Overview of Very Low Density Lipoprotein (VLDL)

One Kind of "Bad Cholesterol"

Nurse taking blood sample

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If you’ve needed to have your cholesterol tested, you may have heard of very low density lipoprotein (usually abbreviated as VLDL). VLDL is a type of lipoprotein made by your liver, and it is considered one of the types of “bad” cholesterol. Though your VLDL isn’t the most important measure of your cardiovascular health, it may be worth understanding how it fits into your total health picture. 

What is VLDL?

To understand VLDL, it’s helpful to get a broader sense of how cholesterol and triglycerides (components of fats) are moved around in the body. Cholesterol and triglycerides are both lipids, which are substances that don’t dissolve in your blood. Because of this, they must be carried along by specific proteins. When the proteins are packaged with non-dissolvable fatty substances, they are called “lipoproteins.”

These lipoproteins are very important in moving cholesterol and triglycerides around in the body to places where they are needed. For example, lipoproteins help absorb triglycerides and cholesterol from the small intestine, and they take them from the liver to other places in the body. You need some cholesterol and triglycerides to help keep your body healthy.

Scientists classify lipoproteins based on their size and the amount of cholesterol, triglycerides, and specific proteins they contain. High-density lipoproteins (HDLs) have the most protein, and they are the smallest and most dense of the lipoproteins. Low-density lipoproteins (LDLs) are less dense than HDLs and contain more cholesterol.

Many people have heard of HDL and LDL because they are both an important part of standard cholesterol tests. But there are also some other kinds of lipoproteins, such as VLDL. VLDLs are even less dense than LDLs. Unlike LDL, they contain more triglycerides than cholesterol.

The liver releases VLDL particles into the bloodstream. Ultimately, these VLDL particles are transformed into LDL particles, as they release the triglycerides they are carrying to other parts of the body.

Is VLDL Harmful?

It’s normal and healthy to have some VLDL in your body. However, it may increase your risk of certain health problems, such as heart attack and stroke, if your VLDL is too high.

According to the 2018 guidelines from the American Heart Association, evidence shows that VLDL contributes to the process of atherosclerosis. Both LDL and VLDL are sometimes referred to as “bad cholesterol” because they both increase this risk. (However, this label is a bit of a misnomer, since VLDL contains relatively little cholesterol.) In contrast, HDL seems to help protect against atherosclerosis, which is why it is sometimes called “good cholesterol.”

Atherosclerosis is a disease that causes a kind of plaque to gradually build up in some of your blood vessels. Over time, this can lead to serious potential health problems, such as heart attack or stroke.

Elevated VLDL and triglycerides seem to increase the risk of atherosclerosis. So taking steps to lower your VLDL might theoretically decrease your risk of having such problems.

What Medical Conditions Might Cause Altered VLDL?

Research suggests that triglycerides and VLDL levels might be particularly important for understanding the increased cardiovascular risk in people with Type 2 diabetes or metabolic syndrome.

Other conditions might also lead to elevated triglycerides and elevated VLDL. These include:

  • Obesity
  • Kidney disease
  • Hypothyroidism
  • Excess alcohol consumption
  • Rare genetic syndromes
  • Certain autoimmune disorders, like lupus

Certain medications might also raise your triglycerides and your VLDL. Some of these include:

  • Birth control pills
  • Tamoxifen
  • Retinoids
  • Beta blockers
  • Glucocorticoids
  • Certain diuretics (like the thiazide type)
  • Certain immunosuppressive drugs (like cyclosporine)
  • Certain HIV drugs (like protease inhibitors) 

How is VLDL Tested?

VLDL is not usually included as part of a routine screen for cholesterol, called a lipid panel. That’s partly because it’s not as easy to measure VLDL as it is to assess the other components of the cholesterol test, such as LDL, HDL, and triglycerides. But in some cases, your doctor might add it to the rest of the tests included in a cholesterol screen.

VLDL Estimation

Even if you didn’t have VLDL included in your cholesterol screen, your VLDL can be estimated based on your triglyceride levels (which are usually included in standard cholesterol screenings). The triglyceride test measures all triglycerides present in your blood, not just the ones attached to VLDL. You can get an estimate of your VLDL by dividing your triglyceride level by 5. (This works if the value is mg/dL.) Most of the time, this provides a pretty good estimate, but it might not if your triglycerides are very high.

A VLDL of greater than 30 mg/dL or 0.77 mmol/L is considered high.

An elevated level of VLDL may be of concern, since it may increase your risk of heart attack or stroke. A VLDL of greater than 30 mg/dL or 0.77 mmol/L is considered high.

Researchers are still learning more about the exact importance of VLDL and how it fits into cardiovascular health. They are also learning more about whether it might capture different information than the standard blood triglyceride test, since these do not measure exactly the same thing. So it’s possible that in the future, more people might have this test as well. 

Who Needs to Get Their VLDL Tested?

VLDL is not usually tested on its own but is added on to standard lipid and cholesterol tests, if desired. Most of the time, VLDL won’t give additional helpful information if you already know your triglyceride number. But your doctor might order a separate VLDL test to get a fuller picture of your health, especially if something about your case is unusual. If you don’t have this test, your doctor probably still will have enough information to guide your health treatment.

Adults need regular screenings included on standard cholesterol and lipid tests. These usually include such values as HDL, LDL, triglycerides, and total cholesterol. You might need more frequent tests if you are at higher risk for cardiovascular disease. For example, this might be necessary if you have any of the following risk factors:

What Can I Do to Lower My VLDL and Triglycerides?

Because VLDL and triglycerides are so closely related, lowering your triglycerides should also lower your VLDL. You may need lifestyle changes or medical intervention to decrease your risk of heart attack and stroke.

Lifestyle changes are critically important in both lowering triglycerides and reducing your overall risk of medical problems due to atherosclerosis. So it’s key to work on the following:

Even after making such changes, some people still have a high risk of having a heart attack or stroke. If that’s the case, you might need a medication, like a statin, to help lower your risk. Your clinician will also need to assess whether another medication you are already taking might actually be increasing your VLDL and your triglycerides.

A Word From Verywell

Fortunately, a lot of people can take real, actionable steps to decrease their VLDL and lower their risk of getting a heart attack or stroke. Ask your doctor to make sure you are getting your regular cholesterol and lipid screening that you need. It’s particularly important to keep up on your screenings if you have other risk factors for heart disease. That will give you and your clinician the best information to create your optimal health plan. 

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