The effects of high VLDL cholesterol, how to best measure it and maintain healthy levels is still a hot topic of research. It is clear, though, that high VLDL is a major risk factor for heart disease and may contribute to chronic inflammation. Read on to learn more about VLDL-C and find out which lifestyle and dietary changes can help lower VLDL-C levels.
VLDL-cholesterol (VLDL-C) is cholesterol bound to very-low-density lipoprotein (VLDL) particles. It transports triglycerides (fats) and cholesterol in the bloodstream .
Only a couple of decades ago, it was thought that high cholesterol in the blood was the main cause of heart disease. Now it is obvious that this picture is incomplete and that the levels of different particles that carry cholesterol in the body are more important than total cholesterol levels [2, 3].
There are several types of particles that carry cholesterol through the blood, such as VLDL, HDL, and LDL, each with different effects on the body and functions. These particles are all lipoproteins, made up of both fats (lipids) and proteins. Since fats do not easily dissolve in the blood, lipoproteins help to transport them [3, 4].
Lipoproteins are named according to their density and size. HDL stands for high-density lipoprotein and is the densest and smallest of the three. LDL and VLDL stand for low-density lipoprotein and very-low-density lipoprotein, respectively. Cholesterol that is bound to these two types of lipoproteins is also referred to as “bad” cholesterol .
VLDL is made in the liver after the body absorbs fat from dietary sources. It transports triglycerides (with fatty acids) to the muscles and fat tissue, where they are deposited. In return, VLDL takes up cholesterol from the tissues. As it loses triglycerides, VLDL becomes LDL – a particle rich in cholesterol and low in triglycerides .
Though VLDL is required by the body, high levels of VLDL may cause serious health problems .
- Some VLDL particles are larger than others because they contain more fat.
- The protein portion of VLDL may also become oxidized, which can cause oxidative damage to the inner lining of blood vessels, contributing to the formation of plaques in blood vessels.
There is no simple test for directly measuring VLDL-C levels. Due to the complicated nature of the laboratory techniques needed to measure VLDL-C, its levels are estimated based on triglyceride levels found in the blood [10, 11].
The most widely used method for estimating VLDL-C is to divide the level of blood triglycerides by 5. This equation assumes that there is a fixed 5:1 ratio of triglycerides to VLDL particles. This assumption is not always true because the actual ratio varies due to ethnicity, gender, and diet [11, 12, 13]. In addition, the calculation is not accurate when the triglyceride level is > 400 mg/dl (4.5 mmol/L). In cases like this, VLDL-C may be measured directly using specialized testing.
It is important to note that the level of VLDL-C alone is not the only factor that plays a role in heart disease. Other factors, such as the size and chemical makeup of VLDL-C, also play a role. Currently, there are no simple tests that account for these factors [6, 8].
VLDL-C levels tend to rise in women following menopause. It is not clear if this increase in VLDL-C levels is due to the drop in hormones, increased body fat after menopause, or other factors .
Causes listed below are commonly associated with high VLDL-cholesterol levels. Work with your doctor or another health care professional to get an accurate diagnosis.
A study in postmenopausal women showed that diets high in carbs and low in fats can increase VLDL-C levels .
About 50% of obese people have increased VLDL-C caused by increased production of VLDL by the liver, decreased removal of VLDL-C from the blood, or both .
In a study that compared 12 obese men and 12 lean men, the obese men had increased liver production of VLDL .
A study of 1,850 patients showed that people with greater insulin resistance had not only higher levels of VLDL-C but also produced larger, fattier VLDL particles. Studies in mice have also confirmed this [27, 28].
There’s a study that found that type-1 diabetes may not be associated with changes in VLDL-C levels in response to sugar. This suggests that only insulin resistance, characteristic of type-2 diabetes, adds to the risk of increased VLDL-C (a study of 8 men with type-1 diabetes) .
In a study of 45 women, women with slightly lower thyroid function had higher levels of VLDL-C than women with normal thyroid function. Women with slightly higher thyroid function had lower levels of VLDL-C .
Another study of 113 patients, both male and female, confirmed that patients with slightly less active thyroid were more likely to have higher levels of VLDL-C and larger-sized VLDL .
Inflammation-promoting cytokines in Inflammation and infection increase VLDL production .
People with chronic kidney disease may produce VLDL-C at a normal rate but are less able to remove the VLDL-C from the blood .
