High Cholesterol, high HDL, low triglycerides

Question: 

I'd like to ask a question about my recent cholesterol test results.  I had it tested for the first time ever recently.  I am a 38-yr-old female, 5'3" and 115 lbs, no known health issues.  I do cardio exercise 4 -6 days a week for a half hour.  My diet is fairly healthy, as I actively avoid high fat/high sodium foods (though I do not specifically eat 'diet' foods, I just limit my intake of the bad stuff, such as saturated/trans fats and sodium).  I consider myself health conscious and fairly healthy.  There is no heart disease or high cholesterol in my very large family that anyone is aware of.

So I was very surprised to receive my cholesterol results in the mail and see that it is considered very high.  
Total Cholesterol: 250
LDL: 162 (normal <130)
HDL: 79 (normal >45)
Triglycerides: 42 (Normal <150)

As you can see, my HDL and triglyceride numbers appear to be very good, but I'm perplexed about the high LDL.  As I said, high cholesterol and heart disease do not run in my family, and I do attempt to exercise and eat a healthy diet, and am far from overweight.  
What might account for this high LDL?  Could I be eating too much of something else that I'm not paying enough attention to, such as sugar?  Are there any nutritional deficiencies or other issues that could contribute?  (I do have to keep getting tested for my vitamin D levels, which are continuously very low despite taking prescription doses.) Thyroid disease does run heavily in my family - is this in any way connected to cholesterol levels?

There are 2 kinds of LDL cholesterol, A and B, of which B is associated with heart disease.
Most labs calculate LDL as follows:

LDL = Total Cholesterol - HDL - triglycerides/5.

This doesn't diffrentiate between LDL A (no risk)  or B (at risk for heart disease).

Studies have shown that there is a strong correlation between a low triglyceride/high HDL level and LDL pattern A (good kind).

On the other hand, a high triglyceride/low HDL level is strongly associated with LDL pattern B (heart disease risk). Thus high triglycerides are an independent risk factor for heart disease.

From this you can calculate that in your situation a high LDL is mostly Type A (good), confirmed by a high HDL and low triglyrerides and that therefore there a very low risk of heart disease.

Having high cholesterol may still be healthy if good cholesterol levels, triglycerides, and other markers of cardiovascular health are good. You can calculate this here. People with high good cholesterol levels (60 mg/dL or more) and low levels of triglycerides (less than 100 mg/dL) may actually be at a lower risk for heart disease than people with normal cholesterol levels who have lower levels of good cholesterol and higher levels of bad cholesterol.

Hope this helps,

Dr T

Comments

I am 52 year old male, 5' 6", 70kg. I have no known health issues. I am quiet active and pretty health conscious. Following is the recent cholesterol test results.

  • Cholesterol, Serum      192 mg/dl
  • Triglyceride, Serum    262 mg/dl
  • LDL  Cholesterol          103 mg/dl
  • HDL  Cholesterol          37   mg/d

My Triglyceride value is too high and HDL is too low. I do not use alcohol.

After this test, I am strictly controlling my diet and started physical activity. What might create this high triglyceride and low HDL. Should I take any medicine. Please advice.

Your two problem areas are high triglycerides and low HDL.  Typically, the steps you take to lower triglycerides will raise HDL and vice versa.

HDL levels below 40 mg/dL result in an increased risk of coronary artery disease, even in people whose total cholesterol and LDL cholesterol levels are normal. If you would like to estimate your risk of developing coronary artery disease (CAD), stroke and cardiovascular disease (CVD), click here.

On the other hand, HDL levels greater than 60 mg/dL may actually protect people from heart disease. Indeed, when it comes to HDL levels, the higher the better. Click here to learn more about cholesterol.

How to Increase Your HDL Levels

Diet

Limiting total fat in your diet is useful not only for cholesterol control but also for weight reduction. However, there is evidence that too little fat in your diet can be dangerous. A fat-free diet can result in a deficit in the essential fatty acids - certain fatty acids that are essential to life, but that your body cannot manufacture, and ultra-low-fat diets may even result in a significant reduction in your HDL cholesterol. Click on this link for more information about a Heart-Healthy Diet.

The best advice regarding fat in the diet appears to be this: Eliminate animal and dairy fat, and substitute unprocessed vegetable fats. Such a diet will avoid the problems seen with an ultra-low-fat diet, and should help raise HDL cholesterol levels.

  • Cut out the trans fatty acids. Trans fatty acids are currently present in many of your favorite prepared foods -- anything in which the nutrition label reads "partially hydrogenated vegetable oils" -- so eliminating them from the diet is not a trivial task. Trans fatty acids not only increase LDL, but also reduce HDL. Avoiding trans fatty acids from your diet will almost certainly increase your HDL.
  • Increase the monounsaturated fats in your diet. Monounsaturated fats such as canola oil, avocado oil, or olive oil and in the fats found in peanut butter can increase HDL cholesterol levels without increasing the total cholesterol.
  • Add soluble fiber to your diet. Soluble fibers are found in oats, fruits, vegetables, and legumes, and result in both a reduction in LDL cholesterol and an increase HDL cholesterol. For best results, at least two servings a day should be used.
  • Other dietary means to increasing HDL. Cranberry juice has been shown to increase HDL levels. Fish and other foods containing omega-3 fatty acids can also increase HDL levels. In postmenopausal women (but not, apparently, in men or pre-menopausal women) calcium supplementation can increase HDL levels.

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Exercise.  Regular aerobic exercise (any exercise, such as walking, jogging or bike riding, that raises your heart rate for 20 to 30 minutes at a time) may be the most effective way to increase HDL levels. There is some evidence that duration of exercise, rather than intensity, is the more important factor in raising your HDL.

Lose weight. Obesity results not only in increased LDL cholesterol, but also in reduced HDL cholesterol. If you are overweight, reducing your weight should increase your HDL levels. This is especially important if you have Metabolic Syndrome..

Stop smoking. If you smoke, giving up tobacco will result in an increase in HDL levels.

Alcohol. While one or two drinks per day (especially red wine) can increase your HDL, more can lead to substantial health problems including heart failure.

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Medications that raise your HDL

Drug therapy, statins, in particular, have not been very effective at increasing your HDL.

Niacin appears to be the most effective at raising HDL levels. The amount of niacin needed for increasing HDL is so high, that it may cause flushing, itching and hot flashes.

A combination of niacincholestyramine, and gemfibrozil therapy has been shown to increase HDL cholesterol substantially, but can be particularly difficult to tolerate.

Hope this helps,

Dr T

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Is there an actual test to test for LDL A or B types..?  What is the name of the test?

It is called a Lipid Profile

Hope this helps,

Dr T

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