Rarely even mentioned during an annual physical, very-low density lipoprotein (VLDL) is the cholesterol you've probably never heard of. But it's certainly one you'd be better off without.
Cholesterol comes in several guises. The U.S. National Library of Medicine points out that high-density lipoprotein cholesterol (HDL) is the "good" cousin. You want more HDL, not less. That's because the higher your HDL, the lower your risk for coronary heart disease.
On the other hand, low-density lipoprotein cholesterol (LDL) is the well-known "bad" relative. You want less of it because too much can clog up your arteries and up your risk for heart disease and stroke.
And then there's VLDL. This cholesterol may be somewhat under the radar, but in reality it's a just-as-bad cholesterol hiding in plain sight. Produced by the liver, VLDL is composed of various lipoproteins and fat, just like LDL and HDL. But Mayo Clinic experts note that what sets VLDL apart is the degree to which it's composed of a type of fat known as triglycerides.
VLDL is Largely Fat
According to the American Association for Clinical Chemistry, VLDL gets released into the blood by the liver. The association cites growing evidence that fat-carrying VLDL particles play an important role in the plaque-formation process that can lead to heart disease and increased stroke risk.
So how does that work, exactly? "VLDLs are small particles that carry high levels of fat," explains Lona Sandon, PhD, RDN, an assistant professor of nutrition at the University of Texas Southwestern Medical Center, in Dallas. This fat gets distributed as it travels through the body. "Some can end up sticking to artery walls and build up as plaque," Sandon explains. "This is why it is not good for us."
VLDL levels in the range of 2 to 30 milligrams per deciliter are considered normal. "A high level of VLDL would be anything greater than 30 milligrams per dicileter," warns Sandon.
The problem, Mayo experts caution, is that it can be hard to accurately measure VLDL levels during a routine check-up. "Testing for VLDL is not standard in most places," Sandon concurs. "But if you have other risks for heart disease, your doctor might include VLDL along with other cholesterol tests."
As a practical matter, VLDL levels are most often estimated as a percentage of a person's triglyceride count. That's because as much as half of VLDL is composed of triglycerides.
Triglycerides Are Not Your Friend
In fact, VLDL contains the highest percentage of triglycerides of all the cholesterols, according to the National Library of Medicine. That alone is a big fat helping of bad news. As Mayo Clinic experts explain, triglycerides are the unhealthful byproduct of unused calories.
After converting into triglycerides, those excess calories get stored inside fat cells. That's a particular problem for those who regularly eat more food than can be burnt off because, over time, it can lead to an excessively high buildup of triglycerides and, therefore, a higher risk for obesity, diabetes, high blood pressure and high blood sugar.
That's why high levels of triglyceride-rich VLDL has been linked to a higher risk for plaque buildup in the arterial walls. Over time that buildup can narrow arterial pathways, reduce blood flow and ultimately increase the risk for cardiovascular complications, such as a heart attack or stroke. And that, says Sandon, means "a higher risk for heart disease."
Take Action to Reduce VLDL
Some people do have a genetic propensity for high VLDL, Sandon adds. For them, medication (like statins) may be required to bring high VLDL levels under control. But for most people, triglycerides, and thereby VLDL, can be lowered by actively embracing healthy eating and an active lifestyle.
Diet strategies for lowering VLDL should focus on "cutting out excess added sugars, alcohol and saturated fats," says Sandon. The Mayo Clinic specifically advises steering clear of refined carbohydrates, such as foods made with white flour or fructose, and opting for foods that contain relatively healthy fats.
Choose plant-based meals over meat dishes, and choose olive and canola oils over hydrogenated oils and fats.
And get moving if you need to lose weight. To that end, the Mayo Clinic suggests aiming for a minimum of 30 minutes of physical activity each day and trying to integrate more movement into your daily routine whenever possible. So step out of that elevator, climb the stairs and leave big bad VLDL behind on the ground floor.