There is much confusion about cholesterol both in the public and medical communities. One of the key issues causing confusion is that there are in fact many different types of cholesterol and associated co-factors that relate to your risk of cardiovascular disease. Most physicians tell patients that there is “good” and “bad” cholesterol with LDL being “bad” and HDL being “good”.
First understand that when we talk about LDL and HDL cholesterol we are really talking about different carriers of cholesterol. LDL stands for Low Density Lipoprotein, and HDL stands for High Density Lipoprotein. For decades, we have been told a simple story about the relationship between LDL cholesterol and heart disease. This story has affected everything from the food we eat to the drugs we take to the test results we track. This oversimplified view of cholesterol — that all LDL is the same and that all LDL is bad — has enabled the adoption of an accompanying oversimplified dietary belief, that all saturated-fat consumption raises your risk of heart disease. Neither are true!
The fact is there are 7 different types of LDL cholesterol that can be split into two categories: Large Buoyant – which is NOT unhealthy and Small Dense which is a problem. A diet high in saturated fat actually tends to increase the amount of the large buoyant LDL, while a low-fat diet high in carbohydrates increases the small dense LDL. