Understanding the Impact of Different Cholesterol Types on Heart Health

When you think about cholesterol, your mind probably jumps to its effect on your heart disease risk, particularly if your doctor has said your levels aren’t where they should be.

It’s more than a little anxiety-inducing when blood test results come back with a laundry list of terms—LDL, HDL, triglycerides—followed by hard-to-interpret numbers. What does it all mean?

Here’s the thing: Cholesterol is both good and bad when it comes to your health, depending on where it is in your body, how much there is, and what kind it is. Here’s a rundown of the different types of cholesterol and what you should know about each.

First, what is cholesterol?

Cholesterol is a waxy fat that’s churned out by your liver. It gets paired with proteins and hitches a ride on them so it can get ferried throughout your bloodstream.

Despite its bad rap, cholesterol plays a vital role in your health, according to cardiologist Nieca Goldberg, MD, medical director of Atria New York City and a clinical associate professor at NYU Grossman School of Medicine. Your body uses cholesterol to make cells, certain hormones, and the bile used to digest food, among other things.1

But not all cholesterol is the same. Depending on the proteins it’s paired with—known scientifically as lipoproteins—cholesterol might get dropped off, picked up, or otherwise handled in ways that might affect your health as it travels through your blood vessels.

Knowing your lipoprotein situation can give you some insight into what’s happening inside your body—and help you sort out what those cholesterol test results mean.

Low-density lipoprotein or LDL (a.k.a. “bad cholesterol”)

Since you need cholesterol, calling LDL “bad” is overly simplistic. But this is one type of cholesterol that you want to have less of, Dr. Goldberg says, because it can contribute to clogging your arteries, which increases your risk of heart disease.

When your body has too much LDL, cholesterol can be deposited in places you don’t want it, like your blood vessels (including the ones leading to your heart). This can contribute to a waxy buildup of plaque that makes your arteries narrow and stiff, also known as atherosclerosis.

That said, atherosclerosis—which affects about 50% of adults over the age of 45 in the US—slows blood flow to the heart (as well as other organs and tissues), and if a plaque bursts, a blood clot can form and trigger a heart attack. Things don’t always get to this dire stage but, “sometimes the first sign that something’s wrong is a heart attack,” Guy Mintz,

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