What is cholesterol?

Cholesterol is a fat-like substance found naturally in every cell of the body. The human body produces cholesterol by itself, but it can also be obtained through food.

The body cannot break down cholesterol. It leaves the body in such a way that the liver excretes cholesterol into bile, either as such or converted into bile acids. Some of the cholesterol leaves the body with the feces and some is absorbed from the intestine back into the bloodstream.

Cholesterol is sometimes referred to as “good” and “bad” cholesterol, but it is actually cholesterol-carrying lipoproteins. LDL cholesterol (LDL-C) is associated with an increased risk of arterial disease, while a high concentration of HDL cholesterol (HDL-C) does not in itself mean a lower risk.

Elevated cholesterol increases the risk of cardiovascular disease.

What does total cholesterol mean?

As the name suggests, total cholesterol measurement can determine the total amount of cholesterol in the blood. Total cholesterol gives an overview of the amount of cholesterol in the blood, but in assessing the risk of cardiovascular disease, LDL cholesterol, HDL cholesterol, triglycerides and non-HDL cholesterol are particularly examined, as well as apolipoprotein B (ApoB) if necessary.

Cholesterol measurement can determine how much “bad” cholesterol (LDL cholesterol) is in the blood, which travels to the artery walls under unfavorable conditions, gradually narrowing them. The measurement also determines how much “good” cholesterol (HDL cholesterol) is in the body.

The measurement also shows the triglyceride content in the blood. Triglycerides are fats that circulate in the blood and play a significant role as a reserve source of energy in the body.

Cholesterol is insoluble in water, so it cannot be transported in the bloodstream as such. Cholesterol must become water-soluble, which means it is packaged into transport proteins called lipoproteins, which are used to transport it throughout the body in the bloodstream.

Lipoproteins contain four components: cholesterol, triglycerides, phospholipids, and protein.

Total human cholesterol is divided into classes that differ in their function, size, density, and composition.

VLDL, or very low-density lipoproteins. The liver produces VLDL cholesterol and releases it into the bloodstream. VLDL particles transport triglycerides, a fat-like substance, to the tissues. VLDL and LDL cholesterol are bad cholesterol because they can contribute to the formation of blockages in the arteries.

LDL, or low-density lipoproteins. LDL carries most of the cholesterol in the blood and helps cholesterol move from the blood to the tissues. Excess cholesterol remains in the bloodstream and can build up on the walls of the arteries, narrowing them. This cholesterol is also called bad cholesterol.

HDL, or high-density lipoproteins. HDL transports cholesterol away from tissues and artery walls back to the liver, where it is broken down. This cholesterol is called good cholesterol.

Apolipoprotein B (ApoB)

Apolipoprotein B, or ApoB, is a structural protein of atherogenic lipoproteins. The concentration of ApoB provides information about how many atherogenic lipoprotein particles, such as LDL and VLDL particles, are in the blood.

ApoB complements the measurement of LDL cholesterol. LDL cholesterol indicates the amount of cholesterol carried by lipoproteins, while ApoB indicates the amount of atherogenic particles. There can be a difference between the two, so ApoB can provide additional information when assessing the risk of cardiovascular disease.

Measuring Cholesterol

The amount and quality of cholesterol can be measured using blood tests. Total cholesterol is measured by examining the cholesterol content in the blood.

Cholesterol and fat values, or lipid testing, provide information about blood cholesterol, triglycerides and cholesterol-carrying lipoproteins. The Puhti test includes the following subtests:

• Total cholesterol
• Triglycerides
• LDL cholesterol
• HDL cholesterol
• Non-HDL
• Col/HDL ratio
• Apolipoprotein B (ApoB / P-LipoB)

Total Cholesterol Target Values

The recommended total cholesterol target value for adults is less than 5 mmol/L (millimoles per liter).

The ratio of total cholesterol to HDL cholesterol should not exceed four (4). 

The reference values for cholesterol

Effect of fasting on the interpretation of cholesterol levels 

Triglycerides: If you have fasted before sample collection, the reference value is under 1.7 mmol/L. If you have not fasted, the reference value is under 2 mmol/L. 

High cholesterol levels 

The most common cause of high cholesterol (LDL) is a diet excessively rich in saturated fats. Avoiding hard fats, exercising and avoiding excess weight can affect the quantity and quality of total cholesterol in the body. Opt for soft vegetary fats. 

If there is excess LDL cholesterol in the body, it can build up in the arterial walls and lead to a blood clot in coronary or brain arteries. Therefore, it is important to take elevated cholesterol seriously and start monitoring your cholesterol levels regularly. 

What are the risk factors for high cholesterol? 

Elevated cholesterol is also associated with factors beyond our control. These include age, gender and genetic predisposition. 

• Gender. Women’s cholesterol levels often increase after menopause. 
• Age may increase the risk of elevated cholesterol. Men aged 45 and older and women aged 55 and older are at risk of high cholesterol. 
• Genetic predisposition. The risk of elevated cholesterol may increase if the person’s family member, such as father (before the age of 55) or mother (before the age of 65), suffers from early-onset heart disease. 

