LDL cholesterol too high: what the values mean for your vessels

If your LDL cholesterol is too high, that alone is not yet a diagnosis. What matters is how high your overall vascular risk is and what condition your vessels are already in today. I am a specialist in internal medicine and cardiology and I never assess blood lipids in isolation. I look together at which fat particles are circulating in the blood, whether they are oxidised, how elastic the arteries are and which metabolic burdens additionally attack the vessel wall.

What the blood-lipid values mean

• Total cholesterol: the sum of all cholesterol fractions. On its own the value says little.
• LDL cholesterol: carries cholesterol from the liver into the tissues. When there is an excess it is deposited in the vessel wall and contributes to arteriosclerosis.
• HDL cholesterol: carries cholesterol from the tissues back to the liver.
• Triglycerides: neutral fats that depend strongly on diet, alcohol and blood glucose.
• Non-HDL cholesterol: covers all particles that can form plaques. When triglycerides are high it is more informative than LDL alone.
• Lipoprotein(a): partly determined genetically. A raised value increases vascular risk independently of LDL.
• Apolipoprotein B: shows the number of particles that can form plaques and therefore has more informative value than the amount of LDL cholesterol alone.
• LDL subgroup analysis: not all LDL particles are the same. Small, dense particles enter the vessel wall more easily than large ones.

Why there is no single value for everyone

Which LDL value is appropriate for you depends on your overall risk: age, blood pressure, diabetes, smoking, heart disease in the family and plaques that are already present. The guidelines set distinctly lower values for people at high risk than for people without further risk factors. A value that is unremarkable in one person can be too high in another. I discuss with you in the practice where your personal range lies, once all findings are available.

The basis: laboratory tests and vascular examination

The foundation includes the complete lipid profile with lipoprotein(a), blood glucose, HbA1c and the HOMA index as an indication of insulin resistance, as well as kidney and liver values, uric acid and the thyroid, because an underactive thyroid can raise LDL. With ultrasound of the carotid arteries I look for plaques. How this is carried out in my practice I describe on the page about the vascular check. You will find more on high blood pressure as a further risk factor in the article Checking high blood pressure.

My focus: assessing vascular risk as a whole

Arteriosclerosis begins with damage to the endothelium, the inner cell layer of the vessels. LDL is one factor among several. Oxidative stress, inflammation, insulin resistance and nutrient deficiencies play a role as well. That is why, in the diagnostic work-up, I go beyond the standard values.

Specialist laboratory

In the specialist laboratory I determine, depending on the question, homocysteine, the omega-3 index and fatty-acid status, micronutrients in whole blood and the inflammation marker hs-CRP. Homocysteine is regarded as an independent risk factor for the vessels and is closely linked to the supply of vitamin B6, B12 and folic acid. The omega-3 index shows how much of the omega-3 fatty acids EPA and DHA is built into the membranes of the red blood cells. Which further values the practice determines you will find under Laboratory diagnostics.

Oxidised LDL and redox status

Alongside the amount of LDL, its condition also counts. LDL becomes a problem above all when it is oxidised. Oxidised LDL is taken up by scavenger cells in the vessel wall, which turn into foam cells, the starting point of a plaque. I determine oxidised LDL through the specialist laboratory of the practice. In addition I measure the redox status, that is the balance between oxidative burden and antioxidant protection, and the glutathione level. Glutathione is one of the cell’s most important protective molecules.

Functional vascular diagnostics

With pulse-wave analysis I measure the stiffness of the arteries. Stiff vessels burden the heart, because it has to pump against a higher resistance. By ultrasound I determine the intima-media thickness (IMT) of the carotid artery, that is the thickness of the inner wall layers. It can show changes in the vessel wall before a plaque becomes visible. A measurement of body composition completes the picture with the proportions of muscle, fat and water, because abdominal fat in particular is closely linked with blood lipids and insulin resistance.

Extended investigation of causes

When the vascular values are worse than the usual risk factors explain, I look for further burdens:

• Heavy metals: A heavy-metal burden causes vascular calcification and hypertension.
• Gut barrier: Leaky gut and lipopolysaccharides (LPS) cause vascular inflammation.
• Stress: With neurostress diagnostics and analysis of heart-rate variability (HRV) I assess whether raised stress hormones are burdening the circulation.
• Spike protein: A spike-protein burden (from vaccination or infection) causes massive vascular damage and microthrombi.

What can follow from the findings

From the results I work out together with you what is sensible. The foundation is nutrition, movement and sleep. Where deficits have been demonstrated, orthomolecular and functional approaches can be considered, for example omega-3 fatty acids when the omega-3 index is low, or B vitamins when homocysteine is raised. If the extended assessment shows one of the burdens named, we discuss which further steps come into question for you.

Vascular check or Premium Check-up

The vascular check focuses on blood lipids and vessels. The Premium Check-up extends it to the heart, the detailed specialist laboratory, hormone status and further organs. We discuss beforehand which scope suits you.

Arrange an appointment

Bring your previous laboratory values with you. You arrange an appointment via Doctolib or via Contact. Further specialist articles can be found under Expert tips.

The information on this page does not replace individual medical advice, examination or treatment. Whether any measures are appropriate is decided in a personal consultation. Courses differ from person to person.