Optimal Cholesterol Levels

Cholesterol is a fat molecule, about 80% of which is produced by the body and 20% is introduced through the diet. It is naturally present in the blood and in all the cells of our body. In physiological amounts, it is essential for:

• The construction of cell membranes and tissues;
• The synthesis of thyroid hormones;
• The production of vitamin D.

The problem arises when the amount of cholesterol in the blood (which can be detected with a simple blood test) becomes excessive. This can be caused by a hereditary predisposition in which the body produces too much of it or by a diet too rich in saturated fats.

"When cholesterol, particularly LDL cholesterol (or bad cholesterol), circulates in excess in the arteries, it can deposit and initiate a process called atherosclerosis, which is the formation of plaques on the inner walls of the arteries. Over time, these fat plaques can damage the artery walls, leading to serious blockages and severe consequences such as heart attack, stroke, or peripheral artery disease," explains Dr. Robba.

Normal cholesterol values

"According to guidelines, the 'ideal' total cholesterol value should be below 200 mg/dL. Values between 200 and 250 mg/dL are considered borderline, while levels above 250 mg/dL are considered dangerous.

It is important to remember that the total cholesterol value includes not only LDL cholesterol but the total amount of cholesterol, which is the sum of:

• LDL cholesterol or 'bad' cholesterol;
• HDL cholesterol, also known as 'good' cholesterol;
• VLDL cholesterol, which stands for Very Low-Density Lipoprotein, a very low-density lipoprotein that carries triglycerides and can be considered a precursor of bad cholesterol," continues the specialist.

The most important value to consider, as mentioned, is that of bad cholesterol. "The ideal level of LDL bad cholesterol in the blood should be below 130 mg/dl.

However, be careful," Dr. Robba points out, "the 'safety' limit decreases further if there are other risk factors for cardiovascular diseases, such as:

• Diabetes;
• Overweight;
• Hypertension;
• Smoking;
• Excessive alcohol consumption;
• Sedentary lifestyle."

LDL cholesterol values:

• Between 130-159 mg/dl are considered borderline and deserving of treatment in at-risk patients;
• Between 160-189 mg/dl indicate a condition of high cholesterol;
• Above 190 mg/dl indicates very high cholesterol, potentially dangerous to health.

Unlike bad cholesterol, HDL cholesterol is an ally of cardiovascular health. HDL particles help clear the body of excess bad cholesterol.

"HDL cholesterol acts as a 'scavenger,' transporting LDL cholesterol from the peripheral tissues to the liver, where it is then eliminated through bile," explains Dr. Robba. "For HDL to perform its protective function against the risk of cardiovascular diseases, it is important that its level is not lower than 40 mg/dL.

There is no upper maximum limit, although generally, HDL levels are considered desirable if they are above:

• 55 mg/dL in men;
• 65 mg/dL in women of childbearing age."

Hypercholesterolemia can affect not only adults but also children and the elderly.

In children, high cholesterol can be caused by congenital conditions, such as congenital dyslipidemia, or metabolic diseases like obesity. "In this case, the total cholesterol value is considered normal up to about 160 mg/dl, while borderline values range from 170 to 199, and high values are those above 200."

For the elderly, the cholesterol values considered normal are the same as for adults. "However, it should be noted that, with age, total cholesterol physiologically increases. Therefore, it is advisable for elderly individuals to monitor their lipid profile more closely and adopt a healthy lifestyle and a low-fat diet," suggests Dr. Robba.

The first tool for controlling high cholesterol is diet. "The first rule is to avoid or reduce as much as possible processed meats and sausages, fatty cheeses, animal-based condiments (butter and lard), and packaged products (such as snacks, cookies, spreads, and certain oils).

Instead, it is beneficial to use cold-pressed vegetable oils (like seed and olive oil) as condiments, and when it comes to cheeses and dairy, choose low-fat cheeses (limiting consumption to 2-3 times a week) and skimmed or semi-skimmed milk," continues the specialist.

In addition to a proper diet, physical exercise can help lower bad cholesterol while raising good cholesterol levels. There's no need to engage in strenuous sports; even walking at a moderate pace for 30-40 minutes a day or taking the stairs are good habits. Alternatively, practicing high-intensity physical activity at least three times a week for 20-30 minutes a day is recommended.

"If lifestyle changes are not effective in keeping cholesterol levels under control, supplements like plant sterols can be helpful. They work by limiting cholesterol absorption from food, although they cannot control endogenous cholesterol, which is produced by the body.

If cholesterol levels remain high and other cardiovascular risk factors are present, a specialist may recommend taking statins, a class of drugs that inhibit the synthesis of LDL cholesterol by the body," concludes Dr. Robba.