LabCorp and its Specialty Testing Group, a fully integrated portfolio of specialty and esoteric testing laboratories.
To determine your risk of developing heart disease; to monitor effectiveness of lipid-lowering therapy
Screening: as part of a health exam with a lipid profile; every four to six years in adults with no risk factors for heart disease; youth should be tested at least once between the ages of 9 and 11 and once again between the ages of 17 and 21
Monitoring: may be done more frequently and at regular intervals when risk factors for heart disease are present, when prior results showed high risk levels, and/or when undergoing treatment for unhealthy lipid levels
A blood sample drawn from a vein in your arm or from a fingerstick
Laboratory tests for LDL-C typically require a 9 to 12-hour fast; only water is permitted. Your healthcare practitioner may decide that you may be tested without fasting. Follow any instructions you are given and tell the person drawing your blood whether or not you have fasted. For youths without risk factors, testing may be done without fasting.
Low-density lipoprotein (LDL cholesterol, LDL-C) is one type of lipoprotein that carries cholesterol in the blood. LDL-C consists mostly of cholesterol and similar substances with a small amount of protein. Most often, this test involves using a formula to calculate the amount of LDL-C in blood based on results of a lipid profile. Occasionally, LDL-C is measured directly.
Monitoring and maintaining healthy levels of lipids is important for staying healthy. Eating too much of foods that are high in saturated fats and trans unsaturated fats (trans fats) or having an inherited predisposition can result in a high level of cholesterol in the blood. The extra cholesterol may be deposited in plaques on the walls of blood vessels. Plaques can narrow or eventually block the opening of blood vessels, leading to hardening of the arteries (atherosclerosis) and increased risk of numerous health problems, including heart disease and stroke.
LDL-C is considered to be undesirable and is often called "bad" cholesterol because it deposits excess cholesterol in blood vessel walls and contributes to hardening of the arteries and heart disease. This is in contrast to high-density lipoproteins (HDL) that tend to transport cholesterol from the arteries to the liver. HDL is thought to protect against heart disease and so it is often called "good" cholesterol.
The LDL-C test can help determine an individual's risk of heart disease and help guide decisions about what treatment may be best if the person is at borderline or high risk. The results are considered along with other known risk factors of heart disease to develop a plan of treatment and follow up. Treatment options may involve lifestyle changes such as diet and exercise or lipid-lowering medications such as statins.
The results of a standard lipid profile, which consists of total cholesterol, HDL-C, and triglycerides, are usually used to calculate the amount of LDL-C in the blood. The results are entered into a formula that calculates the amount of cholesterol present in LDL (see below). In most cases, the formula provides a good estimate of the LDL-C, but it becomes less accurate with increased triglyceride levels when, for example, a person has not fasted before having blood drawn. In this situation, the only way to accurately determine LDL-C is to measure it directly. Direct measurement of LDL-C is less affected by triglycerides and can be used when an individual is not fasting or has significantly elevated triglycerides (above 400 mg/dL).
A blood sample is obtained by inserting a needle into a vein in the arm. Sometimes a blood sample is collected by puncturing the skin on a fingertip. A fingerstick sample is typically used when a lipid profile is being measured on a portable testing device, for example, at a health fair.
A calculated test result for LDL cholesterol typically requires a 9 to 12-hour fast before your blood is drawn; only water is permitted. Your healthcare practitioner may decide that you may be tested without fasting. Follow any instructions you are given and tell the person drawing your blood whether or not you have fasted. For youths without risk factors, testing may be done without fasting.
The test for low-density lipoprotein cholesterol (LDL-C) is used as part of a lipid profile to predict an individual's risk of developing heart disease and to help make decisions about what treatment may be needed if there is borderline or high risk. It may also be used to monitor the effectiveness of treatment once it is initiated.
LDL-C is usually not measured directly but is a calculated from the results of the other components of the lipid profile, including total cholesterol, HDL cholesterol (HDL-C), and triglycerides (see below for the formula). In most cases, the formula provides a good estimate of the LDL-C, but it becomes less accurate with increased triglyceride levels (i.e., above 400 mg/dL). In this case, the only way to accurately determine LDL-C is to measure it directly.
