Good vs. Bad Cholesterol: A Patient's Guide to Understanding Your Lipid Profile

This episode is a comprehensive episode designed to educate listeners about the complexities of cholesterol and its impact on cardiovascular health. The episode defines hyperlipidemia  detailing various types of lipids, including LDL, HDL, and triglycerides. The discussion covers recommended lipid screening guidelines, risk factors, and the importance of personalized risk assessment. By the end of this episode, listeners will have a deeper understanding of cholesterol and will be empowered to take proactive steps towards better heart health.

Takeaways

Cholesterol is a crucial aspect of cardiovascular health.
High levels of lipids can increase the risk of heart disease.
LDL is considered the 'bad' cholesterol, while HDL is the 'good' cholesterol.
Triglycerides are sensitive to food intake and should be measured after fasting.
Screening for cholesterol levels typically starts at age 40, but can vary based on individual risk factors.
Understanding lipid panels is essential for managing heart health.
Diet and exercise can significantly impact cholesterol levels.
Non-HDL cholesterol is another important metric to consider.
Personalized medical advice is crucial for managing cholesterol.
Misinformation about cholesterol can lead to confusion and poor health decisions.

Keywords

cholesterol, lipids, cardiovascular health, LDL, HDL, triglycerides, hyperlipidemia, health education, patient podcast

Transcript

Ed Delesky, MD (00:07)
Hi, welcome to your checkup. are the Patient Education Podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky, a family medicine resident in the Philadelphia area. And we are so excited you were able to join us here again today. So we have conflicting issues here. We'd like to give an episode to everyone this week, but we also have...

Nicole Aruffo, RN (00:21)
and I'm Nicole Aruffo I'm a nurse

to

discuss.

Ed Delesky, MD (00:34)
in the background. We do. We have a lot of preamble to entertain everyone with and a really valuable episode. So we'll see how all of this

Nicole Aruffo, RN (00:43)
Right now. So.

The commander's just got two touchdowns in a row and our friend Mike is at the game. And I'm wondering if he has a little bit of excrement in his pants right now because of what just happened.

Ed Delesky, MD (01:00)
He might. I mean, no matter how dominant the Eagles seem, this is a tough commander's team as they homage to the cardiac commanders. They're just tough. that Jaden Daniels is a tough rookie to get behind. And we'll see how the game goes. But we have it on our sports bar at home. And we just had a beautiful birthday celebration. I feel like the luckiest guy in the world.

Nicole Aruffo, RN (01:28)
yeah, we have to talk about dinner.

Ed Delesky, MD (01:30)
that you took care of me and we went to dinner. That's the first one. It was a surprise dinner, 8 p.m. reservation after we went and spent some time at Victory. And the dinner was at a location called Villa Custa, a northern Italian cuisine. And it was during restaurant week. So we had a restaurant tasting menu style dinner.

Nicole Aruffo, RN (01:50)
I look out because your birthday always is during restaurant week.

Ed Delesky, MD (01:53)
Yeah, that was a nice thing for you. And we ended up starting with a rosemary focaccia with a honey butter. And they took this little bowl of butter and they stamped it with what looked like a honeycomb. That was delicious. And I know that people normally don't take the bread away as the most like the best part of the meal. But for me, that kind of was the showstopper. But why don't you tell us about it?

I think so. Yeah, it's the piece that I took away. But why don't you tell us about the that next piece of dinner, the pasta dish.

Nicole Aruffo, RN (02:30)
Wait, hold on, I'm looking it up on the menu right now. It's, wait, now brunch, dinner.

Ed Delesky, MD (02:43)
So this was a total surprise. We went to Victory. Nikki took a half day. And we were able to go to enjoy several drinks. Maybe not this episode. We will encapsulate our thing. But a shout out to the gentleman that we spent so much time with at the bar who was very

Nicole Aruffo, RN (03:01)
Yeah,

we didn't even talk about Brent.

