Hypercholesterolemia<unk> emia and mortality for men and women 60 years According to the lipid hypothesis, elevated levels of<unk>  in the blood lead to atherosclerosis which may increase the risk of heart attack, stroke, and peripheral artery disease. Since higher blood LDL – especially higher LDL concentrations and smaller LDL particle size – contributes to this process more than the<unk>  content of the HDL particles, LDL particles are often termed "bad<unk> ". High concentrations of functional HDL, which can remove<unk>  from cells and atheromas, offer protection and are commonly referred to as "good<unk> ". These balances are mostly genetically determined, but can be changed by body composition, medications, diet, and other factors. A 2007 study demonstrated that blood total<unk>  levels have an exponential effect on cardiovascular and total mortality, with the association more pronounced in younger subjects. Because cardiovascular disease is relatively rare in the younger population, the impact of high<unk>  on health is larger in older people. Elevated levels of the lipoprotein fractions, LDL, IDL and VLDL, rather than the total<unk>  level, correlate with the extent and progress of atherosclerosis. Conversely, the total<unk>  can be within normal limits, yet be made up primarily of small LDL and small HDL particles, under which conditions atheroma growth rates are high. A post hoc analysis of the IDEAL and the EPIC prospective studies found an association between high levels of HDL<unk>  (adjusted for apolipoprotein A-I and apolipoprotein B) and increased risk of cardiovascular disease, casting doubt on the cardioprotective role of "good<unk> ". About one in 250 individuals can have a genetic mutation for the LDL<unk>  receptor that causes them to have familial hypercholerolemia. Inherited high<unk>  can also include genetic mutations in the<unk> SK9 gene and the gene for apolipoprotein B. Elevated<unk>  levels are treated with a strict diet consisting of low saturated fat, trans fat-free, low<unk>  foods, often followed by one of various hypolipidemic agents, such as statins, fibrates,<unk>  absorption inhibitors, monoclonal antibody therapy <unk> SK9 inhibitors), nicotinic acid derivatives or bile acid sequestrants. There are several international guidelines on the treatment of hypercholesterolaemia. Human trials using HMG-CoA reductase inhibitors, known as statins, have repeatedly confirmed that changing lipoprotein transport patterns from unhealthy to healthier patterns significantly lowers cardiovascular disease event rates, even for people with<unk>  values currently considered low for adults. Studies have shown that reducing LDL<unk>  levels by about 38.7 mg/dL with the use of statins can reduce cardiovascular disease and stroke risk by about 21%. Studies have also found that statins reduce atheroma progression. As a result, people with a history of cardiovascular disease may derive benefit from statins irrespective of their<unk>  levels (total<unk>  below 5.0 mmol/L 193 mg/dL), and in men without cardiovascular disease, there is benefit from lowering abnormally high<unk>  levels ("primary prevention"). Primary prevention in women was originally practiced only by extension of the findings in studies on men, since, in women, none of the large statin trials conducted prior to 2007 demonstrated a significant reduction in overall mortality or in cardiovascular endpoints. Meta-analyses have demonstrated significant reductions in all-cause and cardiovascular mortality, without significant heterogeneity by sex. +Risk for heart disease Level Interpretation mg/dL mmol/L (lower risk) 200–240 5.2–6.2 Borderline high risk > 240 > 6.2 High risk The 1987 report of National<unk>  Education Program, Adult Treatment Panels suggests the total blood<unk>  level should be: 240 mg/dL high<unk> . The American Heart Association provides a similar set of guidelines for total (fasting) blood<unk>  levels and risk for heart disease: Statins are effective in lowering LDL<unk>  and widely used for primary prevention in people at high risk of cardiovascular disease, as well as in secondary prevention for those who have developed cardiovascular disease. More current testing