Medically reviewed by Meredith Goodwin, MD, FAAFP — Written by Zia Sherrell, MPH on March 4, 2021
Both VLDL and LDL are particles that transport fats around the body. A doctor can test for both to form an accurate picture of how a person’s cholesterol levels are likely to affect their health.
Cholesterol has historically been a controversial topic among health professionals, but it is an essential factor in a person’s body.
The liver naturally produces this fat-like substance, which plays a key role in several body processes, such as digestion and hormone production.
The Centers for Disease Control and Prevention (CDC) estimate that 93 million adults over the age of 20 years in the United States have high cholesterol.
Although the body needs some cholesterol, excessive levels can cause health problems and increase someone’s risk of developing heart disease or stroke.
This article explains the differences between very low-density lipoprotein (VLDL) and low-density lipoprotein (LDL) cholesterol, and how to lower a person’s levels. It then looks at causes and treatments of high cholesterol.
What is VLDL?
Cholesterol and triglycerides are oily substances that cannot travel throughout the blood by themselves. Instead, they combine with proteins to form lipoproteins.
The liver makes VLDL to transport triglycerides to the bloodstream. Cells around the body then use these triglycerides as an energy source.
VLDL consists of around:
- 70% triglycerides
- 10% protein
- 10% cholesterol
- 10% other fats
If a person consumes more calories than they burn, their body converts the additional calories into triglycerides, leading to increased VLDL levels in the blood. Fat cells store the excess triglycerides until the body needs the energy.
Research shows an association with high levels of triglycerides and an increased risk of cardiovascular disease and stroke.
Raised triglyceride levels can cause a build-up of hard deposits in the arteries, called plaques, which can lead to atherosclerosis.
These plaques have several negative health consequences, such as increasing blood pressure and inflammation, as well as triggering changes to the blood vessels.
What is LDL?
Firstly, the body uses enzymes to extract the fatty acids from VLDL. After removing these triglycerides, VLDL becomes LDL. LDL is commonly known as “bad” cholesterol. Diet also plays a role in LDL levels.
These lipoproteins differ in their composition. When comparing VLDL versus LDL, the former has a greater triglyceride level, while LDL contains lower triglycerides, at around 10%, and greater cholesterol levels, at about 26%.
Instead of transporting triglycerides, LDL carries cholesterol throughout the body in the bloodstream.
High LDL levels can also lead to arterial plaque and its associated health consequences.ADVERTISEMENTCheck your vitamin levels with an at-home micronutrient test
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How are VLDL and LDL tested?
Doctors measure LDL using a blood test. Usually, it is part of a cholesterol test called a lipid or lipoprotein panel, which measures:
- total cholesterol
- LDL
- high-density lipoproteins (HDL)
- triglyceride levels
The CDC list the following as ideal cholesterol levels:
- total cholesterol less than 200 milligrams per deciliter (mg/dl)
- LDL cholesterol less than 100 mg/dl
- triglycerides less than 150 mg/dl
- HDL cholesterol 60 mg/dl or more
VLDL cholesterol requires special testing to measure levels directly. Usually, doctors estimate the amount of VLDL based on their triglyceride readings.
Total cholesterol, VLDL, LDL, and HDL cholesterol interact in the body and affect health in a complicated way.
For this reason, the American Heart Association (AHA) recommend focusing on an individual’s overall risk of developing cardiovascular disease rather than specific blood results, so they can change their lifestyle or begin medication as appropriate.
In the past, guidelines recommended that people fast before the test, but recent updates say this is unnecessary in individuals not taking statins.
However, some people may need to fast for 9–12 hours before their test, so appointments often take place in the morning.
Everyone over the age of 20 years should have regular cholesterol testing every 4–6 years, or more frequently, if they are at an increased risk for heart disease.
Causes of high cholesterol
The body naturally creates any cholesterol that it needs. However, unhealthful lifestyle choices can lead to excessive LDL and VLDL levels.
Risk factors include:
- an unhealthful diet high in processed food, red meat, and full fat dairy products
- inactivity
- having obesity
Consuming excessive carbohydrates and sugars can lead to high VLDL, whereas fatty meat and dairy are more likely to lead to high LDL.
Family history may also play a part. A person can inherit genes that affect how well the liver can metabolize excess LDL cholesterol, referring to a condition called familial hypercholesterolemia.
Familial hypercholesterolemia can lead to increased LDL levels and can cause heart problems, even in young people, without treatment.
Researchers have also found that the following conditions are associated with elevated VLDL levels:
- alcoholism
- hypothyroidism
- kidney disease
- nonalcoholic fatty liver disease
- obesity
- some genetic syndromes
Smoking is another trigger for high cholesterol. The CDC state that breathing tobacco smoke alters blood chemistry, leading to rising triglyceride levels and falling HDL levels.MEDICAL NEWS TODAY NEWSLETTERStay in the know. Get our free daily newsletter
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Treatment
The AHA recommend the following changes to a person’s habits to help lower LDL cholesterol.
Eat a healthful diet
People should lower their dietary intake of saturated fat to less than 6% of their total daily calories and minimize trans fats by avoiding or limiting the following foods:
- foods with hydrogenated oils
- fried foods
- full fat dairy products
- processed meats
- red meat
- sodium and sugar-sweetened foods and drinks
- tropical oils
Instead, people should eat a healthful diet focusing on:
- fruits and vegetables
- whole grains
- nuts and seeds
- legumes
People can still enjoy meat, but they should ideally choose skinless poultry, lean pork, and baked or grilled fatty fish.
Habit changes
In addition to a healthful diet, the AHA also suggest:
- maintaining a moderate weight
- stopping smoking
- taking regular exercise
Medications
Some individuals may find that dietary and habit changes are enough to control their cholesterol.
For other people, doctors may prescribe the following medications:
- statins to prevent the liver from forming cholesterol
- ezetimibe to block cholesterol absorption from food
- bile-acid-binding agents, which cause the body to get rid of more cholesterol
- PCSK9 inhibitors help the liver clear away LDL cholesterol
People may also benefit from medications that reduce triglyceride levels and LDL cholesterol to a lesser extent. These include fibrates, niacin, and omega-3 fatty acids. However, no data confirms that they help people taking statins.
Summary
VLDL and LDL are particles that transport fats around the body.
VLDL carries triglycerides in the bloodstream. Once the body extracts the triglycerides, cholesterol-rich LDL remains.
People who eat an unhealthful diet, smoke, or lead a sedentary lifestyle are at greater risk of high cholesterol.
Certain medical conditions or genetics can also increase this risk. High cholesterol levels put people at a greater likelihood of heart disease and stroke.
A doctor can measure someone’s cholesterol levels with a simple blood test. If these levels are too high, people can make lifestyle changes or take medication to lower their cholesterol.