Of all the forms of cholesterol in the blood, the LDL-C is considered the most important form in determining risk of heart disease. It is considered to be undesirable and is often call "bad" cholesterol because it deposits excess cholesterol in blood vessel walls and contributes to hardening of the arteries and heart disease.
Results of the LDL-C test and other components of the lipid profile are considered along with other known risk factors of heart disease to develop a plan of treatment and follow-up. Treatment options may include lifestyle changes such as diet or exercise programs or lipid-lowering drugs such as statins.
In addition to measuring the amount of LDL-C in blood, a test that measures the number of LDL particles (LDL-P) and/or their size may be useful in helping to determine risk of heart disease in certain people, according to some recent studies. For more on this, see below and the article on LDL Particle Testing.
LDL-C levels may be ordered as part a lipid profile when a person has a routine health exam. It is recommended that all adults with no risk factors for heart disease be tested every four to six years.
For people who have one or more major risk factors for heart disease (see below), a fasting lipid profile may be ordered more frequently. It may also be ordered when someone has had a high screening cholesterol result to see if the total cholesterol is high because of too much LDL-C.
Major risk factors for heart disease other than a high LDL-C include:
[Note: High HDL-C (60 mg/dL or above) is considered a "negative risk factor" and its presence allows the removal of one risk factor from the total.]
For children and adolescents, routine lipid testing is recommended by the American Academy of Pediatrics once between the ages of 9 and 11 and again between the ages of 17 and 21. Earlier and more frequent screening with a lipid profile is recommended for children and youth who are at increased risk of developing heart disease as adults. Some of the risk factors are similar to those in adults and include a family history of heart disease or health problems such as diabetes, high blood pressure, or being overweight. High-risk children should have their first lipid profile between 2 and 8 years of age. Children younger than 2 years old are too young to be tested.
LDL-C levels may also be ordered at regular intervals to evaluate the success of lipid-lowering lifestyle changes such as diet and exercise or to determine the effectiveness of drug therapy such as statins. Guidelines from the American College of Cardiology and the American Heart Association recommend that adults taking statins have a fasting lipid profile done 4 to 12 weeks after starting therapy and then every 3 to 12 months thereafter to assure that the drug is working.
In general, healthy lipid levels help to maintain a healthy heart and lower the risk of heart attack or stroke. A healthcare practitioner will take into consideration the results of the LDL-C and the other components of a lipid profile as well as other risk factors to help determine a person's overall risk of heart disease, whether treatment is necessary and, if so, which treatment will best help to lower the person's risk.
In 2002, the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATPIII) provided guidelines for evaluating lipid levels and determining treatment. However, in 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) issued guidelines for adults that made recommendations on who should receive cholesterol-lowing therapy, depending on age, presence of heart disease and/or diabetes, and LDL-C level.
In healthy adults with no heart disease, the decision to treat is based on a risk calculator that takes into account several factors (e.g., age, gender, race, blood pressure, cholesterol level) and determines the risk of having a heart attack or stroke in the next 10 years. A person with a 7.5% or higher risk should be prescribed statins, according to the ACC/AHA guidelines.
Recent guidelines also recommend focusing on a percentage reduction in LDL-C rather than target values to reduce the risk of atherosclerotic cardiovascular disease (ASCVD).
However, use of the updated risk calculator and guidelines remains controversial. Many still use the older guidelines from the NCEP ATP III to evaluate lipid levels and heart disease risk. According to the NCEP, if a person has no other risk factors, an LDL-C level can be evaluated as follows:
Desired goals for LDL-C levels change based on individual risk factors. Lifestyle changes, such as altering diet and exercise, are recommended as treatment to lower elevated levels of LDL-C to target LDL-C values. Certain combinations of LDL-C levels and individual risk factors for heart disease may warrant treatment with cholesterol-lowering drugs, such as statins, in addition to lifestyle changes.
Target values based on risk factors are:
*Some organizations recommend that LDL-C be less than 70 mg/dL (1.82 mmol/L) if a person has heart disease or has had a heart attack.
