illness to have LDL-C measured.
Certain types of prescription drugs may raise or lower LDL cholesterol levels. Inform your health care provider of any drugs or supplements that you are taking before testing.
In women, LDL cholesterol usually rises during pregnancy. Women should wait at least six weeks after having a baby to have LDL-C measured.
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