Drugs that can increase VLDL-C levels include:
- Glucocorticoids, such as prednisone [32, 40]
- Water pills (diuretics) such as hydrochlorothiazide (Apo-hydro) 
- Vitamin A derivative isotretinoin (Accutane) used to treat severe acne 
- Second-generation antipsychotics such as clozapine (Clozaril, FazaClo, Versacloz) and risperidone ( Risperdal, Risperdal Consta) 
Some rare genetic disorders (e.g. familial hypertriglyceridemia, familial combined hyperlipoproteinemia) cause an increase in VLDL-C .
High VLDL levels can cause non-alcoholic fatty liver disease. Fat may build up in the liver when it is unable to move all the VLDL cholesterol to the blood. Reducing VLDL levels may reduce fat build-up fat in the liver, which may improve symptoms of fatty liver syndrome and diabetes [44, 45].
A study of 128 patients with fatty liver disease showed that the larger the VLDL particles a patient had, the more severe the disease was. Larger VLDL molecules can carry more fat than smaller ones. Another study of 25 obese people also showed that those with fat in their liver had increased production of VLDL [46, 47].
However, fatty liver disease can eventually cause liver damage that prevents the liver from producing VLDL, so VLDL-C levels may be lower in people with long-term fatty liver disease .
A study of over 30k people showed that those with high levels of VLDL-C (30 mg/dL or more) were 2-3 times more likely to develop heart disease .
When VLDL is broken down by the body, it is turned into byproducts that also contribute directly to the blocking of arteries. In addition, larger molecules of VLDL carry more fat that is then more likely to become stuck to the walls of the blood vessels. Therefore, lowering the size and levels of VLDL may protect against this effect [49, 50].
Metabolic syndrome is a cluster of conditions that occur together, including high blood pressure, high cholesterol and triglycerides, abdominal obesity, and high blood sugar.
Metabolic syndrome is marked by insulin resistance and often leads to type-2 diabetes. People with large VLDL particles, but small LDL and HDL, had the worst symptoms of metabolic syndrome, and a higher risk of developing type-2 diabetes (study with 1,036 people) .
Increased VLDL-C levels occurred before the development of type-2 diabetes in patients with metabolic syndrome, suggesting that high VLDL-C may contribute to this progression .
Obesity often leads to high blood pressure, which may be caused by high levels of VLDL-C. Lowering VLDL-C levels may reduce obesity-related high blood pressure .
The most important thing is to work with your doctor to find out what’s causing your high VLDL-C levels and to treat any underlying conditions.
Depending on your medical history and other test results, your doctor may prescribe a cholesterol-lowering medication.
Discuss the additional lifestyle changes listed below with your doctor. None of these strategies should ever be done in place of what your doctor recommends or prescribes!
Because of the relationship between VLDL and triglycerides, you can lower your VLDL cholesterol level by taking steps to lower your triglyceride level. These include making healthy lifestyle changes, such as losing excess weight and exercising regularly. It has also been advised to avoid sugary foods and alcohol in particular since these have a strong effect on triglycerides.
The following dietary changes can help reduce VLDL-C levels:
- Avoid overeating in general. Eat less of sugary and processed foods and minimize your intake of saturated and trans fats [18, 19, 20].
- Eat more fiber-rich foods, such as fruits and vegetables .
- A Mediterranean diet is a good example of a diet that can help lower your triglyceride and VLDL-C levels and decrease your risk of heart disease. This type of diet includes lots of fruits and vegetables, fatty fish, olive oil, and nuts [62, 63, 64, 65].
- Increase your consumption of fatty omega-3 rich fish .
Discuss the following foods and supplements with your doctor. Research has shown they can help decrease triglyceride and therefore VLDL-C levels:
- Omega-3 (DHA) [19, 68, 69, 70, 71]
- Berberine [72, 73, 74]
- Chromium [75, 76]
- Red yeast rice 
- Green tea [78, 79]
- Turmeric/curcumin [80, 81]
- Vitamin C 
Lipases are a group of enzymes that help to break down VLDL. A mutation in the lipoprotein lipase gene has been associated with larger VLDL particles in people with metabolic syndrome. Other mutations in this gene result in low levels of the lipoprotein lipase protein and higher VLDL [83, 84].
ApoE is a protein found in VLDL molecules. As a result of mutations in the gene that encodes the protein, different versions exist. A version known as ApoE4 is found to produce more inflammation in the blood vessels after meals than the normal version, ApoE3 [86, 87].
Having a defective copy of ApoE contributes to high VLDL levels, but this factor alone does not significantly raise VLDL levels .