LDL
LDL cholesterol
A key particle in the development of atherosclerosis: in excessive amounts, it can build up in the artery walls.5
Health education · Heart and blood vesselsSaint‑Hyacinthe
Cholesterol and dyslipidemia: understanding your results and your cardiovascular risk
LDL, HDL, triglycerides, ApoB and lipoprotein(a): your lipid profile provides much more than a simple cholesterol level.
Cholesterol is a type of fat that the body needs to function normally; most of it is made by the liver.5 The problem is therefore not having cholesterol, but that certain lipids circulate in abnormal amounts in the blood: this is called dyslipidemia.
At the Clinique IPS du Palais in Saint-Hyacinthe, assessing cholesterol is not just about checking whether a number is “too high.” The results are interpreted along with your other risk factors to assess your overall cardiovascular risk.
Your results at a glance
Four benchmarks for reading your results
HDL
HDL cholesterol
Useful information, but to be interpreted with the whole profile.
TG
Triglycerides
Another type of blood fat, which can rise in several metabolic situations.7
Lp(a)
Lipoprotein(a)
A mainly genetic factor that the Canadian Cardiovascular Society recommends measuring once in a lifetime.1
Your cholesterol result is never interpreted on its own. Your overall cardiovascular risk determines what your results mean for you.
Understanding
What is dyslipidemia?
The Government of Quebec describes it as a chronic disease characterized by an abnormal level (too high or too low) of lipids in the blood, and notes that it is an important cardiovascular risk factor.3
Because it does not dissolve in blood, cholesterol circulates carried by different particles called lipoproteins. These are the particles that a lipid profile seeks to assess.
It can take various forms, including:
- high LDL cholesterol;
- high triglycerides;
- high non-HDL cholesterol;
- high ApoB;
- a combination of several abnormalities;
- or certain abnormalities of genetic origin.
The parameters
What your lipid profile measures
LDL cholesterol
LDL-C, or cholesterol carried by low-density lipoproteins, is one of the most widely used parameters for assessing cardiovascular risk. In excessive amounts, it can build up in the artery walls and impair circulation to the heart and brain.5
That is why it is often called “bad cholesterol.” The expression is convenient but imperfect: what matters most is its level and your cardiovascular context.
HDL cholesterol
HDL-C is cholesterol carried by high-density lipoproteins. It helps remove excess cholesterol from the blood, hence its nickname “good cholesterol.”5
However, it should not be interpreted in isolation: a high HDL does not cancel out the risk associated with a high LDL, smoking, diabetes, hypertension or other factors.
Triglycerides
This is the most common form of fat in the body.5 Triglycerides can rise with obesity, high blood sugar and insulin resistance, alcohol consumption, certain liver or kidney diseases, hypothyroidism, pregnancy or certain medications.7
When very high, they also increase the risk of pancreatitis.7
Non-HDL cholesterol
It corresponds to the cholesterol carried by all the particles that can contribute to atherosclerosis. It is calculated simply:
Total cholesterol − HDL
The Canadian Cardiovascular Society gives it an important place in risk assessment.1,2
Apolipoprotein B (ApoB)
ApoB is a protein found on the particles that can contribute to atherosclerosis. It provides an approximation of their number.
When triglycerides exceed 1.5 mmol/L, the CCS prefers non-HDL cholesterol or ApoB over LDL-C for screening.1
Genetics
Lipoprotein(a), a factor to measure once
Lp(a) is a particle whose level is mainly controlled by a single gene. According to the Canadian Cardiovascular Society, it is not influenced by age, sex, fasting, inflammation or lifestyle habits.1
Cardiovascular risk increases with the Lp(a) level. When it is at least 50 mg/dL (or 100 nmol/L), the CCS recommends earlier and more intensive lifestyle changes.1
This information can be particularly useful in the presence of a family history of premature cardiovascular disease, cardiovascular disease that occurred despite few risk factors, or a risk that is difficult to explain.
- Mainly genetic
- Measured once in a lifetime
- Little influenced by lifestyle habits
What is atherosclerosis?
It is a process that develops gradually in the artery walls. Cholesterol can build up there and form plaques that narrow the arteries and promote clot formation.5
Depending on the artery affected, this increases the risk of heart attack, heart failure or stroke.5 Atherosclerosis can also affect the arteries of the legs.
