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Cholesterol is a word that we tend to think of as being related to heart disease and check-ups, yet few people are aware of the subtleties of various types of cholesterol—particularly one referred to as VLDL cholesterol. Knowing more about this not-so-well-known type of cholesterol is important, as it can affect your risk for developing cardiovascular diseases.
If you're an individual having borderline cholesterol levels or are just interested in knowing about your heart health, this blog is for you.
VLDL refers to Very Low-Density Lipoprotein. It is one of the five primary types of lipoproteins that transport cholesterol and triglycerides in the blood. The others are HDL (high-density), LDL (low-density), IDL (intermediate-density), and chylomicrons.
VLDL is manufactured by the liver and is primarily tasked with delivering triglycerides—a different form of fat—via your bloodstream to your tissues. After delivering the triglycerides, VLDL particles convert to LDL ("bad cholesterol"), which can subsequently lead to plaque in arteries.
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Although both VLDL and LDL are "bad" cholesterol, they differ in what they transport. VLDL transports the majority of triglycerides, while LDL transports primarily cholesterol. Both have the potential to lead to atherosclerosis (arising from the accumulation of fatty deposits in arteries), but VLDL is found to be more harmful because it has a higher concentration of triglycerides.
Another crucial difference is that VLDL is denser and has a higher percentage of fat than LDL. That makes VLDL particles potentially more atherogenic—that is, more likely to lead to plugged arteries.
VLDL cholesterol isn't often actually measured. Rather, it's usually an estimate as a percent of your triglycerides. The equation most laboratories use is:
VLDL Cholesterol (mg/dL) = Triglycerides ÷ 5
According to this formula, here's how the range appears:
Normal VLDL: Below 30 mg/dL
Borderline high: 30–40 mg/dL
High VLDL: Above 40 mg/dL
More than a VLDL level of 30 mg/dL is typically regarded as an indication of cardiovascular disease risk.
Having elevated VLDL cholesterol is problematic because it signals a high level of triglycerides in your blood. Having high triglycerides tends to mean your body is not very good at metabolizing fat. This inefficacy can result in fat being deposited in your arteries, putting you at risk for:
Atherosclerosis: Plaque buildup that narrows your arteries
Heart Attack: Clogged arteries decreasing blood flow to the heart
Stroke: Blocked arteries in the brain leading to brain damage
Pancreatitis: Inflammation of the pancreas, especially when triglyceride levels exceed 500 mg/dL
Because VLDL eventually turns into LDL, having high VLDL often means you’re battling a double threat—both high triglycerides and high cholesterol.
Several factors can cause elevated VLDL cholesterol levels. In many cases, it’s a combination of lifestyle and genetic factors. Common causes include:
Obesity: Excess weight, particularly around the waist, raises triglyceride levels.
Poor diet: Consuming a lot of sugar, saturated fats, and refined carbohydrates triggers triglyceride production to peak.
Lack of physical activity: A sedentary lifestyle lowers your body's capacity to efficiently burn fat.
Heavy use of alcohol: Alcohol tends to raise the liver's production of triglycerides.
Type 2 diabetes: Insulin resistance is frequently accompanied by raised VLDL and triglycerides.
Hypothyroidism: Underactive thyroid slows down fat metabolism.
Kidney or liver disease: These organs are tasked with metabolizing and filtering fat.
In some cases, high VLDL is also genetic. If high cholesterol is something that happens in your family, you should have your lipid profile tested routinely—even if you are young and otherwise healthy.
One of the scariest things about high VLDL cholesterol is that it typically has no warning signs. You won't feel any different until you have complications. That's why it's sometimes referred to as a "silent killer."
When symptoms do present, they typically are indicators of the complications of high cholesterol, including:
Chest pain or pressure (angina)
Shortness of breath
Fatigue upon exertion
Leg pain (due to circulatory problems)
Yellowish patches on the skin (xanthomas)
Sudden heart attack or stroke
Because it is mostly asymptomatic, regular blood tests are the only way to monitor your VLDL levels.
Doctors typically assess VLDL cholesterol as part of a lipid profile—a blood test that evaluates different types of fats in your bloodstream. Your triglycerides, total cholesterol, HDL, and LDL are measured, and VLDL is estimated using the formula mentioned earlier.
This test is usually performed after a fast for 9–12 hours since eating transiently elevates triglycerides.
If your VLDL cholesterol is elevated, the good news is that it can be treated—often without drugs if detected early. Lifestyle modifications are the initial treatment of choice.
Follow a heart-healthy diet by lowering the consumption of saturated fats, red meats, whole-fat dairy foods, and sweets. Increase your consumption of:
Whole grains
Leafy greens
Berries
Nuts and seeds
Fatty fish such as salmon or sardines
Check our blog on foods that improve heart health
Cardio exercises such as walking, bicycle riding, and swimming are excellent for the burning of triglycerides. Engage in a minimum of 30 minutes of moderate exercise on most days of the week.
Even a 5–10% weight reduction can have a big impact on lowering triglycerides and VLDL levels.
Alcohol leads to the production of triglycerides in the liver. Reducing or giving up alcohol altogether assists in lowering VLDL cholesterol.
Smoking harms blood vessels and accelerates the accumulation of plaque. Stopping smoking enhances your overall lipid profile.
If lifestyle changes are not enough, your doctor may recommend medications, especially if you’re at high risk for cardiovascular disease. Common options include:
Statins: Mainly reduce LDL but also lower VLDL modestly
Fibrates: Specifically reduce triglyceride levels and VLDL
Niacin: Helps reduce LDL and VLDL while increasing HDL
Omega-3 fatty acids: Prescription-strength versions can lower triglycerides significantly
Always take medications as prescribed and have regular follow-ups to monitor side effects and effectiveness.
India is experiencing an epidemic of lifestyle diseases, with cardiovascular disease taking the lead. Low levels of physical activity, increasing obesity, high-carb diets, and growing rates of diabetes all contribute to elevated triglyceride and VLDL levels.
Young adults in India are particularly vulnerable, with many people in their 30s and 40s developing risk factors traditionally associated with older age. It’s crucial to get annual health check-ups and discuss your lipid profile with a healthcare provider.
🔗 Source: PMC article
Women tend to be underdiagnosed and undertreated for heart health. Menopause brings hormonal shifts that increase bad cholesterol, such as VLDL. Women pregnant with gestational diabetes also experience high triglycerides and VLDL.
It is crucial that women monitor their heart health very closely—not only during menopause but for life.
While everybody is aware of HDL and LDL, VLDL cholesterol is also a significant indicator of cardiovascular health. By neglecting to address high VLDL levels, one is neglecting an important risk factor for heart attack, stroke, and other life-threatening disorders.
The good news is that VLDL is measurable, treatable, and controllable—particularly if you intervene early. By making simple, regular changes in your lifestyle and collaborating with your healthcare provider, you can lower your risk and safeguard your heart for the long term.
A: Yes, VLDL is a bad cholesterol because it carries triglycerides and is involved in plaque formation in arteries.
A: Although complete reversal is uncommon, levels can be greatly reduced by lifestyle modification and drugs.
A: Levels over 40 mg/dL are elevated and can dramatically raise the risk of heart disease.
A: Yes, because VLDL is triglyceride-based, and 9–12-hour fasting provides better results.
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