The Four Numbers on Your Lipid Panel
A standard fasting lipid panel measures four values: total cholesterol, LDL-C (low-density lipoprotein cholesterol), HDL-C (high-density lipoprotein cholesterol), and triglycerides. Each tells a different story about cardiovascular risk.
LDL: The Primary Driver of Atherosclerosis
LDL particles carry cholesterol to tissues. When LDL-C is elevated, LDL particles accumulate in arterial walls, triggering the inflammatory cascade that forms plaques — the root cause of heart attacks and strokes. The causal relationship is supported by Mendelian randomisation studies showing that people with naturally lower LDL have proportionally lower cardiovascular disease throughout life.
- Optimal: <100 mg/dL (very high risk: <70 mg/dL)
- Near optimal: 100–129 mg/dL
- Borderline high: 130–159 mg/dL
- High: 160–189 mg/dL
- Very high: ≥190 mg/dL
HDL: The "Good" Cholesterol
HDL particles transport cholesterol from arterial walls back to the liver for excretion (reverse cholesterol transport). Higher HDL-C correlates with lower cardiovascular risk in observational studies. However, drugs that raise HDL (niacin, CETP inhibitors) have not reduced cardiovascular events in trials, suggesting HDL is more a marker than a direct protective agent. Nevertheless, very low HDL (<40 mg/dL in men, <50 mg/dL in women) is an independent risk factor.
Triglycerides
Triglycerides are the main form of fat in the bloodstream, reflecting dietary fat and carbohydrate intake, alcohol use, and metabolic health. Elevated triglycerides (>150 mg/dL fasting) are associated with cardiovascular risk, particularly when combined with low HDL — the hallmark of metabolic syndrome. Very high triglycerides (>500 mg/dL) also risk acute pancreatitis.
- Normal: <150 mg/dL · Borderline high: 150–199 · High: 200–499 · Very high: ≥500
How to Improve Your Cholesterol Profile
Diet
Replace saturated fats (red meat, full-fat dairy, tropical oils) with unsaturated fats (olive oil, avocado, nuts). Eliminate trans fats entirely. Increase soluble fibre (oats, barley, legumes, psyllium) — 5–10 g/day of soluble fibre lowers LDL by 5–11 mg/dL. Reduce refined carbohydrates and sugar to lower triglycerides.
Exercise
Aerobic exercise (150+ min/week moderate intensity) raises HDL, lowers triglycerides, and modestly reduces LDL. Resistance training adds further metabolic benefit.
Statins
High-intensity statins (atorvastatin 40–80 mg, rosuvastatin 20–40 mg) reduce LDL by 50–60% and cardiovascular events by ~25% per mmol/L reduction in LDL. They are the cornerstone of pharmacotherapy for elevated cardiovascular risk. For patients who need additional LDL lowering, ezetimibe (adds ~20% reduction) or PCSK9 inhibitors (50–60% further reduction) can be added.