What is VLDL?
VLDL stands for very-low-density lipoprotein. Your liver makes VLDL and releases it into your bloodstream. The VLDL particles mainly carry triglycerides, another type of fat, to your tissues. VLDL is similar to LDL, but LDL mainly carries cholesterol to your tissues instead of triglycerides.
VLDL and LDL are sometimes called "bad" cholesterols because they can contribute to the buildup of plaque in your arteries. This buildup is called atherosclerosis. The plaque that builds up is a sticky substance made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, the plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your body. It can lead to coronary artery disease and other heart diseases.
A normal VLDL level is below 30 mg/dL. Your healthcare provider can measure your VLDL cholesterol through a simple blood test. If your VLDL is high, lifestyle changes and medication can help.
Due to their chemical structure, fats (like cholesterol and triglycerides) can’t travel solo through your blood. That’s why they need lipoproteins to carry them to various organs and tissues throughout your body.
The main job of VLDL is to carry triglycerides and cholesterol to the places that need them. In their transport role, VLDLs help your body gain energy, store energy and regulate blood pressure. So, they’re important for your overall body function. But having too many VLDLs in your blood can be dangerous and raise your risk of cardiovascular disease.
Why do I need this test?
You may need this test if you are at risk for CVD. Risk factors for CVD include:
- Older age
- Gender–men are at higher risk
- Family history
- High blood pressure
- Obesity and overweight
- Sedentary lifestyle
- Diabetes
What other tests might I have along with this test?
You may also need these other tests at the same time to check your cholesterol levels:
- Total cholesterol
- LDL (bad) cholesterol
- HDL (good) cholesterol
- Triglycerides
You may also need these tests:
- Electrocardiogram (records the electrical signal from the heart to check for different heart conditions)
- Stress test (shows how the heart works during physical activity)
- Echocardiogram (uses sound waves to show how blood flows through the heart and heart valves)
- Cardiac catheterization (a procedure to examine how well your heart is working)
What are lipoproteins?
Low-density lipoproteins (LDL) and very low-density lipoproteins (VLDL) are two different types of fatty substances found in your blood. They carry cholesterol and triglycerides through your bloodstream. Cholesterol is a fatty substance that is necessary for building cells. In the body, it’s most commonly created in your liver.
What are Triglycerides?
Triglycerides are another type of fat that’s used to store extra energy in your cells.
Is it VLDL or VLDL-C?
Most people use “VLDL” and “VLDL cholesterol” interchangeably. But there’s a difference worth knowing.
VLDL refers to the lipoprotein, or the particle, that your liver creates. This particle transports fats and proteins in your blood. VLDL is a bit like a bus. The passengers on the bus include the different fats and proteins that need a ride. Cholesterol is one of those passengers. VLDL cholesterol refers to the cholesterol that’s carried on VLDL particles throughout your blood.
Other types of lipoproteins, like LDLs and HDLs, also serve as buses. They each carry different amounts and forms of fat and protein. LDL cholesterol refers to the cholesterol that LDL particles carry. Similarly, HDL cholesterol refers to the cholesterol that HDL particles carry.
What is the difference between VLDL and LDL?
Though VLDL and LDL share the same building blocks, these two types of lipoproteins differ in the percentages of the cholesterol, protein, and triglycerides that make them up. VLDL contains more triglycerides, while LDL contains more cholesterol.
VLDL and LDL are both considered carriers, and types of “bad” cholesterol. While your body needs both cholesterol and triglycerides to function, having too much of them can cause them to build up in your arteries. This can increase your risk for heart disease and stroke. One is not worse than the other, and they’re both equally atherogenic (meaning they promote atherosclerosis).
Most people will get their LDL-C and VLDL level tested during a routine physical exam. They are usually tested as part of a lipid panel.
What are the main components of VLDL?
All lipoproteins are made of fats and proteins. But the chemical makeup differs based on the specific type of lipoprotein. For example, each type of lipoprotein contains different amounts of fat and protein, as well as different forms of each. Researchers call VLDLs “triglyceride-rich lipoproteins” because of their high triglyceride content.
VLDL is created in your liver to carry triglycerides throughout your body. It’s made up of the following components by weight:
Main components of VLDL:
- Cholesterol 10%
- Triglycerides 70%
- Proteins 10%
- Other fats 10%
Is VLDL bad cholesterol?
VLDL cholesterol is “bad” when there’s too much of it in your blood. You need some to support your body’s needs. But high levels of VLDL cholesterol can raise your risk of atherosclerosis (buildup of plaque in your arteries).
The role of VLDL in atherosclerosis:
When your liver produces more VLDLs than you need, your body has to metabolize them (break them down). Your body uses VLDLs to make intermediate-density lipoproteins (IDLs) and ultimately LDLs. These are important lipoproteins that your body needs. But, again, your body only needs so many. Excess LDLs in your blood can become trapped inside the walls of your arteries and promote plaque growth.
Research shows that the combination of high VLDLs and high LDLs is more dangerous than high levels of either of those alone. Plus, when your body breaks down VLDLs to make LDLs, some leftover bits remain. These “remnant particles” are made mostly of cholesterol. They’re small enough to get trapped inside your artery walls and promote atherosclerosis.