Can you have high cholesterol without symptoms?
Yes, in fact that is the norm.
High cholesterol has no symptoms: only a blood test can detect it.5 The Government of Quebec specifies that dyslipidemia generally does not cause direct symptoms.3
Screening is based on a blood test, not on the presence of symptoms.
Screening
Who should have their cholesterol checked?
The Canadian Cardiovascular Society recommends screening for men and women aged 40 and over (or after menopause), and earlier for certain higher-risk groups, such as people of South Asian or Indigenous origin.1,2
The Government of Quebec indicates that screening may be recommended between ages 40 and 75, and that younger or older people may also benefit depending on their situation.4
Do you need to fast?
Not necessarily. The CCS recommends a non-fasting profile, except for people whose triglycerides are known to be above 4.5 mmol/L.2
At any age, in the presence of conditions such as:1
- known atherosclerosis or abdominal aortic aneurysm;
- diabetes, hypertension or current smoking;
- family history of premature cardiovascular disease or dyslipidemia;
- skin or eye signs of dyslipidemia (xanthomas, xanthelasma, corneal arcus);
- chronic kidney disease or obesity (BMI ≥ 30);
- inflammatory disease (rheumatoid arthritis, lupus, inflammatory bowel disease…), HIV or COPD;
- erectile dysfunction;
- history of a hypertensive disorder of pregnancy.
Interpreting
What is a “good” cholesterol level?
There is no single ideal number that applies to everyone.
An LDL value that is acceptable for a person at low risk may be too high for a person who has already had a heart attack, or who has arterial disease, diabetes, chronic kidney disease or a high overall cardiovascular risk.
The profile usually includes total cholesterol, LDL, HDL, triglycerides and non-HDL cholesterol. ApoB and Lp(a) may be added depending on the situation.
Cardiovascular risk
It is the probability of having a cardiovascular event over a given period. It depends on factors such as age, sex, blood pressure, cholesterol, smoking, diabetes and medical history.
The CCS recommends assessing it with a tool validated in Canada (Framingham Risk Score or CLEM model) every 5 years between ages 40 and 75.2
Same LDL, different decisions
Why two people with the same LDL may receive different recommendations
Because treatment aims first and foremost to reduce overall cardiovascular risk, not simply to correct a lab result.
First person
- does not smoke;
- does not have diabetes;
- has normal blood pressure;
- has no history of cardiovascular disease.
Second person
- lives with diabetes;
- has hypertension;
- smokes;
- has already had a cardiovascular event.
The expected benefit of treatment will be very different between these two situations.
Causes
What factors contribute to dyslipidemia?
Lifestyle habits
According to the Government of Quebec: a diet high in sugars or saturated fats, physical inactivity, excessive alcohol consumption and smoking.3
Health
Diabetes, chronic kidney disease, certain medications and a large waist circumference (102 cm or more in men, 88 cm or more in women), according to Québec.ca.3
Heredity
The Government of Quebec cites a family history of premature cardiac events: before age 55 in a man or before age 65 in a woman.3
Can cholesterol be hereditary?
Yes.
Some dyslipidemias are strongly influenced by genetics. The best-known example is familial hypercholesterolemia.6
According to the Canadian Cardiovascular Society, an LDL-C of 5.0 mmol/L or higher possibly suggests a genetic dyslipidemia such as familial hypercholesterolemia, and a statin is then recommended.1,2
A specific assessment may also be indicated in the presence of a family history of very high cholesterol or of cardiovascular events at a young age.
Can certain diseases change cholesterol?
Yes.
Dyslipidemia can be secondary to another condition. Examples cited by the Medical Council of Canada include:6
- diabetes and hypothyroidism;
- certain liver diseases (cholestasis);
- nephrotic syndrome (kidney disease);
- smoking and obesity;
- certain medications, such as steroids and estrogens.
It is therefore sometimes relevant to investigate beyond the lipid profile.
Diabetes and cholesterol
High blood sugar and insulin resistance can raise triglycerides.7 The CCS recommends a statin for most people with diabetes aged 40 and over, or aged 30 and over with diabetes for 15 years or more or with microvascular complications.2
Hypertension and cholesterol
These are two major cardiovascular risk factors. When present together, their effect on risk is greater than that of a single isolated factor. Hypertension is also one of the situations in which the CCS recommends lipid screening at any age.1
A comprehensive approach
A complete cardiovascular assessment considers blood pressure, cholesterol, diabetes, smoking, medical history, physical activity and metabolic health.