According to the American Academy of Pediatrics, the LDL-C level can be evaluated for youth with no other risk factors as follows:
For children and teens:
For young adults:
Low levels of LDL cholesterol are not generally a concern and are not monitored. They may be seen in people with an inherited lipoprotein deficiency and in people with hyperthyroidism, infection, inflammation, or cirrhosis.
LDL-C should be measured when a person is not ill. LDL-C is temporarily low during acute illness, immediately following a heart attack, or during stress (like from surgery or an accident). Wait at least six weeks after any illness to have LDL-C measured.
Certain types of prescription drugs may raise or lower LDL-C levels. Inform your healthcare provider of any drugs or supplements that you are taking before testing.
In women, LDL-C usually rises during pregnancy. Women should wait at least six weeks after having a baby to have LDL-C measured.
Yes. While for many people, the LDL-C test is a good indicator of risk of cardiovascular disease (CVD), research has found that some people with healthy levels of LDL-C still have increased risk of CVD. Similarly, individuals with some chronic conditions such as diabetes may have increased risk even though their LDL-C is at a healthy level. For these populations, it has been suggested that the number of LDL particles and/or their size might be an additional factor to consider when determining their CVD risk. In these cases, lipoprotein subfraction testing may be used to further evaluate an individual for CVD risk. For example, an LDL-P may be performed. This is a test that measures the number of LDL particles, rather than measuring the amount of LDL cholesterol. For more on this, see the article on LDL Particle Testing.
The first step in treating high LDL-C is adoption of lifestyle changes, including decreasing the amount of saturated fat in the diet, achieving and maintaining desirable body weight, and getting regular exercise. Dietary supplements, such as fiber, may also be recommended. If lifestyle changes do not adequately lower LDL-C, drugs such as statins may be prescribed. For people with certain combinations of risk factors and LDL-C levels, drug therapy may be prescribed in concert with lifestyle changes.
The formula most often used by laboratories is called Freidewald's formula. It uses the results from the components of the lipid profile that are measured directly and is below. In the U.S., units are in mg/dL and the formula can only be applied if total triglycerides are less than 400 mg/dL.
LDL cholesterol = Total cholesterol – HDL cholesterol – (Total triglycerides/5)
LOINC Observation Identifiers Names and Codes (LOINC®) is the international standard for identifying health measurements, observations, and documents. It provides a common language to unambiguously identify things you can measure or observe that enables the exchange and aggregation of clinical results for care delivery, outcomes management, and research. Learn More.
Listed in the table below are the LOINC with links to the LOINC detail pages. Please note when you click on the hyperlinked code, you are leaving Lab Tests Online and accessing Loinc.org.
|LOINC||LOINC Display Name|
|91105-7||Cholesterol in LDL 1 [Mass/Vol]|
|91112-3||Cholesterol in LDL 1 [Moles/Vol]|
|91106-5||Cholesterol in LDL 2 [Mass/Vol]|
|91113-1||Cholesterol in LDL 2 [Moles/Vol]|
|91107-3||Cholesterol in LDL 3 [Mass/Vol]|
|91114-9||Cholesterol in LDL 3 [Moles/Vol]|
|91108-1||Cholesterol in LDL 4 [Mass/Vol]|
|91115-6||Cholesterol in LDL 4 [Moles/Vol]|
|91109-9||Cholesterol in LDL 5 [Mass/Vol]|
|91116-4||Cholesterol in LDL 5 [Moles/Vol]|
|91110-7||Cholesterol in LDL 6 [Mass/Vol]|
|91117-2||Cholesterol in LDL 6 [Moles/Vol]|
|91111-5||Cholesterol in LDL 7 [Mass/Vol]|
|91118-0||Cholesterol in LDL 7 [Moles/Vol]|
|18261-8||Cholesterol in LDL (S/P ultracentrifugate) [Mass/Vol]|
|2089-1||Cholesterol in LDL [Mass/Vol]|
|13457-7||Cholesterol in LDL Calc [Mass/Vol]|
|18262-6||Cholesterol in LDL Direct assay [Mass/Vol]|
|55440-2||Cholesterol in LDL VAP [Mass/Vol]|
|14155-6||Cholesterol in LDL [%]|
|22748-8||Cholesterol in LDL [Moles/Vol]|
|39469-2||Cholesterol in LDL Calc [Moles/Vol]|
|69419-0||Cholesterol in LDL Direct assay [Moles/Vol]|
Sources Used in Current Review
(2016 March 23 Updated). Good vs. Bad Cholesterol. American Heart Association. Available online at http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/Good-vs-Bad-Cholesterol_UCM_305561_Article.jsp#.Vy9hEXq9b5M. Accessed on 5/01/16.