Elevated cholesterol can also be caused by other factors 

Cholesterol can also be elevated in the following situations: 

• diabetes 
• liver or kidney disease 
• hypothyroidism 
• polycystic ovarian syndrome 
• pregnancy or other life situation that increases the amount of oestrogen or other female hormones in the body 
• the use of drugs that increase LDL cholesterol and reduce the amount of HDL cholesterol in the body (progesterone, anabolic steroids and corticosteroids). 

In addition, smoking reduces the amount of HDL cholesterol. Quitting smoking is always a good idea. 

Symptoms of high cholesterol 

High cholesterol is a major risk factor for other more serious diseases but does not in itself usually cause any symptoms. Therefore, high cholesterol cannot be felt or discovered except by measuring the values with laboratory tests. 

Regular blood tests will help to identify elevated cholesterol, enabling appropriate treatment. 

How can high cholesterol be treated? 

Elevated cholesterol is often related to a person’s lifestyle, which is why lowering it begins with changes in diet and daily habits. 

• In nutrition, attention is paid to the amount and quality of fats, as well as the sufficient amount of dietary fiber. 
• In addition, adding exercise to everyday life can increase the amount of good (HDL) cholesterol in the body. 
• Quitting smoking is also an important change as smoking lowers the levels of good cholesterol. 

The harmfulness of cholesterol depends on simultaneous factors that damage blood vessels, such as smoking, high blood pressure, and lack of physical activity. 

If a healthy person does not have other risk factors, such as hereditary diseases, and their cholesterol levels remain at the recommended level, the primary solution is to lower cholesterol through diet and lifestyle changes. 

If a person’s risk of arterial disease is clearly increased, it is even more important to lower their cholesterol levels. This applies to diabetics or asymptomatic individuals who, according to the risk calculator, have a 10% chance of developing coronary artery disease or having a stroke within the next 10 years. Medication is considered to support self-treatment. 

The risk is highest in a person who have already been diagnosed with an arterial disease or additional disorders related to diabetes or whose result in the risk calculator is more than 15%. In that case, it is important to lower the person’s cholesterol levels with medication. 

Treatment of high cholesterol with dietary choices 

Diet affects blood cholesterol levels, especially LDL cholesterol. The tips below can help you prevent and treat elevated cholesterol. 

Remember to pay attention to the quality and quantity of dietary fats. The quality of fats obtained from food is good when it mostly consists of soft vegetary fats. 

Get started with small steps: replacing products high in hard fats with products high in soft vegetable fats, and making sure that your meals consist of diverse, colourful and fiber-rich foods.  

Common sources of hard fats include: 

• dairy products 
• fatty meat 
• animal products 
• sausages and similar products 
• baked goods 
• unhealthy snacks 
• ultra-processed foods 

The amount of hard fats can be reduced by switching from animal fats to soft vegetable fats. 

Vegetable oils, such as olive oil and rapeseed oil, are great sources of soft fats. 

Tips to help you reduce the amount of hard fats and increase the amount of soft fats in your diet: 

• Reduce the use of animal products, especially animal fats. If you use animal products, choose low-fat products. 
• Opt for lean meats, such as chicken and turkey. 
• Opt for fatty fish, such as salmon and sardines. 
• Avoid ultra-processed foods, such as hamburgers and unhealthy snacks. 
• Opt for nuts and seeds as a source of vegetable fats. 
• Opt for vegetable oils and liquid vegetable oil products. 
• Don’t forget fiber and vegetables. Increase your overall consumption of plant-based foods.

Treatment of high cholesterol with medication 

Medication is considered if diet and lifestyle changes do not reduce cholesterol levels sufficiently. 

In addition to cholesterol levels, the decision to start medication is affected by: 

• overall risk of arterial disease 
• elevated blood pressure 
• smoking. 

What is FH? 

FH, or familial hypercholesterolemia, is a cholesterol-increasing disease caused by a gene mutation. FH is one of the most common hereditary diseases, affecting around 10,000 people in Finland. The disease is predominantly inherited, meaning that 50% of the children of those suffering from FH will also have the disease. 

In FH, the cholesterol value is often more than 10 mmol/L, but the value can also be lower. With FH, diet and lifestyle do not affect the cholesterol level. The disease is treated with medication. If left untreated, the disease can lead to early-onset coronary heart disease. 

How can I get my cholesterol tested?

Check out the Puhti laboratory packages, which include cholesterol measurement.

Cholesterol measurement (lipid levels) includes the following values:

• Total cholesterol
• Triglycerides
• LDL cholesterol
• HDL cholesterol
• Non-HDL
• Chol/HDL ratio

The cholesterol measurement is included in the following test packages:

• Puhti laboratory package
• Extensive Puhti laboratory package women
• Extensive Puhti laboratory package men

Through Puhti as a separate service, you can also easily book a remote appointment with a doctor, during which you can go through all the results. 

Measures lipoproteins

Even more important than cholesterol levels are the quality and number of particles that carry fat in the body. See also the lipoprotein test package. The test is used in the following situations: assessing the risk of cardiovascular disease, investigating dyslipidemias, and monitoring cholesterol-lowering drug therapy.

ApoB, which is part of the cholesterol test package, provides information about the number of atherogenic lipoprotein particles. A separate lipoprotein test also measures ApoA1 and the ApoB/A1 ratio.

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