Ed Delesky, MD (03:04)
Yeah, I don't know if we're going to do that right now or maybe we will, why don't we... What about that pasta?

Nicole Aruffo, RN (03:11)
So was so good. was like a... How do you describe it? It's kind of like a...

Ed Delesky, MD (03:18)
an orb.

Nicole Aruffo, RN (03:19)
It's like a dumpling. Like I don't want to describe it as like a ravioli because it's not like the dough is a little bit thicker and they're balls. And I guess it's kind of like a dumpling situation is the best way I can describe it with ricotta in the middle. And then there's some sort of like sage, lemony, buttery, creamy light sauce on top. That was my favorite.

Ed Delesky, MD (03:21)
Okay, yeah, that's dumb.

Mm. It was really good. You

saw you seek and destroyed that item on the menu. You were like, that is what we have to get. That's that. And on the second, they had the brand Zeno, which was a crispy, light, tasty fish. I think it's a sea bass, isn't it? Yeah, that's really what that is. And it's a crispy skin that you could eat right off of it. I'm not numb and a toasted potato to join it on the side.

We there was like a nice like frappe multi-layered with like cacao nibs. Little little like dessert dish that we had and the company that we had to next to us was very interesting. I think we like jump right in here. That guy was something else.

Nicole Aruffo, RN (04:25)
day.

Yeah, okay, so that guy Well, first of all, it was his birthday, too And they brought him out like a birthday thing and like the sparkler candle Just kind of annoyed that they didn't bring out for you

Ed Delesky, MD (04:52)
You clearly told her it was me.

Nicole Aruffo, RN (04:53)
I

told them it was your birthday. asked what we were celebrating and I said your birthday. But I guess it was because we like got dessert with the tasting money that we did. I don't know. Anyway, so is this guy's birthday? The girl he was with paid for the dinner.

Ed Delesky, MD (05:09)
She did. Yeah.

Nicole Aruffo, RN (05:10)
Yeah, she paid for the dinner. Like for his birthday, obviously. Sure. And then while they're still there and like wrapping up, he's caught me making phone calls in the restaurant at the table to his buddies to like see where they're going to meet up after jail. And then he's like having a hissy fit and he's like looking up different bars in the area. He's like, don't know where to go. Where do I go? And I'm like, what?

Ed Delesky, MD (05:33)
So directionally challenged.

Nicole Aruffo, RN (05:40)
What do mean where you going? This is where you were going tonight. Right. To dinner with your girlfriend. What do mean? You're here. So then, I don't know, they were also having like weird conversation and like he was seems like not a fun guy and really annoying. But then they got up.

Ed Delesky, MD (05:46)
went.

This is the piece de resistance.

Nicole Aruffo, RN (05:59)
And

so like, they get up, the girl's like getting her bag and like getting her stuff and is putting her jacket on. The guy had already left, he's at the door. And the girl's still like.

Ed Delesky, MD (06:07)
already.

the table. Yeah. Standing getting her stuff on how how would like a birthday diva. And after she did all of that and just like the way to seem so ungrateful. And this wasn't a nice guy like and we're not like I would never like disparage someone who seemed like maybe there's this guy stunk like that. And there's no two ways about it. But you know, they left through maybe like a third or halfway through the dinner and then got this like, you know,

Nicole Aruffo, RN (06:13)
fruit.

He sucks.

Ed Delesky, MD (06:41)
nondescript party that was next to us. It was distracting, though. Like I had a tough time talking to you because I could not get my attention off of this disaster that was next to us. And like, I don't know if that girl knew what was going on or if she knows that he was behaving like this. But like this guy, that was so rude. like you saw it, but I saw it. And if you're out there like that was so nice of her.

Nicole Aruffo, RN (07:00)
hope so.

