VLDL Cholesterol: Risks, Healthy Levels, Treatment Options, and Further Information

Introduction

Cholesterol is a form of lipid that is required for the body to function normally. It is carried in the bloodstream by lipoproteins, which can be classified into different types based on their size, density, and composition. The three main types of cholesterol are:

VLDL cholesterol is produced by the liver and contains high levels of triglycerides, which are a type of fat that can increase the risk of heart disease.

Unlike LDL, which primarily carries cholesterol, VLDL primarily carries triglycerides.

High levels of VLDL cholesterol are often associated with other conditions, such as obesity, insulin resistance, and metabolic syndrome.

• High-density lipoprotein (HDL) cholesterol
• Very low-density lipoprotein (VLDL) cholesterol
• LDL cholesterol (commonly known as ‘bad’ cholesterol)

While VLDL cholesterol is essential for the body’s normal functioning, too much of it can be harmful.

Let us explore the basics of VLDL cholesterol, its effects on the body, and how to manage its levels to promote optimal health.¹

What Is VLDL Cholesterol and Its Role?

VLDL, also known as very low-density lipoprotein, is a type of lipoprotein that is synthesized in the liver and carries high amounts of triglycerides. Triglycerides are a form of fat that is stored in the body for energy. VLDL cholesterol plays a crucial role in transporting triglycerides from the liver to the tissues of the body, where they can be either used for energy or stored as fat.

While VLDL cholesterol is important for the body’s normal functioning, high levels can increase the risk of cardiovascular disease. This is because VLDL cholesterol can increase the fat deposition in the arteries, thus narrowing the arteries and increasing the risk of heart attack and stroke.¹

Healthy Range of VLDL Cholesterol

The normal level range for VLDL cholesterol is typically between 2 and 30 mg/dL, although the specific values may differ slightly depending on the laboratory. It’s important to discuss the interpretation of your individual test results with your healthcare provider. 1/5 of your triglyceride levels are your VLDL. The normal range of triglycerides according to the National Heart, Lung and Blood Institute:⁸

Low levels of VLDL cholesterol are generally not a cause for concern and may even be beneficial for heart health. However, extremely low levels of VLDL cholesterol may be a sign of a rare genetic disorder called a-beta-lipoproteinemia. In this disorder, the body is unable to properly absorb and transport fats and fat-soluble vitamins, leading to a range of symptoms such as poor growth, vision problems, and neurological issues.⁷

VLDL cholesterol is not typically the primary focus of cholesterol management. However, an increased level of VLDL cholesterol has been linked to a greater risk of stroke and heart disease.

To decrease your VLDL cholesterol levels, it is recommended to reduce your triglycerides by engaging in regular exercise and losing weight. Additionally, it’s advisable to limit your intake of sugary foods and alcohol. Medications may also be prescribed to help manage VLDL cholesterol levels.^1,2

Symptoms of Unhealthy Levels of VLDL Cholesterol  

• VLDL cholesterol, or very low-density lipoprotein is a type of cholesterol that is produced in the liver and plays a role in the transportation of triglycerides, another type of fat, to various parts of the body.
• Although high VLDL cholesterol levels do not typically cause any noticeable symptoms, they can contribute to the development of serious health conditions over time, including heart disease and stroke.
• VLDL (very low-density lipoprotein) is a type of lipoprotein that contains high levels of triglycerides. Therefore, high levels of VLDL cholesterol in the blood can indicate high triglyceride levels.
• Symptoms of high triglycerides in the blood include abdominal pain, nausea, vomiting, and pancreatitis.
• Additionally, high triglyceride levels can cause changes in the eye’s blood vessels.
• People with extremely high levels of triglycerides may also experience memory loss, liver and spleen enlargement, stomach pain, and skin flushing with alcohol use.^3,8

Since most of the cholesterol in blood is transported via LDL, measuring serum LDL levels could be useful to predict the risk for ASCVD( Atherosclerotic cardiovascular disease). VLDL levels are more predictable than LDL levels in heart attacks.

