High Cholesterol, high HDL, low triglycerides

Cardiac Health Admin Ask Doctor T, Cardiac Risks 14 Comments

 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: 250LDL: 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?
 
Answer:

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 explain the difference 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 14

  1. Dr. T,

    My husband is 55 year-old. 5’4″ height, 130lbs weight. His lipid panel shows high triglycerides. His Triglycerides was 800 a few year back and he was referred to a specialist who said his liver has not function well. He did CT scan on liver and was seen a benign cyst and luckily it shows no sign of growing. The doctor put him on Fenofibrate and Lovaza. After taking them for two years, his TC, LDL, and Tri have been lowered to bottomline high level. But CT scan showed his liver was a bit larger than normal, which it was considered as fatty liver or infection. So he stopped taking Lovaza to see if the liver would get back to normal size. And Yes, liver size is normal now. He has been taking Fenofibrate for 5 years now. TC and Triglycerides are still in high level as shown below. I am so worried as it seems that his liver is not functioning well. What else can he do to lower his Tri and LDL?

    TC 229
    HDL 51
    LDL 127
    Tri 255
    AST 41 IU/L
    ALT 56

    His diets are considered ok as he eats high protein, low carbs, low sugar. But he doesn’t drink water but fruit juices. Normally he eats what I eat, but my blood results are good as my TC is 225, HDL 125, LDL 129, Tri 53. I always have very high HDL.

  2. Recently, my mom aged 76, had a lipid profile report. Her cholesterol was 128 and HDL was 62. Doctor says, it’s fine and good report. However, when I asked about the High HDL cholesterol, he said, why you want to lower the good Cholesterol? It’s of no worry at this level. Now, I would like to know is HDL at this level, OK? Or should she gain some weight & bring cholesterol levels upto 150 or so? I am confused. Please explain. Thank you.

  3. Hi Dr.T, I really like your blog. I am here to ask you for my husband. He is 39 year old, weighs 150 lb, 5.9″. he got diagnosed with Hyperlipidemia in 2000. he started taking Statin from 2008.he is very against to that medicine,it gave him insomnia , fatigue and increase in his glucose level . He stopped taking it since July 2017. we did a blood work after three month-Nov 1st.
    TC-269 mg/dl
    LDL-199mg/dl
    HDL-42mg/dl
    TG-140mg/dl
    HBA1c-6.2
    he watches his diet very strictly but no self motivation with his exercise, on the top he is so against to this statin. Is it ok for him to take Baby aspirin once a day? I don’t know what to do, please help me.Thanks!

    1. From the numbers I suspect he has other cardiac risks such as smoking. If not he may have a congenital cholesterol problem and treatment should be considered depending his other risks including the presence of heart disease in his family history.
      Hope this helps,
      Dr T

  4. Good info.

    I’m 32 y/o male and just recently had my health screening done for work which included a finger stick test that measured TC/HDL/LDL/TGs as well as blood glucose. When I took the test, I had just finished a 45 min plyometric workout that morning and was on a 12 hr fast.

    My numbers were
    TC-288
    HDL-79
    LDL-192
    TG- 87
    Glucose-94

    I am not as concerned after reading this article, however, I have a couple questions about the results. Can intense exercise in a fasted state raise LDL temporarily? Also, are finger stick lipid tests reliable?

      1. Hi Ben,

        What we’re finding out is that exercise and fasting can raise LDL a lot in lean, healthy people. Whereas these same factors will tend to lower LDL (at least at first) in high-risk individuals. Recently Dave Feldman has shown that the more fat a lean, healthy person eats before a cholesterol test, the lower their LDL will be.
        From this it seems that LDL cholesterol levels in the past have been based on populations of middling fitness, eating conventional diets, and correlations drawn from them may not be accurate at all for anyone outside this demographic, for example the low carb, crossfit generation. TG and HDL, meanwhile, continue to behave much as expected – sugar will increase TG and (eventually) lower HDL in anyone.
        http://cholesterolcode.com/are-you-a-lean-mass-hyper-responder/

  5. Hi
    I am 33 years old female, i have just had a regular check up for lipid profile i asked for
    HDL: 52
    Trig.: 112
    Total Cholesterol 227
    LDL: 152!
    I exercise three times weekly for 30 minutes
    I was 94 kilos lowered that to 76 kg during 10 months by following healthy diet and exercise. so i am shocked why do i have high LDL?
    also i am concerned regarding my platelet count it is 445 is that normal?

  6. I am 57 year old female, 5’2″ 125 lbs. Just retired and am a fitness trainer for the past 6 months. Working out moderate-high each week (as apposed to sitting at my desk prior to retirement for 31 years). I am surprised to see my cholestrol report this year, too.

    Total Cholestrol 230
    LDL 145
    HDL 64
    Triglyerides 107

    I try to eat healthy (stay away from fried foods/fatty foods). High cholestrol runs in my family, but my levels have been under 200 for the past several years.

    Can you please help me understand? I am taking vitamins, also black cohosh for hot flashes, and drinking vinegar water once a day (supposed health benefits).

    Not sure why my increased activity now but my cholestrol level has gone up. My HDL has also gone up from about 40’s to 64 this year, too.

    Thank you!

  7. Hi, so got my first high cholesterol report ever. I’ve always had a really Good reading. I’m a 57 yo very active female. High intensity exercise 4x a week. Also walk my dogs 2 miles a day. Eat very healthy. Lots of fruit & veggies. I’m 5’7” weigh 123 lbs. I’m shocked
    61 triglyceride
    237 cholesterol
    94 HDL
    131 calculated LDL
    chol/HDL ratio 2.5

    1. The combination of high cholesterol, high HDL is more common in women and does not increase your risks, particularly if combined with a heart healthy lifestyle such as yours!
      Hope this helps,
      Dr T

  8. Hello and thank you for the good information you have shared. I am 64 yo male. 6.2. and 180 lbs. Hiker and I walk ever day. LDL 206, hdl 56 , triglyceride 95 and vldl 19 how high is my risk, I have a family with history of heart disease buy I have not had any symptoms as of yet. Thank you for your time

    1. Hi Adam,
      Your risk is about 9% to develop heart disease w/i the next 10 years vs. 8% in an “optimal patient”, but it doesn’t take into account your weight (BMI=23=optimal), diet and regular exercise, very important for the prevention of heart disease. If you don’t have diabetes, smoke or have hypertension you are an “optimal patient”!
      You can calculate this here:
      https://www.cardiachealth.org/questionnaires/ten-year-risk-assessment/
      Hope this helps,
      Dr T

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