What are lipoproteins?
Parcels of fat and protein that carry cholesterol in your blood. LDL and HDL are the famous two of five. VLDL usually gets no line on your results. It hides inside two others.
On this page
What is a lipoprotein?
A lipoprotein is a tiny parcel of fat and protein. Cholesterol is a fat, and HEART UK says fats can’t travel in the blood on their own. So they ride in these parcels.
Cholesterol itself isn’t the enemy. Your cells use it to stay healthy, and about 80% is made in your liver.
Each parcel is named by how dense it is. Protein is heavy, so more protein means high density. More fat means low density.
| Type | What it carries | What it does |
|---|---|---|
| LDL (low density) | Lots of cholesterol | Delivers cholesterol to your cells. Too much can fur up artery walls. |
| HDL (high density) | Lots of protein, little cholesterol | Takes spare cholesterol back to your liver to be removed. |
| VLDL (very low density) | Lots of fat (triglycerides), some cholesterol | Carries fat and some cholesterol out from your liver. |
| IDL (intermediate density) | Cholesterol and triglycerides | What VLDL becomes once some fat is taken out. |
| Chylomicrons | Triglycerides from food | The biggest. Carries fat from your gut after a meal. |
Source: HEART UK
So “good” and “bad” cholesterol are really names for these parcels.
Got your results? Keep them open for the next section.
Where is each type on my cholesterol results?
UK results don’t list every parcel. They group them into a few lines.
| Line | Which parcels | Healthy level for healthy adults (mmol/L) |
|---|---|---|
| Total cholesterol | All of them added together | Below 5 |
| HDL | HDL only. The NHS calls it good cholesterol. | Above 1.0 (men) or above 1.2 (women) |
| Non-HDL | Everything that isn’t HDL. Mostly LDL. | Below 4 |
| LDL | LDL only. Usually worked out, not measured. | Below 3.0 |
| Triglycerides | The fat in VLDL and chylomicrons | Below 2.0 non-fasting, below 1.7 fasting |
Sources: NHS; HEART UK; BHF; NICE NG238
Two of those lines are where VLDL hides: triglycerides and non-HDL. Its fat is in your triglyceride result. Its cholesterol is in your non-HDL, which counts everything except HDL.
Labs usually work out LDL from your other numbers. If your triglycerides are over 4.5, or 9 at some labs, your LDL may not be reported. Your non-HDL still is.
Only see a total? Ask your doctor or nurse for your HDL and non-HDL. More on each line: LDL, HDL and non-HDL.
What is very low density lipoprotein (VLDL)?
VLDL is the parcel your liver uses to send out fat. It’s big, full of triglycerides and has very little protein.
How fat moves round your body
- 1
After a meal
Your gut packs fat from food into chylomicrons.
- 2
From the liver
Your liver sends out its own fat and some cholesterol in VLDL.
- 3
Around your body
Fat is taken out. VLDL becomes IDL.
- 4
Back to the liver
HDL carries spare cholesterol back to be removed.
Sources: HEART UK; HEART UK triglycerides
Like LDL, too much VLDL cholesterol means fat can be laid down in your artery walls.
This is also why a fasting triglyceride level is lower. With no food in you, there are no chylomicrons, so the test only counts VLDL fat.
Triglycerides over 2.0? Read high triglycerides for what raises them.
What are Lp(a) and oxidised LDL?
Lipoprotein (a), or Lp(a), is a lot like LDL but more sticky. High levels can clog arteries and lead to heart disease and stroke at a young age.
Your genes mainly set it. Diet and lifestyle usually don’t change it, so most people won’t usually need a second test.
| Lp(a) result | HEART UK risk level |
|---|---|
| 32 to 90 | Minor |
| 90 to 200 | Moderate |
| 200 to 400 | High |
| More than 400 | Very high |
Source: HEART UK
Check the unit first. A result in mg/dL or mg/L can mean something very different.
Your GP test doesn’t usually include it. A specialist cholesterol (lipid) clinic can measure it. HEART UK says it should be measured if you:
- had heart or circulation disease before 60, or it runs in your family
- have a parent, brother, sister or child with Lp(a) above 200 nmol/L
- have familial hypercholesterolaemia (FH), an inherited cause of high cholesterol, or another inherited cholesterol condition
- have calcium build-up on a heart valve (calcific aortic valve disease), or it runs in your family
Oxidised LDL is LDL that has been chemically damaged. Many studies link it to furring of the arteries, but it isn’t a line on routine UK results.
If early heart disease runs in your family, ask your GP whether an Lp(a) test is right for you. More in Lp(a) blood test.
How do I lower the bad types?
Six HEART UK changes for a healthier heart
- Cut foods high in saturated fat, and swap in foods with healthy unsaturated fats.
- Eat at least 5 portions of fruit and vegetables a day.
- Choose wholegrains like brown rice, wholemeal bread or wholemeal pasta.
- Have two portions of fish a week, one of them oily, such as mackerel or salmon.
- Eat pulses, beans, lentils, soya and nuts more often.
- Add oats and foods with added plant stanols or sterols.
Source: HEART UK
These can lower LDL and other heart risks. There’s not enough evidence that diet changes Lp(a).
Eggs and prawns contain cholesterol. For most people, that doesn’t have much effect on blood levels. See eggs and cholesterol.
Statins, the most common cholesterol-lowering medicine, lower LDL and non-HDL, but they don’t lower the amount of Lp(a). Never stop or change a prescribed medicine without your prescriber. For more, see how to lower cholesterol.
When to speak to a GP
High cholesterol does not usually cause symptoms. Only a blood test shows it. Book an appointment if:
- Your total is above 7.5, or you or a parent, brother, sister or child had heart disease before 60. NICE says to think about FH.
- Your total is above 9, or your non-HDL is above 7.5. NICE advises a specialist check.
- Your triglycerides are 10 or more. NICE advises a repeat fasting test, and urgent specialist review above 20 if alcohol or poorly controlled diabetes doesn’t explain it.
- You’re over 40, overweight, or high cholesterol or heart problems run in your family, and you’ve never had a test.
Early heart disease in your family? Ask whether an Lp(a) test or a lipid clinic referral is right for you. See also cholesterol results explained.