Ed Delesky, MD (07:09)
Like you don't have to do that. There's no obligation to pay for someone's birthday dinner, especially at a place like that. And then he does that. Anyway, the drinks were also delicious. I got this like margarita adjacent tequila drink. yeah, that was really good. It was like salt down the entire rim, like down the entire wall of the thing. I'm me like a barbarian licking the salt off of the drink before I take a sip. You probably shouldn't do that in public. And then.

Nicole Aruffo, RN (07:33)
can take you in.

Ed Delesky, MD (07:36)
Your drink, I can't describe it. say like to my butt, like a vodka type of drink, but there was more.

Nicole Aruffo, RN (07:41)
yeah, I told the guys you got a vodka drink. As if that narrows it down.

Ed Delesky, MD (07:47)
But you always pick a nice drink and it doesn't...

Nicole Aruffo, RN (07:49)
It was vodka, limoncello, and sage, and it was delicious.

Ed Delesky, MD (07:52)
And it was and it was delicious. So those are those are two of the three. And then there was that really nice gentleman that we met at Victory who we spent hours talking to. And he was great. It very generous. Bought us a couple of rounds for like what we do. We shared the podcast with him and he gave us a couple of stories that were really funny about his own wedding as we kind of like, you know, ponder about ours and how we're going to celebrate it. He was really. I hope you listen. So shout out to I think a first name is fine.

Nicole Aruffo, RN (08:15)
He was cool. I hope he's listening. He said he was going to.

Ed Delesky, MD (08:22)
Shout out to Brent. No government names here, but shout out to him for being so nice to us and being interested in the podcast. Side note, not that we're a sports podcast at all. Looks like the commander's just turned it over at the start of the fourth quarter. We're watching this live. the irony of this is that if anything changes randomly at a moment in time, you'll hear it.

Nicole Aruffo, RN (08:23)
his full government name.

Ed Delesky, MD (08:47)
And we live here in Center City, so if anything comes up and the Eagles win.

Nicole Aruffo, RN (08:52)
We might have to stop this and go to Broad Street real quick.

Ed Delesky, MD (08:55)
All right. So we covered the dinner and we give a nice review. I got like amazing gifts. I won't go into them here because I don't want to seem spoiled. Oh, they're sick one again. Oh, is that almost a touchdown? Almost number three. Damn. Damn. As a giant fan, that hurts. The dinner we did. I think that was pretty good.

Nicole Aruffo, RN (09:24)
I that was pretty good.

Ed Delesky, MD (09:25)
felt good about the recap. So we have an educational episode today.

That didn't go as planned. that didn't go as planned. Maybe they'll they'll run into Saquon again, give it to them.

Nicole Aruffo, RN (09:40)
I

Ed Delesky, MD (09:50)
So what are we gonna talk about today and next?

Nicole Aruffo, RN (09:53)
well, I believe today we're talking about cholesterol.

Ed Delesky, MD (09:56)
Yeah. And I put this episode together as a preamble to talking about cardiovascular disease. And what we won't be talking about is statins, but we will be talking about breaking down what cholesterol is because like anything we talk about here, it's important. and it's important to your overall health. We're going to explain high levels of something called lipids and that includes cholesterol and triglycerides. And we're going to talk about what that means as hyperlipidemia.

And we're also going to talk about different types of lipids and how they impact your cardiovascular health and a little bit on screening recommendations. But overall, that is a confusing topic because we'll kind of explain why and why that really is such a personal decision to you.

So something that I want to define early on is that a lipid is a molecule that is in the body and it is either cholesterol or a triglyceride. And it is something that floats around in the body and it has its own functions. But when we say lipid, that is what we mean. And if you hear your doctor say lipid, they are talking about cholesterol and triglycerides.

Nicole Aruffo, RN (11:06)
So what does it mean when we have high levels of lipids or hyperlipidemia?

Ed Delesky, MD (11:12)
So when we have high levels of lipids, it means that there are elevated levels of... What would an episode be without our intern in the background? So high levels of lipids include high levels of cholesterol and triglycerides, or one or the other. And the reason that it's important is because hyperlipidemia increases the risk of heart attack, stroke, and several other serious health problems.

