LDL Cholesterol: 121 mg/dL

What does a level of 121 mean? Are there any symptoms associated with this level?

An LDL level of 121 mg/dL is considered elevated. Although cholesterol has several important functions in the body, elevated LDL cholesterol may put you at greater risk for heart disease.

Elevated LDL cholesterol doesn’t have symptoms, which is why it’s important to know your levels. Lowering them will lower your risk of developing heart disease and other health issues. If you already have heart disease, lowering your cholesterol can reduce your odds of serious complications, like a heart attack or stroke. 

Factors that could contribute to a level of 121: 

• Diet: Eating a diet that is low in fiber and high in saturated fats, trans fats, and added sugar can cause LDL cholesterol to rise.

• Weight. Being overweight also tends to increase cholesterol levels, including LDL cholesterol. 

• Physical inactivity. A sedentary lifestyle can increase LDL (bad) cholesterol and lower HDL (good) cholesterol levels. 

• Medications: Certain medications can increase cholesterol levels. These include:  corticosteroids, beta-blockers, thiazide diuretics, antivirals, retinoids, and growth hormones.

• Diseases: Some diseases like chronic kidney disease, diabetes, and HIV/AIDS can elevate total cholesterol and LDL.

• Age and Sex: Premenopausal women tend to have lower total and LDL cholesterol levels than men of the same age. However, cholesterol levels tend to increase with age in both women and men. After the age of menopause, women's LDL (bad) cholesterol levels tend to rise.

• Genetics (heredity): Your genes partly determine how much cholesterol your body makes which is why high blood cholesterol can run in families.

• Race. Certain races may have an increased risk of high blood cholesterol. For example, Blacks/African Americans typically have higher HDL and LDL cholesterol levels than Caucasians.

• Smoking. Smoking lowers your HDL (good) cholesterol which can contribute to a higher level of LDL (bad) cholesterol.

What to do if your level is 121?

Adopting healthier habits and making changes to your diet can help lower your LDL cholesterol level back into the optimal range (<100 mg/dL). Here are some things you can do to help lower your LDL:

• Aim to get 30-40g of fiber daily from fiber-rich vegetables, fruit, whole grains, and legumes.

• Limit sources of refined carbs and added sugars such as white bread, packaged baked goods and crackers, soda, candy, sweetened milk and yogurt, and ice cream. 

• Reduce your saturated fat intake to <10% of your total calories and avoid trans fats like partially hydrogenated oils. 

• Eat small, fatty fish such as salmon, sardines, and trout, at least twice a week. 

• Be active daily. Aim to get 30-60 minutes of physical activity 5x/week. 

• Get at least 2g of plant sterols and stanols daily from food and a supplement. 

• Lose excess weight if you are overweight or obese.

• Quit smoking if you smoke.

• If you have diabetes, achieve and maintain good blood sugar control (HbA1c).

Medications and supplements used to improve results

Medications and supplements can help lower your LDL cholesterol into a safer range if diet and lifestyle changes are not enough.

Medications

Medications are typically prescribed if diet and lifestyle changes do not lower LDL cholesterol levels enough on their own. Some common cholesterol medications include:

• Statins: Statins, including atorvastatin, simvastatin, and rosuvastatin, reduce cholesterol production in your liver. Because they typically need to be taken for life, statins are only prescribed if diet and lifestyle changes aren’t enough [3].. 

• Ezetimibe can be helpful for those with familial hypercholesterolemia and/or who have side effects with statins. 

• Bile acid sequestrants: These drugs block cholesterol-rich bile acid from being absorbed into the bloodstream and can be prescribed in place of or in addition to a statin. 

• PCSK9 inhibitors: This medicine is injected under your skin every 2 or 4 weeks. If you are at high risk of heart attack or stroke or have familial hypercholesterolemia, it may be prescribed along with a statin.

• Lomitapide: Typically prescribed if you have familial hypercholesterolemia. Lomitapide requires liver enzyme monitoring as it can cause liver damage and is commonly taken with vitamin E.

Supplements

• Plant sterols and stanols: Plant sterols and stanols (also called phytosterols) are found in plant cell membranes. They are similar in structure to cholesterol in the body and block dietary cholesterol from being absorbed. They are found in vegetable oils, nuts, legumes, whole grains, fruits, and vegetables. The average daily intake of phytosterols from food (500 mg) is typically not enough to lower cholesterol, however. Studies show consuming 2000 mg (2 g) of plant sterol and stanols daily from diet and/or supplements to be most effective [4]. Plant sterol and stanol supplements are taken before or with meals can help lower total cholesterol in parallel with other recommended diet and lifestyle changes [4]. 

• Beta-glucan: Beta-glucan is a form of soluble fiber that has been shown to help lower cholesterol levels. It’s found naturally in whole grains like barley, oats, rye, and wheat, mushrooms, and seaweed, and is also available as a nutritional supplement. For cholesterol-lowering benefits, consume 3-7 g/day from your diet and/or a supplement.

• Psyllium: Another type of soluble fiber made from the husk of psyllium seeds, psyllium is good for digestive health and regularity, and can also be helpful in lowering cholesterol. Psyllium supplements are sold in powder form and can help reduce lipid levels when taken daily at a dose of 8-12 g/day. 

• Alpha-lipoic acid (ALA): ALA is a potent antioxidant made in the body and is also found in foods including carrots, beets, spinach, broccoli, potatoes, and red meat. Research indicates that 600 mg/day of alpha-lipoic acid from your diet and/or a supplement may help lower total cholesterol and LDL (bad) cholesterol [8]. 

• Bergamot extract: Bergamot is a citrus fruit that has long been used for medicinal purposes. Bergamot extract (made from the juice of the fruit) seems to lower cholesterol and triglyceride levels in adults with high cholesterol [9,10]. One study suggests taking bergamot extract daily for a month may be as effective as taking a low dose of the cholesterol-lowering drug called rosuvastatin (Crestor) [10]. A recent research review indicates that 1000 mg/day may be most effective for lowering cholesterol. 

• Green tea extract: Green tea extract is a natural supplement made from the leaves of the Camellia Sinensis plant that has been shown to help lower LDL (bad) and total cholesterol [11]. Taking400 mg/day of green tea extract may help lower your cholesterol but check with your doctor first as it can interact with certain medications, including beta-blockers and blood thinners. Green tea extract may also have a stimulant effect.

• Berberine: A compound extracted from a variety of medicinal herbs, some studies suggest berberine can reduce LDL (bad) cholesterol and triglycerides in type 2 diabetics [12]. It may also slightly increase HDL (good) cholesterol [12]. The standard dose of berberine is 900-2000 mg/day (divided into 3-4 doses), taken with or just after a meal.