Stone N.J. et al. (2013 November 12). 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. Circulation 10.1161/01.cir.0000437738.63853.7. Available online at https://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a. Accessed on 5/01/16.
Mir, F. (2014 March 4, Updated).LDL Cholesterol. Medscape Drugs & Diseases Available online at http://emedicine.medscape.com/article/2087735-overview. Accessed on 5/01/16.
Yang, E. (2015 December 30 Updated). Lipid Management Guidelines. Medscape Drugs & Diseases. Available online at http://emedicine.medscape.com/article/2500032-overview. Accessed on 5/01/16.
(2016 March 28 Updated). About Cholesterol. American Heart Association. Available online at http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/About-Cholesterol_UCM_001220_Article.jsp#.Vy9WX3q9b5M. Accessed on 5/01/16.
Hughes, S. (2015 November 13 Updated). Focus More on % LDL Reductions: New JUPITER Data. Medscape Multispecialty from American Heart Association (AHA) 2015 Scientific Sessions. Available online at http://www.medscape.com/viewarticle/854491. Accessed on 5/01/16.
Lloyd-Jones DM, Morris PB, Ballantyne CM, Birtcher KK, Daly Jr DD, DePalma SM, Minissian MB, Orringer CE, Smith SC. 2016 ACC expert consensus decision pathway on the role of non-statin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2016. Available as pdf at http://content.onlinejacc.org/article.aspx?articleID=2510936#tab1.
Sources Used in Previous Reviews
Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].
American Heart Association. "What are healthy levels of cholesterol?" Available online at http://22.214.171.124/presenter.jhtml?identifier=183.
National Heart, Lung, and Blood Institute of the National Institutes of Health, United States Department of Health and Human Services. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood pressure in adults (Adult Treatment Panel III). Bethesda, Md. 2001 May. Available online at http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3_rpt.htm.
American Heart Association. "Numbers That Count for a Healthy Heart." Available online at http://www.americanheart.org.
Pagana K, Pagana T. Mosby's Manual of Diagnostic and Laboratory Tests. 3rd Edition, St. Louis: Mosby Elsevier; 2006 pp 351-357.
National Heart, Lung, Blood Institute. National Cholesterol Education Program Guidelines, Cholesterol, ATP III (online information). Available online at http://www.nhlbi.nih.gov. Accessed February 2008.
Henry's Clinical Diagnosis and Management by Laboratory Methods. 21st ed. McPherson R, Pincus M, eds. Philadelphia, PA: Saunders Elsevier: 2007.
Falko JM, Moser RJ, Meis SB, Caulin-Glaser T. Cardiovascular disease risk of type 2 diabetes mellitus and metabolic syndrome: focus on aggressive management of dyslipidemia. Curr Diabetes Rev. 2005 May;1(2):127-35.
Hayashi T, et. al. Importance of Lipid Levels in Elderly Diabetic Individuals—Baseline Characteristics and 1-Year Survey of Cardiovascular Events. Cir J 2008; 72:218—225.
American Academy of Pediatrics. 7 Jul 2008. AAP issues new guidelines on cholesterol screening (press release). Available online at http://www.aap.org/new/july08lipidscreening.htm. Accessed August 2008.
Pagana K, Pagana T. Mosby's Manual of Diagnostic and Laboratory Tests. 4th Edition, St. Louis: Mosby Elsevier; 2010, Pp 356-363.