Lifestyle habits
Can you improve your cholesterol day to day?
Yes, to a certain extent. The CCS recommends lifestyle changes for everyone, including most low-risk people who are not taking medication.2
Eating healthily
The Government of Quebec recommends a diet that follows Canada’s Food Guide.4 The CCS recommends a Mediterranean-style diet, which has shown cardiovascular benefits.1
Vegetables, fruits, whole grains, legumes, nuts and minimally processed foods play an important role in it.
Being active
All adults should accumulate at least 150 minutes of moderate- to vigorous-intensity aerobic activity per week.1
Physical activity also benefits blood pressure and metabolic health.
Regardless of weight
Dyslipidemia can occur at any weight. Healthy lifestyle habits help prevent cardiovascular disease, regardless of your body weight.4
Quitting smoking
Smoking is a major factor in cardiovascular disease. The CCS and the Government of Quebec recommend quitting smoking.1,4
Alcohol and triglycerides
Alcohol consumption can raise triglycerides.7 The Government of Quebec recommends abstaining from alcohol or reducing consumption.4
Over-the-counter omega-3s
The CCS does not recommend omega-3 supplements sold without a prescription to reduce cardiovascular risk.1
A specific pharmaceutical form (icosapent ethyl) has been studied in certain highly targeted patients.2
Medications
When is medication used?
The decision depends on overall cardiovascular risk, not just on a cholesterol result.
According to the Canadian Cardiovascular Society, a statin is recommended in cases of clinical atherosclerosis or abdominal aortic aneurysm, for most people with diabetes or chronic kidney disease, and when LDL-C is 5.0 mmol/L or higher.1
For others, the decision is based on calculated risk: a statin is recommended when the 10-year risk is at least 20%, and considered for people at intermediate risk (10% to 19.9%) when LDL-C is at least 3.5 mmol/L (or ApoB ≥ 1.05 g/L or non-HDL ≥ 4.2 mmol/L).2
- Atherosclerosis or aortic aneurysm
- Diabetes or chronic kidney disease (most people)
- LDL-C of 5.0 mmol/L or higher
- High or intermediate calculated risk
What are statins?
Statins are the most widely used class of medications to lower LDL and cardiovascular risk. Their main goal is to reduce the risk of cardiovascular events, not just to improve a number.
The CCS reports a relative risk reduction of 20% to 22% for each 1 mmol/L decrease in LDL-C.2 The absolute benefit, however, depends on the starting risk.
Are they needed for every high LDL?
No. For most low-risk people (Framingham score below 10%), the CCS recommends lifestyle changes without medication.2
Are there other medications?
Yes.
Ezetimibe reduces cholesterol absorption and lowers LDL-C by about an additional 20% when added to a statin.1 PCSK9 inhibitors may also be considered in certain situations.
For people with cardiovascular disease, the CCS recommends intensifying treatment if LDL-C remains at 1.8 mmol/L or higher (or non-HDL ≥ 2.4 mmol/L, or ApoB ≥ 0.7 g/L).1
These treatments are not necessary for everyone.
What about side effects?
Like any medication, statins can cause adverse effects, including muscle symptoms in some people.
When an effect is suspected, the professional can review the symptoms, look for other causes, order certain tests, adjust the dose, try another statin or consider another strategy.
Do not stop a prescribed treatment without discussing it with the professional who provides your follow-up.
What next?
If values return to normal on treatment, this generally means that the treatment is working. The decision to reduce or stop a medication takes into account the initial risk and the reason it was started.
How often should the profile be repeated?
It depends on the context. After starting or changing a treatment, closer monitoring makes it possible to assess the response, tolerance and whether targets are being met.
What if my triglycerides are very high?
Very high triglycerides require a specific assessment. Above 10 mmol/L, they are considered severely elevated, and the risk of acute pancreatitis increases with the level.7
The professional will then look for causes such as poorly controlled diabetes, heavy alcohol consumption, medications, certain diseases or a genetic cause.7
High cholesterol: should you panic?
No.
