BACKGROUND:  Cholesterol is a substance created and used by the human body to keep them healthy. There is ‘good’ cholesterol and ‘bad’ cholesterol, and too much of the bad cholesterol can increase a person’s risk for coronary heart disease, heart attack, or stroke. Cholesterol comes from the human body with the liver and other cells making around 75 percent of blood cholesterol, and the remaining 25 percent of cholesterol comes from food and is only found in animal products. The amount of cholesterol some people’s bodies make is affected by genetics, so family health history may be a good source to understand why someone’s cholesterol is at certain levels despite their lifestyle choices. (Source: American Heart Association)

TYPES:  Often times the different types of cholesterol are simply referred to as ‘good’ cholesterol and ‘bad’ cholesterol. Below are descriptions and explanations of the two types of cholesterol:

·         HDL (aka ‘good’ cholesterol) – HDL is considered the good cholesterol because it helps keep the ‘bad’ cholesterol from getting lodged into the artery walls, and a healthy HDL level may also prevent against heart attack or stroke. You can increase HDL levels with regular physical activity and by eating a balanced nutritious diet.

·         LDL (aka ‘bad’ cholesterol) – LDL is considered the bad cholesterol because when there is too much of it circulating in the blood it can clog arteries, increasing the risk of heart attack and stroke. Eating saturated fat, trans fats, and dietary cholesterol can raise a person’s LDL levels, but LDL cholesterol is also produced by the body and inherited genes can make some people produce too much.         (Source: American Heart Association)

TREATMENT:  The first line of treatment for high cholesterol levels, especially high LDL levels, is lifestyle changes such as regularly exercising and limiting the amount of trans and saturated fats a person eats. However, some people will continue to struggle with high cholesterol even after making these lifestyle changes. For these people they may need to take cholesterol medications such as statins, which block a substance the liver needs to make cholesterol, cholesterol absorption inhibitors which limit the absorption of dietary cholesterol, and bile-acid-binding resins, which prompt the liver to use excess cholesterol to make more bile acids. (Source: Mayo Clinic)

LDL APHERESIS:  LDL apheresis is a treatment for people with high LDL cholesterol levels who have been unable to lower their cholesterol through diet changes and exercise. The LDL apheresis procedure is similar to kidney dialysis in that the patient’s blood is continually removed and run through a machine that separates plasma. While the blood is returned to the patient through a different vein, the plasma is run through another part of the machine that removes the LDL. The procedure takes about 2 to 3 hours and must be repeated every 2 to 3 weeks. (Source:


Amber Sanchez, M.D., in the Division of Nephrology and Hypertension, Associate Medical Director of the Apheresis Program at UC San Diego, talks about a new way to help people clean out their systems of bad cholesterol.

What is LDL?

Dr. Sanchez: LDL is the body’s bad cholesterol.

How do you get it? 

Dr. Sanchez: The liver makes all of your cholesterol, both good and bad. 

Is it too much of the wrong foods? Is it genetic? 

Dr. Sanchez: So, having high cholesterol is a combination of factors including both genetic risk factors as well as unhealthy diet choices.

For most people statins do the trick, correct?

Dr. Sanchez: Most people who have high cholesterol can be managed with a combination of dietary changes and medications such as the statins.

But then for a select few, the statins and the diet changes just don’t work?

Dr. Sanchez: There are certain people who either the statins or dietary changes will not bring the cholesterol down far enough or they have intolerable side effects due to the medications.

What could some of those side effects be?

Dr. Sanchez: Side effects of the medications include severe muscle pains, a dangerous condition called rhabdomyolysis, liver toxicity.

If your LDL is high and you can’t control it, what is the risk?  

Dr. Sanchez: It has been well established that a high LDL level is associated with increased risk factors for heart attacks, cardiovascular disease, strokes. Bringing it down by any means possible reduces that risk.

What is your risk if you can’t bring it down? If you have 5 or 10 years of bad LDL?

Dr. Sanchez: Having a high LDL places people more at risk for heart disease and plaque buildup in the arteries which can lead to a heart attack or a stroke. 

What is a normal level for LDL? What is the worst LDL you have ever seen?