Van Leeuwen A.M., Poelhius-Leth, D.J. Davis's Comprehensive Handbook of Laboratory and Diagnostic Tests With Nursing Implications. 3rd Edition, Philadelphia: F.A. Davis Company; 2009, Pp 325-329.
National Heart, Lung, and Blood Institute of the National Institutes of Health, United States Department of Health and Human Services. ATP III Update 2004: Implications of Recent Clinical Trials for the ATP III Guidelines. Bethesda, Md. 2004 May. Available online at http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3upd04.htm.
(Updated 2011 August 2). Mayo Clinic. High Cholesterol [Online Information]. Available online at http://www.mayoclinic.com/health/high-blood-cholesterol/DS00178. Accessed August 2011.
(Updated 2010 May 23). MedlinePlus Medical Encyclopedia. LDL Test [Online information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003495.htm. Accessed August 2011.
Vujovic A, et al. Evaluation of Different Formulas for LDL-C Calculation. Lipids Health Dis, 2010; 9: 27. Abstract available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847568/. Accessed Sept. 2011.
Davidson M, et al. Clinical Utility of Inflammatory Markers and Advanced Lipid Testing: Advice from an Expert Panel of Lipid Specialists. Journal of Clinical Lipidology 2011 Sep; 5(5): 338-67.
Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Sep 2002. PDF available for download at http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf. Accessed October 2012.
(©2012) American Heart Association. Cholesterol Levels. Available online at http://www.heart.org/HEARTORG/Conditions/Cholesterol/Cholesterol_UCM_001089_SubHomePage.jsp. Accessed October 2012.
(November 2012) American Association of Family Physicians. High Cholesterol. Available online at http://familydoctor.org/familydoctor/en/diseases-conditions/high-cholesterol.html. Accessed October 2012.
Kavey R-EW, et al. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report. Pediatrics 2011; 128: DOI:10.1542/peds.2009-2107C. PDF available for download at http://pediatrics.aappublications.org/site/misc/2009-2107.pdf. Accessed October 2012.
KidsHealth.org. Cholesterol and Your Child. Available online at http://kidshealth.org/parent/medical/heart/cholesterol.html#. Accessed October 2012.
CDC. FASTSTATS – Leading Causes of Death (2009 data). Available online at http://www.cdc.gov/nchs/fastats/lcod.htm. Accessed October 2012.
KidsHealth.org. Cholesterol and Your Child. Available online at http://kidshealth.org/parent/medical/heart/cholesterol.html#. Accessed October 2012.
(2006) Sekar K. Increased Small Low-Density Lipoprotein Particle Number, A Prominent Feature of the Metabolic Syndrome in the Framingham Heart Study. Circulation. Available online at http://circ.ahajournals.org/content/113/1/20.full. Accessed October 2012.
(September 23, 2002) Blake G, et al. Low-Density Lipoprotein Particle Concentration and Size as Determined by Nuclear Magnetic Resonance Spectroscopy as Predictors of Cardiovascular Disease in Women. Circulation, Available online at http://circ.ahajournals.org/content/106/15/1930.full. Accessed October 2012.
Blakenstein R, et al. Predictors of Coronary Heart Disease Events Among Asymptomatic Persons With Low Low-Density Lipoprotein Cholesterol. Journal of the American College of Cardiology Volume 58, Issue 4, 19 July 2011, Pp 364–374.
Krauss R. Lipoprotein subfractions and cardiovascular disease risk. Curr Opin Lipidol 2010 Aug;21(4):305-11. Abstract available online at http://www.ncbi.nlm.nih.gov/pubmed/20531184. Accessed October 2012.
Prado K, et al. Low-density lipoprotein particle number predicts coronary artery calcification in asymptomatic adults at intermediate risk of cardiovascular disease. J Clin Lipidol 2011 Sep-Oct;5(5):408-13. Abstract available online at http://www.ncbi.nlm.nih.gov/pubmed/21981843. Accessed October 2012.
(May 2012) Lavie C, et.al. To B or Not to B: Is Non–High-Density Lipoprotein Cholesterol an Adequate Surrogate for Apolipoprotein B? Mayo Clin Proc. 2010 May; 85(5): 446–450. Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861974/. Accessed October 2012.