An abnormal result deserves an assessment, but a number cannot be interpreted in isolation. An abnormal lipid profile is above all an opportunity to better understand your risk, identify modifiable factors, determine whether treatment is indicated and put appropriate prevention in place.
Cholesterol and cardiovascular risk assessment in Saint-Hyacinthe
At the Clinique IPS du Palais, the assessment of dyslipidemia may include, depending on your situation: a review of your lipid profile (LDL, HDL, triglycerides, non-HDL), ApoB and Lp(a) when relevant, a blood pressure assessment, screening for diabetes or other metabolic factors, your personal and family history, an estimate of your cardiovascular risk, a review of your lifestyle habits and medications, starting or adjusting treatment when indicated, and follow-up planning.
The goal is not only to get a “better number,” but to reduce your long-term cardiovascular risk.
Frequently asked questions
Frequently asked questions
What is “bad” cholesterol?
LDL cholesterol is commonly called “bad cholesterol” because, in excessive amounts, it can build up in the artery walls. The expression is a simplification, however: what matters most is its level and your overall cardiovascular risk.
What is “good” cholesterol?
HDL cholesterol is often called “good cholesterol” because it helps remove excess cholesterol from the blood. However, a high HDL does not automatically protect against a high LDL or other risk factors.
Do I need to fast for my blood test?
Not necessarily. The Canadian Cardiovascular Society recommends a non-fasting lipid profile, except for people whose triglycerides are known to be above 4.5 mmol/L.
At what age should cholesterol be checked?
The Canadian Cardiovascular Society recommends screening for men and women aged 40 and over (or after menopause), and at any age in the presence of certain conditions, such as diabetes, hypertension, smoking or a family history of premature cardiovascular disease.
Does a high LDL automatically mean I need to take a statin?
No. The decision depends on the LDL level and overall cardiovascular risk. However, an LDL-C of 5.0 mmol/L or higher is a situation in which a statin is recommended according to Canadian guidelines.
Why measure Lp(a)?
Because a high Lp(a) increases cardiovascular risk and its level is mainly determined by genetics. The Canadian Cardiovascular Society recommends measuring it once in a lifetime, during the initial lipid profile.
Can cholesterol be high even if I eat very well?
Yes. Genetic factors play an important role in some people. Diet is only one of the factors that influence lipid levels.
Can I tell whether my cholesterol is high from my symptoms?
No. High cholesterol usually causes no symptoms: only a blood test can detect it.
Can a thin person have high cholesterol?
Yes. Weight alone does not predict the lipid profile or cardiovascular risk.
Key takeaways
Dyslipidemia is not just about having “too much cholesterol.” A complete assessment may include LDL, HDL, triglycerides, non-HDL cholesterol, ApoB, sometimes Lp(a), and above all your overall cardiovascular risk.
For some people, lifestyle habits are the main intervention. For others, a medication is indicated to reduce the risk of heart attack, stroke or other complications.
The real goal is to protect your arteries and reduce your long-term cardiovascular risk.
Sources
- Pearson GJ, Thanassoulis G, Anderson TJ et al. 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults. Canadian Journal of Cardiology, 2021; 37(8):1129-1150, accessed October 5, 2026. ccs.ca
- Canadian Cardiovascular Society. Overview of the Management of Dyslipidemia in Primary Prevention (2021 guidelines, chapter 3). Accessed October 5, 2026. ccs.ca
- Government of Quebec. Dyslipidémie (cholestérol). Updated January 30, 2025, accessed October 5, 2026. quebec.ca
- Government of Quebec. Prévention et dépistage des maladies cardiovasculaires. Updated January 30, 2025, accessed October 5, 2026. quebec.ca
- Public Health Agency of Canada. Cholestérol élevé. Modified September 18, 2026, accessed October 5, 2026. canada.ca
- Medical Council of Canada. Dyslipidémie (examination objective, March 2022 version, updated January 17, 2024). Accessed October 5, 2026. mcc.ca
- Squire P, Ghosh M. Acute pancreatitis caused by severe hypertriglyceridemia in a 61-year-old man on a carnivore diet. Canadian Medical Association Journal (CMAJ), April 27, 2026; 198(16):E622, accessed October 5, 2026. cmaj.ca
The information on this page is provided for informational purposes and does not replace an assessment by a health professional.