What is ‘Ugly’ Cholesterol? Here’s What You Need to Know

Researchers have made a new discovery about your cholesterol levels, and it’s not pretty.

By Michael Bohl
doctor & patient

When it comes to cholesterol levels, you've heard of “good” and “bad” cholesterol. But now, things seem to be getting ugly. If you’ve been paying attention to the headlines recently, you may have seen researchers talking about a different kind of cholesterol: “ugly” cholesterol. Doctors have always known that “ugly” cholesterol existed, however, recent research shows that it may play more of a role in the body than originally thought. It may be something we should all pay attention to in order to stay healthy.

Keeping your cholesterol levels in check throughout your lifetime is crucial because high cholesterol levels can lead to a plethora of health issues, like diabetes, high blood pressure, and, most notably, heart disease. According to the CDC, 102 million Americans age 20 or older are living with high cholesterol. That's a staggering number — especially considering the statistics start at such a young age. So what is “ugly” cholesterol exactly and should you be concerned? We’re breaking down all the information you need to know, along with a simple cheat sheet to help you make better sense of your cholesterol numbers.

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What is "ugly" cholesterol?

Before we jump into “ugly” cholesterol, let’s define what cholesterol is. In general, cholesterol is a good thing — in fact, it is essential to life. Cholesterol is a molecule that makes up the membranes of all of our cells. Without cholesterol, there are no cells. And without cells, there is no us.

Cholesterol is transported around our bodies in our bloodstream. “Good” cholesterol is also called HDL, which stands for high-density lipoprotein. And “bad” cholesterol is also called LDL, which stands for low-density lipoprotein. But HDL and LDL aren’t the only kinds of lipoproteins. Triglycerides, which are fats in the blood, also travel around in lipoproteins: these are called triglyceride-rich lipoproteins. It turns out, cholesterol doesn’t only exist inside HDL and LDL. There is also some cholesterol in the three triglyceride-rich lipoproteins called remnant cholesterol. Remnant cholesterol is the scientific name for “ugly” cholesterol. Simply put, “ugly” cholesterol is all the cholesterol in lipoproteins that are not HDL or LDL.

Do I have "ugly" cholesterol?

Just like everybody has “good” cholesterol (HDL) and “bad” cholesterol (LDL), everybody has “ugly” cholesterol as well. The risk factors for having high “ugly” cholesterol are the same as the risk factors for having high “bad” cholesterol and high triglycerides, which include eating unhealthily, being overweight, and living a less active lifestyle. Genetics plays a role as well. 

Why is everyone talking about "ugly" cholesterol now? 

Cholesterol is essential to how the human body functions. However, having too much cholesterol flowing around in the body is a problem.

When there are elevated levels of “bad” cholesterol, the cholesterol can get deposited on the inside of your arteries and get stuck in the artery walls, forming plaques. Plaques are bad because they make arteries more narrow and rigid, therefore, making it difficult for blood to flow through them. Reduced blood flow can cause issues like heart disease, heart attacks, strokes, peripheral artery disease, and many other complications.

What’s new about “ugly” cholesterol is that researchers have found that the amount of it in the blood is much higher than previously thought. This is a bad thing, because like LDL, “ugly” cholesterol can also lead to heart disease. For example, one study found that “ugly” cholesterol levels were associated with plaques, even when LDL levels had been improved. This means that, independent of LDL, “ugly” cholesterol contributes to disease. Another study showed that high levels of “ugly” cholesterol were associated with an increased risk of stroke.

It’s becoming clear that it’s not enough to only pay attention to LDL levels. We need to start paying attention to “ugly” cholesterol numbers as well.

How can I check my "ugly" cholesterol numbers?

When you get your cholesterol checked, the numbers you usually get back are the total cholesterol, HDL, LDL, and triglycerides. The best way to understand how much “ugly” cholesterol you have is to look at the triglyceride level and divide by five. This works, because “ugly” cholesterol travels around in the same lipoproteins as triglycerides, so the triglyceride number can be used as a surrogate. In the future, there may be more routine ways to directly measure “ugly” cholesterol. And as more research is done, we’ll learn even more about what levels of “ugly” cholesterol are actually bad and what can be considered safe.

Reference this cholesterol cheat sheet so you can know what your numbers mean:

How can I decrease my cholesterol levels?

The best way to improve your cholesterol is to eat more healthy foods and increase exercise. It's important to be mindful of what you're eating in order to keep your cholesterol low. Additionally, staying active and replacing unhealthy fats with healthy fats will help keep your triglycerides under control. Limiting alcohol intake and reducing the amounts of sugar and carbohydrates you ingest can also improve triglyceride levels.

You can't change your genetics, but you can change your lifestyle, and that makes all the difference in trying to avoid “ugly” cholesterol. If you are at risk for “ugly” cholesterol, you can also talk to your doctor about more solutions that are specific to your condition and lifestyle.

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Article written by Michael Bohl