LDL Cholesterol - Direct

"Low-density lipoprotein (LDL cholesterol, LDL-C) is one type of lipoprotein that carries cholesterol in the blood. LDL-C consists mostly of cholesterol and similar substances with a small amount of protein. Most often, this test involves using a formula to calculate the amount of LDL-C in blood based on results of a lipid profile. Occasionally, LDL-C is measured directly.

Artery plaqueMonitoring and maintaining healthy levels of lipids is important for staying healthy. Eating too much of foods that are high in saturated fats and trans unsaturated fats (trans fats) or having an inherited predisposition can result in a high level of cholesterol in the blood. The extra cholesterol may be deposited in plaques on the walls of blood vessels. Plaques can narrow or eventually block the opening of blood vessels, leading to hardening of the arteries (atherosclerosis) and increased risk of numerous health problems, including heart disease and stroke. Photo source: NHLBI

LDL-C is considered to be undesirable and is often called """"bad"""" cholesterol because it deposits excess cholesterol in blood vessel walls and contributes to hardening of the arteries and heart disease. This is in contrast to high-density lipoproteins (HDL) that tend to transport cholesterol from the arteries to the liver. HDL is thought to protect against heart disease and so it is often called """"good"""" cholesterol.

The LDL-C test can help determine an individual's risk of heart disease and help guide decisions about what treatment may be best if the person is at borderline or high risk. The results are considered along with other known risk factors of heart disease to develop a plan of treatment and follow up. Treatment options may involve lifestyle changes such as diet and exercise or lipid-lowering medications such as statins.

The results of a standard lipid profile, which consists of total cholesterol, HDL-C, and triglycerides, are usually used to calculate the amount of LDL-C in the blood. The results are entered into a formula that calculates the amount of cholesterol present in LDL (see Common Questions #3). In most cases, the formula provides a good estimate of the LDL-C, but it becomes less accurate with increased triglyceride levels when, for example, a person has not fasted before having blood drawn. In this situation, the only way to accurately determine LDL-C is to measure it directly. Direct measurement of LDL-C is less affected by triglycerides and can be used when an individual is not fasting or has significantly elevated triglycerides (above 400 mg/dL).

** Why to test LDL Cholesterol - Direct?**

To determine your risk of developing heart disease; to monitor effectiveness of lipid-lowering therapy. Screening: as part of a health exam with a lipid profile; every four to six years in adults with no risk factors for heart disease; youth should be tested at least once between the ages of 9 and 11 and once again between the ages of 17 and 21.

Monitoring: may be done more frequently and at regular intervals when risk factors for heart disease are present, when prior results showed high risk levels, and/or when undergoing treatment for unhealthy lipid levels.

** When to test LDL Cholesterol - Direct?**

Adults

LDL-C levels may be ordered as part a lipid profile when a person has a routine health exam. It is recommended that all adults with no risk factors for heart disease be tested every four to six years.

For people who have one or more major risk factors for heart disease (see below), a fasting lipid profile may be ordered more frequently. It may also be ordered when someone has had a high screening cholesterol result to see if the total cholesterol is high because of too much LDL-C.

Major risk factors for heart disease other than a high LDL-C include:

• Cigarette smoking
• Being overweight or obese
• Unhealthy diet
• Being physically inactive, not getting enough exercise
• 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 or already having had a heart attack
• Diabetes or prediabetes

[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.]

Youth

For children and adolescents, routine lipid testing is recommended by the American Academy of Pediatrics once between the ages of 9 and 11 and again between the ages of 17 and 21. Earlier and more frequent 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.

Monitoring

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. Guidelines from the American College of Cardiology and the American Heart Association recommend that adults taking statins have a fasting lipid profile done 4 to 12 weeks after starting therapy and then every 3 to 12 months thereafter to assure that the drug is working.

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LDL Cholesterol - Direct

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