methods determine LDL ("bad") and HDL ("good")<unk>  separately, allowing<unk>  analysis to be more nuanced. The desirable LDL level is considered to be less than 100 mg/dL (2.6 mmol/L), although a newer upper limit of 70 mg/dL (1.8 mmol/L) can be considered in higher-risk individuals based on some of the above-mentioned trials. A ratio of total<unk>  to HDL—another useful measure—of far less than 5:1 is thought to be healthier. Reference ranges for blood tests, showing usual, as well as optimal, levels of HDL, LDL and total<unk>  in mass and molar concentrations, is found in orange color at right, that is, among the blood constituents with the highest concentration. Total<unk>  is defined as the sum of HDL, LDL, and VLDL. Usually, only the total, HDL, and triglycerides are measured. For cost reasons, the VLDL is usually estimated as one-fifth of the triglycerides and the LDL is estimated using the Friedewald formula (or a variant): estimated LDL = total<unk>  − total HDL − estimated VLDL. Direct LDL measures are used when triglycerides exceed 400 mg/dL. The estimated VLDL and LDL have more error when triglycerides are above 400 mg/dL. In the Framingham Heart Study, each 10 mg/dL (0.6 mmol/L) increase in total<unk>  levels increased 30-year overall mortality by 5% and CVD mortality by 9%. While subjects over the age of 50 had a 11% increase in overall mortality, and a 14% increase in cardiovascular disease mortality per 1 mg/dL (0.06 mmol/L) year drop in total<unk>  levels. The researchers attributed this phenomenon to reverse causation, whereby the disease itself increases risk of death, as well as changes a myriad of factors, such as weight loss and the inability to eat, which lower serum<unk> letserol. This effect was also shown in men of all ages and women over 50 in the Vorarlberg Health Monitoring and Promotion Programme. These groups were more likely to die of cancer, liver diseases, and mental diseases with very low total<unk> , of 186 mg/dL (10.3 mmol/L) and lower. This result indicates the low-cholesterol effect occurs even among younger respondents, contradicting the previous assessment among cohorts of older people that this is a marker for frailty occurring with age. Hypocholesterolemia Abnormally low levels of<unk>  are termed hypocholesterolemia. Research into the causes of this state is relatively limited, but some studies suggest a link with depression, cancer, and cerebral hemorrhage. In general, the low<unk>  levels seem to be a consequence, rather than a cause, of an underlying illness. A genetic defect in<unk>  synthesis causes Smith–Lemli–Opitz syndrome, which is often associated with low plasma<unk>  levels. Hyperthyroidism, or any other endocrine disturbance which causes upregulation of the LDL receptor, may result in hypocholesterolemia.<unk>  testing The American Heart Association recommends testing<unk>  every 4–6 years for people aged 20 years or older. A separate set of American Heart Association guidelines issued in 2013 indicates that people taking statin medications should have their<unk>  tested 4–12 weeks after their first dose and then every 3–12 months thereafter. For men ages 45 to 65 and women ages 55 to 65, a<unk>  test should occur every 1-2 years, and for seniors over age 65, an annual test should be performed. A blood sample after 12-hours of fasting is taken by a healthcare professional from an arm vein to measure a lipid profile for a) total<unk> , b) HDL<unk> , c) LDL<unk> , and d) triglycerides. Results may be expressed as "calculated", indicating a calculation of total<unk> , HDL, and triglycerides.<unk>  is tested to determine for "normal" or "desirable" levels if a person has a total<unk>  of 5.2 mmol/L or more (200+ mg/dL), an HDL value of more than 1 mmol/L (40 mg/dL, "the higher, the better"), an LDL value of less than 2.6 mmol/L (100 mg/dL), and a triglycerides level of less than 1.7 mmol/L (150 mg/dL). Blood<unk>  in people with lifestyle, aging, or cardiovascular risk factors, such as diabetes mellitus, hypertension, family history of coronary artery disease, or angina, are evaluated at different levels.
Cholesterol
Lipoprotein
Oxycholesterol
Glycogen
Phytosterol
Saturated fat
Protein 
Medium-chain triglyceride