Dr. M.G. Kartheeka, MBBS, MD(Pediatrics)

Causes of High VLDL Cholesterol

Here are the causes of high VLDL cholesterol:

• Certain modifiable lifestyle factors, such as physical inactivity, obesity, and a diet high in saturated and trans fats, can increase the risk of developing high VLDL cholesterol levels.
• Genetics can also play a role, affecting the body’s ability to remove LDL cholesterol from the bloodstream or metabolize it in the liver, which can contribute to high VLDL cholesterol.
• Various medical conditions, such as chronic kidney disease, diabetes, HIV/AIDS, hypothyroidism, and lupus, can lead to an unhealthy lipid profile that includes high VLDL cholesterol.
• Certain medications used to treat other health conditions, including acne, cancer, high blood pressure, HIV/AIDS, irregular heart rhythms, and organ transplants, can spike cholesterol levels, including high VLDL cholesterol.

Overnight fasting usually for a period of 10-12 hours is recommended for testing of lipid profile as it gives the most accurate evaluation of the cholesterol and triglycerides in the blood.

Dr. Ashish Bajaj, M.B.B.S. M.D. in Clinical Pharmacology and Toxicology

Risks Associated with Higher VLDL Levels

• High VLDL cholesterol increases the risk of cardiovascular disease.
• Individuals with high VLDL cholesterol often have high triglycerides, LDL cholesterol, and total cholesterol.
• To reduce lipid levels in the blood, follow a heart-healthy diet, exercise regularly, maintain a healthy weight, and consider taking medication like statins.
• Certain underlying medical disorders and drugs can also elevate your triglycerides, causing your VLDL cholesterol to rise.
• Make sure you speak to your healthcare provider about potential causes of high VLDL cholesterol and available treatment options.⁶

Tests for High VLDL Level

VLDL Test:

• VLDL is a type of lipoprotein that is primarily composed of triglycerides and is considered ‘bad cholesterol’ because it contributes to the buildup of cholesterol in the blood vessel wall. A lab test is utilized to measure VLDL levels in the blood, typically by drawing a blood sample from a vein in the arm or hand. This test is often done to evaluate an individual’s risk for heart disease, as elevated VLDL levels are associated with atherosclerosis, a condition that can lead to coronary heart disease.
• As there is no direct way of measuring VLDL cholesterol, it is estimated based on the level of triglycerides present.
• Sometimes there may be certain risks associated with the test. It is important to note that veins and arteries vary in size, which can make obtaining a blood sample more challenging for some individuals. While the risks associated with the blood draw procedure are generally low, they may include excessive bleeding, lightheadedness, hematoma, or infection.⁴

Monitoring VLDL Cholesterol

• VLDL levels can be monitored through a blood test, specifically a lipid panel, which measures various types of cholesterol and triglycerides in the blood.
• This test typically includes measurements of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides, as well as VLDL cholesterol levels.
• Your healthcare provider may recommend this test as part of a routine check-up or if you have a personal or family history of high cholesterol or cardiovascular disease.
• Depending on your individual risk factors, your doctor may recommend monitoring your VLDL levels more frequently.
• It is important to follow your healthcare provider’s recommendations for monitoring VLDL levels and managing any associated health conditions.^5,6

Treatment Options for High VLDL Cholesterol 

1. Diet modifications:

• Consuming foods high in sugar, particularly refined sugars, and alcohol can increase triglycerides and, therefore, VLDL levels. It is advisable to restrict or better avoid them entirely.
• A heart-healthy diet like the Mediterranean diet, which emphasizes whole grains, fruits, vegetables, and lean proteins, may help reduce triglycerides and VLDL levels.

2. Exercise:

• Losing weight and engaging in regular exercise are crucial lifestyle modifications for healthy cholesterol levels.