Why is atherosclerosis so dangerous?
Atherosclerosis is dangerous because it narrows your arteries and raises your risk for various forms of cardiovascular disease, including:
- Coronary artery disease.
- Cerebrovascular disease.
- Peripheral artery disease.
- Aortic aneurysm.
How is VLDL tested?
There’s no specific test for VLDL cholesterol. VLDL is usually estimated based on your triglycerides level. Triglycerides are also usually tested during a cholesterol test.
Many doctors don’t do the calculations to find your estimated VLDL level unless you ask for it specifically or have:
- other risk factors for cardiovascular disease
- certain abnormal cholesterol conditions
- early onset heart disease
Risk factors for cardiovascular disease include:
- increased age
- increased weight
- having diabetes or high blood pressure
- having a family history of cardiovascular disease
- smoking
- lack of regular physical activity
- unhealthy diet (high in animal fat and sugar and low in fruits, vegetables, and fiber)
What are triglycerides used for?
The triglycerides carried by VLDL are used by cells in the body for energy. Eating more carbohydrates, or sugars, than you burn can lead to excessive amounts of triglycerides in the body and high levels of VLDL in your blood. Extra triglycerides are stored in fat cells and released at a later time when needed for energy.
High levels of triglycerides:
High levels of triglycerides are linked to the buildup of fatty deposits in your arteries. These deposits are called plaques. Plaque buildup increases your risk for heart disease and stroke. Experts believe this is due to:
- increased inflammation
- increased blood pressure
- changes in the lining of blood vessels
- low levels of high-density lipoprotein (HDL), the “good” cholesterol
High triglycerides are also associated with metabolic syndrome and nonalcoholic fatty liver disease.
How often shall I have my cholesterol levels checked?
The American Heart Association recommends all individuals over the age of 20 get their cholesterol checked every four to six years. Cholesterol levels may need to be followed up more frequently if your risk for heart disease is high or to monitor any treatment.
Sources:
https://www.cdc.gov/cholesterol/cholesterol_screening.htm
References:
Chen X, Zhou L, Hussain MM. Lipids and dyslipoproteinemia. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 23rd ed. St Louis, MO: Elsevier; 2017:chap 17.
Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73(24):e285-e350. PMID: 30423393 www.ncbi.nlm.nih.gov/pubmed/30423393.
Robinson JG. Disorders of lipid metabolism. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 195.
Balling M, Afzal S, Varbo A, Langsted A, et al. VLDL Cholesterol Accounts for One-Half of the Risk of Myocardial Infarction Associated With apoB-Containing Lipoproteins. (https://pubmed.ncbi.nlm.nih.gov/33272366/) J Am Coll Cardiol. 2020;76(23):2725-2735.
Furtado RHM. Searching for the ideal LDL cholesterol estimating formula. (https://pubmed.ncbi.nlm.nih.gov/33711393/) Int J Cardiol. 2021;333:211-212.
Ginsberg HN, Packard CJ, Chapman MJ, et al. Triglyceride-rich lipoproteins and their remnants: metabolic insights, role in atherosclerotic cardiovascular disease, and emerging therapeutic strategies-a consensus statement from the European Atherosclerosis Society. (https://pubmed.ncbi.nlm.nih.gov/34472586/) Eur Heart J. 2021;42(47):4791-4806.
U.S. National Institutes of Health, National Library of Medicine. VLDL Cholesterol. (https://medlineplus.gov/vldlcholesterol.html).
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High VLDL cholesterol raises your risk of cardiovascular disease. However, because VLDL is estimated through a math formula and not directly measured, your provider might not directly discuss VLDL with you. Also, VLDL is not the direct target of treatment. Instead, your provider will discuss your other numbers, such as your LDL-C level and triglycerides, as those are the targets for treatment.
Many people with high VLDL cholesterol also have one or more of the following:
- High triglycerides (hypertriglyceridemia).
- High LDL cholesterol.
- High total cholesterol (hyperlipidemia).
You may be able to reduce all of these lipids in your blood by:
- Following a heart-healthy diet like the Mediterranean diet.
- Exercising regularly (talk to your provider before starting any new exercise plan).
- Keeping a weight that’s healthy for you.
- Taking medication, such as statins.
In some cases, an underlying medical condition can raise your triglycerides and, in turn, raise your VLDL cholesterol. Certain medications can also raise both. Talk to your provider about possible causes for your high VLDL cholesterol and what you can do in response.
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Laboratories do not report a level of VLDL that is too low. Nevertheless, chronic infections and certain autoimmune diseases can cause very low triglyceride levels and, in turn VLDL-C levels. In rare cases, low VLDL is caused by a genetic condition. It is also possible that they are experiencing a severe disease such as cancer or severe anemia. Low VLDL levels do not cause symptoms on their own, but the disease that is causing the low VLDL will cause its own, specific symptoms.
Some specific causes of a low VLDL are:
- Hereditary abetalipoproteinemia
- Hypobetalipoproteinemia
- HIV/AIDS
- Hepatitis (chronic, active hepatitis B, hepatitis C)
- Hyperthyroidism
- Malnutrition and undernutrition
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