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Overview of Cholesterol and Lipid Disorders

By

Michael H. Davidson

, MD, FACC, FNLA, University of Chicago Medicine;


Vishnu Priya Pulipati

, MD, Warren Clinic Endocrinology

Last full review/revision Aug 2021| Content last modified Aug 2021
CLICK HERE FOR THE PROFESSONAL VERSION
Topic Resources

The body needs fats for growth and energy. It also uses them to synthesize hormones and other substances needed for the body’s activities. The body may deposit excess fat in blood vessels and within organs, where it can block blood flow and damage organs, often causing serious disorders.

Important fats (lipids) found in the blood are

  • Cholesterol

  • Triglycerides

Cholesterol is an essential component of cell membranes, of brain and nerve cells, and of bile, which helps the body absorb fats and fat-soluble vitamins. The body uses cholesterol to make vitamin D and various hormones, such as estrogen, testosterone, and cortisol. The body can produce all the cholesterol that it needs, but it also obtains cholesterol from food.

Triglycerides, which are contained in fat cells, can be broken down, then used to provide energy for the body’s metabolic processes, including growth. Triglycerides are produced in the intestine and liver from smaller fats called fatty acids Fats Carbohydrates, proteins, and fats supply 90% of the dry weight of the diet and 100% of its energy. All three provide energy (measured in calories), but the amount of energy in 1 gram (1/28 ounce)... read more . Some types of fatty acids are made by the body, but others must be obtained from food.

Fats, such as cholesterol and triglycerides, cannot circulate freely in the blood, because blood is mostly water. To be able to circulate in blood, cholesterol and triglycerides are packaged with proteins and other substances to form particles called lipoproteins.

There are different types of lipoproteins. Each type has a different purpose and is broken down and excreted in a slightly different way. Lipoproteins include

  • Chylomicrons

  • High-density lipoproteins (HDL)

  • Low-density lipoproteins (LDL)

  • Very low density lipoproteins (VLDL)

Cholesterol transported by LDL is called LDL cholesterol, and cholesterol transported by HDL is called HDL cholesterol.

The body can regulate lipoprotein levels (and therefore lipid levels) by increasing or decreasing the production rate of lipoproteins. The body can also regulate how quickly lipoproteins enter and are removed from the bloodstream.

Levels of cholesterol and triglycerides vary considerably from day to day. From one measurement to the next, cholesterol levels can vary by about 10%, and triglyceride levels can vary by up to 25%.

Lipid levels may be

Lipid levels may become abnormal because of changes that occur with aging, various disorders (including inherited ones), use of certain drugs, or lifestyle (such as consuming a diet high in saturated fat, being physically inactive, or being overweight).

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Complications of abnormal lipid levels

Abnormally high levels of certain lipids (especially cholesterol) can lead to long-term problems, such as atherosclerosis Atherosclerosis Atherosclerosis is a condition in which patchy deposits of fatty material (atheromas or atherosclerotic plaques) develop in the walls of medium-sized and large arteries, leading to reduced or... read more Atherosclerosis . Generally, a high total cholesterol level (which includes LDL, HDL, and VLDL cholesterol), particularly a high level of LDL (the "bad") cholesterol, increases the risk of atherosclerosis and thus the risk of heart attack Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) Acute coronary syndromes result from a sudden blockage in a coronary artery. This blockage causes unstable angina or heart attack (myocardial infarction), depending on the location and amount... read more Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) or stroke Overview of Stroke A stroke occurs when an artery to the brain becomes blocked or ruptures, resulting in death of an area of brain tissue due to loss of its blood supply (cerebral infarction) and symptoms that... read more . However, not all types of cholesterol increase this risk. A high level of HDL (the "good") cholesterol may decrease risk, and conversely, a low level of HDL cholesterol may increase risk.

The effect of triglyceride levels on the risk of heart attack is less clear-cut. But very high levels of triglycerides (higher than 500 milligrams per deciliter of blood, or mg/dL [5.65 mmol/L) can increase the risk of pancreatitis Overview of Pancreatitis Pancreatitis is inflammation of the pancreas. The pancreas is a leaf-shaped organ about 5 inches (about 13 centimeters) long. It is surrounded by the lower edge of the stomach and the first... read more .

Measuring lipid levels

The fasting lipid profile (sometimes called a lipid panel), is the levels of total cholesterol, triglycerides, LDL cholesterol, and HDL cholesterol measured after a person fasts for 12 hours. Doctors usually do this test every 5 years starting at age 20 as part of assessing whether the person is at risk of coronary artery disease Overview of Coronary Artery Disease (CAD) Coronary artery disease is a condition in which the blood supply to the heart muscle is partially or completely blocked. The heart muscle needs a constant supply of oxygen-rich blood. The coronary... read more Overview of Coronary Artery Disease (CAD) .

In children and adolescents, screening with a fasting lipid profile is recommended between the ages of 2 and 8 years if the child has risk factors, such as a family member with severe dyslipidemia Dyslipidemia Dyslipidemia is a high level of lipids (cholesterol, triglycerides, or both) or a low high-density lipoprotein (HDL) cholesterol level. Lifestyle, genetics, disorders (such as low thyroid hormone... read more Dyslipidemia or one who developed coronary artery disease at a young age. In children with no risk factors, screening with a non-fasting lipid profile is usually done once before the child reaches puberty (usually between age 9 to 11) and once more between the ages of 17 to 21.

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