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Causes of low-density lipoprotein elevations and decreases
Last reviewed: 06.07.2025
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LDL-C correlates more closely with the risk of developing atherosclerosis and coronary heart disease than total cholesterol concentration. Low risk is observed when LDL-C concentration is less than 3.37 mmol/l, moderate risk is observed when LDL-C concentration is 3.37-4.27 mmol/l, and high risk is observed when value exceeds 4.27 mmol/l. LDL-C can be determined by calculation method using Friedewald formula: LDL-C (mmol/l) = Total C-HDL-C-TG / 2.18. This method cannot be used when triglyceride concentration is higher than 4.52 mmol/l and in patients with type III HLP.
Atherogenicity of cholesterol is primarily determined by its belonging to a particular class of lipoproteins. In this regard, LDL should be especially highlighted, as it is the most atherogenic due to a number of reasons.
LDL transports two thirds of all plasma cholesterol and is the richest in it (their cholesterol content can reach 45-50%). The size of the particles (diameter 21-25 nm) allows LDL, along with HDL, to penetrate the vessel wall through the endothelial barrier, but unlike HDL, which is easily removed from the wall, facilitating the removal of excess lipids, LDL is retained in it, since it has a selective affinity for glucosaminoglycans and smooth muscle cells. The latter is explained by the presence of apo-B in LDL, and receptors for the latter on the surface of the vessel wall cells. Due to the above reasons, LDL is the main transport form of cholesterol for the needs of vascular wall cells, and under pathological conditions - a source of its accumulation in the vessel wall. This is why early and pronounced atherosclerosis and coronary heart disease are often observed in type II HLP, characterized by a high concentration of LDL-C. Determination of LDL-C is very informative, and deviation of this indicator from the norm can indicate with a high degree of probability what the danger is in relation to the development of atherosclerosis and coronary heart disease.
Lipid indices in adults and their relationship with the risk of developing diseases
Indicator |
Reference values |
High risk cutoff values for coronary heart disease |
High risk of coronary heart disease |
High risk of pancreatitis |
Cholesterol, mmol/l |
<5.2 |
5.2-6.2 |
>6.2 |
- |
LDL-C, mmol/l |
<3.4 |
3.4-4.1 |
>4.1 |
- |
HDL-C, mmol/l |
>1.6 |
- |
<0.9 |
- |
Triglycerides, mmol/l |
<2.3 |
2.3-4.5 |
>4.5 |
>11.3 |
TC/HDL-TC |
<5.0 |
5.0-6.0 |
>6.0 |
- |