Blood cholesterol, HDL and LDL

Molecules, Transport and Health · Health risks, evidence and treatment · note 4 of 7

Blood cholesterol, HDL and LDLSpec 1.18(i)

In short

Cholesterol is carried in the blood in lipoproteins. Low-density lipoproteins (LDL) carry cholesterol from the liver to body tissues and, at high levels, deposit it in artery walls. High-density lipoproteins (HDL) carry cholesterol from tissues back to the liver. High LDL and total cholesterol increase CVD risk; high HDL is protective.

Cholesterol is needed to make cell membranes and some hormones, but it is hydrophobic and cannot dissolve in plasma. It is carried in blood inside lipoproteins: particles with a surface of phospholipid and protein around a core of cholesterol and triglyceride.

LDL and HDL
LDL (low-density lipoprotein)HDL (high-density lipoprotein)
Carries cholesterolFrom the liver to the body tissuesFrom the tissues back to the liver
Effect on arteriesExcess LDL is taken into the artery wall and contributes to plaque formationRemoves excess cholesterol from the artery wall, so protective
Effect on CVD riskHigher level = higher riskHigher level = lower risk

Doctors look at total cholesterol, LDL and HDL, and often the ratio of total cholesterol to HDL. The lower the ratio, the lower the risk. Typical UK guidance suggests a total cholesterol below about 5 mmol dm⁻³ and LDL below about 3 mmol dm⁻³ (you are not expected to learn these values). A diet high in saturated fat tends to raise LDL.

Exam tip:

When analysing data, compare people using LDL and the total:HDL ratio, quote the values, and say a high LDL level with a low HDL level means the highest risk.

Written and checked against the Edexcel International AS Level Biology (XBI11) specification · Updated October 2026

Frequently asked questions

What is the difference between correlation and causation?

A correlation is a relationship between two variables, such as smoking and heart disease. Causation means one variable directly produces the change in the other. A correlation does not prove causation, as a third (confounding) variable could be responsible, so extra evidence such as a mechanism is needed.

What is the difference between HDL and LDL cholesterol?

LDL carries cholesterol from the liver to the body tissues, and a high level raises the risk of atherosclerosis. HDL carries cholesterol from the tissues back to the liver, so a high HDL level is protective. A high LDL with a low HDL is the highest-risk combination.

How do you calculate BMI and waist-to-hip ratio?

BMI is body mass in kilograms divided by height in metres squared. Waist-to-hip ratio is waist circumference divided by hip circumference. Both indicate obesity, but BMI does not separate muscle from fat, while waist-to-hip ratio shows how much fat is stored around the abdomen.

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