Mainly because of vessel wall narrowing or obstruction. So this is the stuff that gets gunked into your blood vessel walls and narrows it leading to less blood flow getting through and causing problems.

Nicole Aruffo, RN (11:57)
So this is like when people say something's gonna clog your arteries.

Ed Delesky, MD (12:00)
Exactly that. Yes. This is that's the money. And so like the classic teaching is that like you can lower your cholesterol through diet, exercise and medication to reduce all of those risks. But here we really think that it's important that you understand what you're reducing when you look at your lipid panel quote unquote and like your doctor ordered some stuff and you're to look at it. What does all of that mean? And so that's really what we're going to try to get at today.

Nicole Aruffo, RN (12:28)
What are the different types of lipids?

Ed Delesky, MD (12:30)
So lipids includes, like I said earlier, cholesterol and triglycerides. And these are included in a lot of standard blood panels, which include total cholesterol, LDL, HDL cholesterol, and triglycerides. And so breaking each of those down, the total cholesterol is, truly an elevated total cholesterol means like somewhat of an important thing.

In a lot of studies, does, you know, can note a risk of increased cardiovascular disease. So like less than 200 of a total cholesterol is normal. 200 to 239 is borderline high and greater than 240 is generally considered high. But what I will say is that I had a lot of patient messages that come back and say like, oh my God, my cholesterol is high. And the first thing that I tell them is that that really isn't the most important thing to look at. And so

Cholesterol itself is broken down into two other ones, mainly. It's broken down into LDL and HDL. LDL is defined as the bad cholesterol. This one specifically, if that one's higher, you have increased risk of cardiovascular disease. That's the one that most people who are making decisions about whether you should be on medicine or how hard they're leaning into giving you advice about exercise, diet, risk factor management.

They're looking at LDL and saying like, that's the one that needs to be changed. And when like when people have a cardiovascular event, their LDL goal is the one that changes. People who have higher LDLs are at higher risk. And so what I really want to hammer home is that it's the LDL that's the one that people look at. Because when you look at that in contrast to the HDL, the HDL is the good cholesterol. And so in that way,

when people say like, my God, my HDL is high. HDL is a good cholesterol. So honestly, the higher, the better. So that one is cardio protective.

Nicole Aruffo, RN (14:38)
sorry. Do you want to give people a roundabout number for each or no?

Ed Delesky, MD (14:44)
Yeah, so when...

Nicole Aruffo, RN (14:46)
What is that to like.

Ed Delesky, MD (14:48)
No, that's OK. So you'll see your general lab will probably give you a border. If your LDL comes up at 120, it'll probably be red. But if it's over 100, or 120, 130, 40, 50, 60, what that's going to do is the LDL is going to incorporate into a risk calculator, which either later this episode or some other episode, we're going to talk about that, where it takes your age. It takes your cholesterol.

It takes your blood pressure, diabetes, and all of that goes together to predict how likely are you to have cardiovascular disease in 10 years, in 30 years. And so the real hard answer number for LDL is if you have a 190, you should be on a statin. If there's something like less than that, it's a conversation is really what it is between you and the person taking care of you.

Nicole Aruffo, RN (15:44)
When I had to first remember this in school, remembered HDL was healthy, so like H for healthy and then L was for Lorde. It was a bad one. So if you're looking at your labs and you forget which one's the good and which one's the bad one. H for healthy, L for Lorde.

Ed Delesky, MD (15:56)
HT.

healthy

L for lard. think we have our clip there too. Well, because I got people messaging me and they're saying like, oh my God, my HDL is 90. And I'm like, no, congratulations. That's excellent. You're doing awesome. It's like a level of like an HDL level of 60 milligrams per deciliter or higher is excellent. Levels less than 40 are actually considered low. And so when you improve your diet, when you lose some weight, when you eat healthier foods, then

those numbers will change and you can track that over time. So now with this information, you're able to go back and say like, okay, I had my lipid profile at time zero and three months from now, six months from now, a year from now, my doctor is gonna check it. What changes will I see based on the changes I made at home?

