LDL Cholesterol: 165mg/dL

What does an LDL level of 165 mean? Are there any symptoms associated with this level?

An LDL level of 165 mg/dL is considered high. Although cholesterol serves several important functions, high LDL cholesterol puts you at greater risk for heart disease.

While high cholesterol is typically tied to diet and lifestyle factors, familial hypercholesterolemia (FH) can also cause high cholesterol levels. FH is a common genetic disorder that causes LDL cholesterol to increase. If untreated, FH can lead to early heart attacks and heart disease even in young adults and children. Because this condition is inherited, when one family member is diagnosed, it’s important that all family members are also screened for this condition.

High LDL cholesterol doesn’t have symptoms, which is why it’s important to know your levels. Lowering your LDL cholesterol levels 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 165: 

• Diet: Diets that are high in saturated fats, trans fats, added sugar, and low in fiber can cause LDL cholesterol to rise.

• Weight. Being overweight also tends to increase cholesterol levels. 

• Physical inactivity. Not being physically active can cause LDL levels to increase and HDL (good) cholesterol levels to decrease. 

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

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

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

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

• Genetics (heredity): High blood cholesterol can run in families. This is because your genes partly determine how much cholesterol your body makes. 

• 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.

What to do if your level is 165?

Making changes to your diet and adopting healthier habits can help lower your LDL cholesterol level back into the elevated (100-160 mg/dL) or optimal range (<100 mg/dL). To lower your cholesterol:

• Aim to get 30-40 grams of fiber each day from fiber-rich foods like veggies, fruit, whole grains, and legumes. 

• Limit sources of refined carbs and added sugars such as soda, chips, candy, baked goods, sweetened yogurt, and ice cream. 

• Avoid trans fats (partially hydrogenated oils) and reduce saturated fat intake to < 10% total calories. 

• Eat small, fatty fish at least twice a week. Some good options include salmon, sardines, and trout. 

• Be active every day: Aim for 30-60 minutes of physical activity 5x/week. 

• Incorporate plant sterols and stanols daily (2g) in the form of food or a supplement. 

• Lose weight if you are overweight or obese.

• Quit smoking.

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

Medications and supplements used to improve results

If diet and lifestyle changes are not enough to lower your cholesterol, some medication and supplements can be helpful to get them into a safer range.

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].

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

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

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

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

Supplements

• Plant sterols and stanols: Found in plant cell membranes, plant sterols and stanols (also called phytosterols) are similar in structure to cholesterol in the body and block dietary cholesterol from being absorbed. Phytosterols can be found in small quantities in vegetable oils, nuts, legumes, whole grains, fruits, and vegetables, however, the average daily intake (500 mg)  is typically not enough to lower cholesterol. 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, 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 8-12g/day. 

• Alpha-lipoic acid: A potent antioxidant made in the body, alpha lipoic acid 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]. 

• Green tea extract: Made from the leaves of the Camellia Sinensis plant, green tea extract is a natural supplement that has been shown to help lower LDL (bad) and total cholesterol [11]. A daily dose of 400 mg may help lower your cholesterol but check with your doctor first as green tea extract can interact with certain medications, including beta-blockers and blood thinners. In addition, green tea extract may also have a stimulant effect.

• Bergamot extract: Bergamot is a citrus fruit that has long been used for medicinal purposes. Taking 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. 

• 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, as well as 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.