This is a good question. First, some definitions. Our lipid panel is broken into 4 parts: total cholesterol, triglycerides, HDL and LDL. Triglycerides are the most modifiable acutely with diet. these are responsibe to decreasing sugars and excess intake in our diets. We aim for a goal of <150 gm/dL for triglycerides. Recent data shows that people with lower triglycerides do better with long term mortality (i.e. they live longer). The HDL is the “health” cholesterol. A way to think about it is that it the cholesterol that takes plaque out of the heart. So the higher the better here. We aim for an HDL of >50 gm/dL in women and >40 gm/dL in men. The last number is the LDL which is the “lethal” cholesterol. I always tell people to think about that as the cholesterol that gets put into the heart. Then the goal is to have low LDL, low triglycerides and high HDL. The total cholesterol is just a sum of the whole. We dont know what number the LDL should be at. We know that >160 gm/dL is high. We also know that lower is better. We have studied statins use and bringing LDL to <70 gm/dL and those patients has improved mortality. When we are born are LDL is about 40-50 gm/dL. We also know that young people at age 5-6 years already have fatty streaks (cholesterol lines) in the heart arteries. Autopsies of Vietnam and Korean war mortalities (average age 22 years) had plaque in their hearts.
Bottom Line
Lower is better. We will never drop it too low that we will not have enough. Our livers can make it. It is essential for cell wall production but an LDL of somewhere between 40-70 gm/dL is perfect. Remember, it starts in our very young. We have to eat well and have our kids eat well. There is no pass for our kids that “it is okay, they are little” Plaque builds at very young ages. Raise them as kids the way you want them to be as adults.