Nicole Aruffo, RN (16:52)
I peaked in my life when I was doing my yearly employee, it's just physical quote unquote, and you get a couple of labs. It's got a discount on your insurance payment. they had this machine that did this. And for the LDLs, mine was so low that the machine didn't read it. There you go. And that was the height of my life. And it's probably all been downhill from there.

Ed Delesky, MD (17:21)
So

there's definitely more to it than just the one cholesterol number. Like I remember like a dear friend growing up. He's like my cholesterol is over 200. Using that voice. can imagine who it is. And I'm like at the time I was like I had no idea about medicine and I was like, oh boy. And I was sitting in a seat of like where a lot of people who are listening to this might be. But I'm sure if you broke it down, I mean maybe if his LDL at 18 years old was like 160. Yeah, we got to make a change.

Nicole Aruffo, RN (17:50)
He also you can cut this if it's too embarrassing But didn't he like figure out what a calorie was at like 23 and then he would like eat on your walks He would because the calories kids

Ed Delesky, MD (18:00)
And

well, has no one knows what his name is. So we would walk around the development and he'd be like, burn calorie, eat calorie, burn calorie, gain calorie, burn calorie, gain calorie. And like he would be eating a sandwich while we were doing that. And it was a beautiful thing to see a burn calorie, gain calorie, burn calorie. Anyway, so that's LDL and that's HDL. Something they will see and it lives in the calculator is non HDL cholesterol. And this isn't

talked about so much, but what it is is the, it takes into factor all of the non-HDL cholesterol like LDL, but also the other ones that cause plaques in the arteries. And it's calculated basically by taking the total cholesterol and subtracting the HDL. And so, some people, practices, some science has some evidence that this might be better at predicting cardiovascular disease, but a lot.

or all of the evidence and advice that we get that goes out is about LDL. And so hands tied behind the back. But the one piece to say about this is that if your doctor gives you an LDL cholesterol goal and you're curious about non-HDL cholesterol goals, add 30 to the LDL cholesterol goal and that's your non-HDL cholesterol goal.

a little convoluted, talk it over with your own person, but just know that that exists. That is a cousin of LDL. Maybe it's a little bit better. We're getting into the weeds of like lipidology here. And so not terribly important, but for the purposes of like cholesterol one-on-one, just knowing that non HDL goes in the same category as LDL.

Nicole Aruffo, RN (19:45)
What about these pesky triglycerides?

Ed Delesky, MD (19:48)
So triglycerides are another cholesterol or another lipid that actually do correlate with an increased cardiovascular risk. In my practice and other people's practice, we don't, yeah, if you see a high triglyceride, you're gonna talk about it, but it's, I don't know if it moves the needle to make you jump as much as the LDL. And so a normal is less than 150 milligrams per deciliter. When mildly increased, we're talking a wide range from 150 to 499.

and a moderately increased is like 500 to 886. That's kind of high. Very high is like 886 and over. And really what we look at is like that's a risk factor for something called pancreatitis. But sure, if your triglycerides are off, you probably have some room to make improvements in your diet and exercise anyway.

Treglycerides are the most sensitive to food and the food that you ate. And so you really should be fasting for at least eight hours, probably nine hours before getting that one. But these days, I think a lot of people, myself included, we have a lab that's very close. I'd rather people go get their labs after the visit than wait till the next day. Maybe they're really busy. Maybe they don't go at all. And so that's something that I say is like the triglycerides are the ones that have to do with fasting.

