LDL cholesterol: risk factor for blood vessels

LDL is also known as "bad cholesterol" because high levels of LDL are considered a risk factor for cardiovascular disease

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In a nutshell:

LDL cholesterol is known as the "bad cholesterol", as increased serum concentrations can lead to vascular calcification with dangerous consequences. The doctor has to decide on an individual basis which values ​​are considered normal and which are risky for a person, depending on the existing risk factors.

What is LDL?

LDL means low density lipoprotein. Lipoproteins are fat-protein compounds that bind fat-soluble substances such as cholesterol and transport them through the bloodstream. In contrast to HDL (High Density Lipoprotein), LDL has a low physical density - hence the name "low density". LDL carries vital cholesterol from the liver to various tissues.

If there is too much LDL cholesterol in the blood, the cholesterol can accumulate on the inner walls of the blood vessels. Especially if these have already been damaged - for example due to high blood pressure or smoking. The deposits on the vessel walls, the so-called plaques, contain not only fat, but also a large number of cells, including inflammatory cells.

The deposits "calcify" the inner walls of the vessels, thereby constricting the affected blood vessels. Angina pectoris, circulatory disorders in the legs (intermittent claudication) or in the brain are the possible consequences.

The surface of a plaque can tear, and the blood platelets (thrombocytes) that swim by in the blood immediately adhere to the place where the plaque tears. In doing so, they can completely or partially close the blood vessel in question. If a vessel, for example a coronary artery, is completely blocked, an infarct occurs.

When is LDL elevated?

Elevated LDL cholesterol levels are particularly pronounced in certain forms of familial hypercholesterolemia. For genetic reasons, fewer LDL receptors (docking points for LDL cholesterol) are formed on the surface of the liver cells in this lipid metabolism disorder. Or their ability to absorb LDL cholesterol is limited. Genetic factors play a role in most lipid metabolism disorders. But they often only come to the fore in an unhealthy lifestyle - such as an unhealthy diet, obesity or lack of exercise.

Elevated LDL cholesterol levels can have nasty consequences, including arteriosclerosis, a heart attack or a stroke.

Which LDL values ​​should be aimed for and when?

How high the LDL cholesterol should ideally be depends on the so-called overall cardiovascular risk. Basically, the more risk factors for the development of cardiovascular diseases are present and the more important these risk factors are, the lower the LDL cholesterol should be. These risk factors include high blood pressure, smoking or a family history of heart attacks. The doctor orients himself in his therapy recommendation on the overall risk of the patient.

Expertly checked by Prof. Dr. med. Peter B. Luppa, Institute for Clinical Chemistry and Pathobiochemistry, Klinikum rechts der Isar of the Technical University of Munich