3. Lifestyle changes:

• In some cases, an underlying medical condition may be the cause of high VLDL levels. Diagnosing and treating the underlying condition can help lower VLDL levels.
• Regular monitoring of VLDL levels is essential to track progress and adjust treatment plans accordingly.

4. An expert opinion:

• Consult your healthcare provider. Medications can be used to lower VLDL levels. Your healthcare provider can help determine which medication is best suited for you.^1,6

When to See a Doctor

It is recommended to consult a doctor if you have high levels of VLDL cholesterol, as it can increase the risk of heart disease and stroke. However, VLDL cholesterol levels are usually measured as part of a lipid panel test, which is routinely done during regular check-ups or if you have certain risk factors for heart disease. Here are some signs that may indicate the need for an expert opinion:

• Chest pain or discomfort
• Shortness of breath
• Arm or leg numbness or weakness
• Dizziness or lightheadedness
• Sudden severe headache
• Slurred speech
• Vision changes
• Difficulty swallowing
• Persistent abdominal pain or nausea

When to See a Doctor for Cholesterol Screening

Got it! Here’s the information in the pointer format you’re looking for:

• 9-11 years: First screening
• Children and young adults: Every five years
• 45-65 years (men): Every 1-2 years
• 55-65 years (women): Every 1-2 years
• 65 and above: Annual checkup

If you have a family history of high cholesterol, heart disease, or other risk factors such as diabetes or high blood pressure, your doctor may recommend more frequent testing.³

Research Facts

Here are some research facts about VLDL and high cholesterol:

• Some studies suggest that high levels of cholesterol may also be associated with an increased risk of developing Alzheimer’s disease.⁹
• Research has shown that higher levels of VLDL cholesterol are associated with an increased risk of coronary heart disease (CHD) and that reducing VLDL levels may help prevent CHD.¹⁰

References

1) VLDL cholesterol [Internet]. MedlinePlus. U.S. National Library of Medicine; Available from: https://medlineplus.gov/vldlcholesterol.html 

2) VLDL [Internet]. ucsfhealth.org. 2020. Available from: https://www.ucsfhealth.org/medical-tests/vldl-test

3) Diagnosis [Internet]. U.S. Department of Health and Human Services; [cited 2023 May 10]. Available from: https://www.nhlbi.nih.gov/health/blood-cholesterol/diagnosis

4) Bredefeld CL, Lau R, Hussain MM. Lipids and dyslipoproteinemia. In: McPherson RA, Pincus MR, eds. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 18. Available from: https://archive.lib.cmu.ac.th/newbook/health/ams/2022/b16562240.pdf

5) Cholesterol levels: Medlineplus medical test [Internet]. MedlinePlus. U.S. National Library of Medicine; [cited 2023Apr27]. Available from: https://medlineplus.gov/lab-tests/cholesterol-levels/ 

6) What is VLDL cholesterol? [Internet]. Cleveland Clinic. [cited 2023Apr27]. Available from: https://my.clevelandclinic.org/health/articles/24540-vldl-cholesterol

7) Junaid SZ, Patel K. Abetalipoproteinemia. InStatPearls [Internet] 2022 Jun 23. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513355/ 

8) High blood triglycerides [Internet]. U.S. Department of Health and Human Services; [cited 2023 May 9]. Available from: https://www.nhlbi.nih.gov/health/high-blood-triglycerides 

9) Shepardson NE, Shankar GM, Selkoe DJ. Cholesterol level and statin use in Alzheimer disease: I. Review of epidemiological and preclinical studies. Archives of neurology. 2011 Oct 1;68(10):1239-44. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3211071/

10) Ren J, Grundy SM, Liu J, Wang W, Wang M, Sun J, Liu J, Li Y, Wu Z, Zhao D. Long-term coronary heart disease risk associated with very-low-density lipoprotein cholesterol in Chinese: the results of a 15-Year Chinese Multi-Provincial Cohort Study (CMCS). Atherosclerosis. 2010 Jul 1;211(1):327-32. Available from: https://pubmed.ncbi.nlm.nih.gov/20223457/

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