So then there's the concept of lipoprotein A or lipoprotein little a and this is a type of cholesterol. It's usually genetically predetermined and a lot of guidelines don't have really strong evidence to look into this. It's not included on standard lipid panels and so like you may have to ask for it if you're interested but this is not me proposing that someone should ask for it.

I think if your doctor wants to look into it or your cardiologist wants to look into it, sure. I've had a friend recently who did this, but like he also has a family history of heart disease. So I don't have a lot to say about that, but mainly that it's genetically has a genetic predisposition and is probably related to increased cardiovascular disease if those are out of whack as well.

Nicole Aruffo, RN (21:58)
All right, so we talked about all of these different lipids and some numbers. When do you start lipid screening?

Ed Delesky, MD (22:07)
This is a, it's a great question, it's also a little bit of a frustrating one. A lot of the moves that people make, there's no straight answer here as the headline, and it's that like the moves that individual physicians and people who are taking care of patients make are based on guidelines. And it depends on which guideline you look at. And so if you're looking at the American Heart Association, they're gonna say one thing. If you look at the United States Preventative Task Force,

they're going to look and say another thing. I would say generally, if there's no other reason, 40. But I don't think anyone is going to be faulted if someone has extra weight or if they have obesity that you're going to fault them if they throw on a lipid panel to be able to say, is the cholesterol high? Is the LDL controlled? Or if someone has a family history of heart disease. And so you're going to see different numbers. If you go look this up, you're going to see 35.

You're going to see 25 to 30. You're going to see 45. USPSTF says 40 years old is like the time to start and to go from there.

And the main thing being is that the cholesterol plays into your overall cardiovascular risk. And so there are different calculators that we're going to talk about in future episodes once we define cardiovascular risk. But the major thing being is that it is one piece of the puzzle that involves the whole calculation of your risk of having heart attack, stroke, or other disease related to your vascular system. And so

To be able to calculate that, United States Preventative Task Force says 40 years old is the time to start. But I don't think I would fault anyone. Me, myself, I've done it earlier. If someone's curious at a whiff, I'll try to come up with some reason to be able to do it, whether that's like guideline-based medicine or something a little less than that. That's what it is. there's a third. Third touchdown for Saquon.

Nicole Aruffo, RN (24:11)
Your boy. This guy's playing like he has to pay his rent today.

people are freaking out.

Ed Delesky, MD (24:23)
Yeah. And then if you start a medicine or like if the conversation at that point is between you and your physician, when you decide to recheck it, what the plan is from there. So keep it simple and keep it there. So on this episode, we were able to break down the different types of cholesterol and realize that like when someone says like their cholesterol is high, quote unquote, it may mean different things because there are multiple components which we covered in this episode here and we're really happy about.

Do you have any other thoughts or things that we should talk about? So, okay. Yeah, I mean, like this, the spark of this episode was from like something that your mom sent us where like, this woman's out here like talking about anything on TikTok and the theme of like misinformation. And she's like one of these like natural, like holistic remedy people. And it's just a disaster. And they're like, your cholesterol is high. Like, well, it depends is really the answer.

Nicole Aruffo, RN (24:54)
I don't think so.

Ed Delesky, MD (25:20)
So thank you for coming back to another episode of your checkup. We hope you were able to learn something for yourself, a loved one or please check out our website, check out our Instagram, see if we have any videos on TikTok, but most importantly, send us some fan mail. Please share it with a friend or a neighbor if you'd like to and tune in next week for another topic related to health and wellness and bringing conversations to you or your neighbor. But until then, stay healthy, my friends. I'm Ed Delesky

Nicole Aruffo, RN (25:26)
a neighbor.

Ed Delesky, MD (25:49)
I'm Nicole Aruffo. Thank you. Goodbye. Bye.

This information may provide a brief overview of diagnosis, treatment, and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments, or medications for a specific person.

This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for a complete information tailored to you. In short, I'm not your doctor and make sure you go get your own checkup with your own personal doctor.

Nicole Aruffo, RN (26:52)
I am not your nurse.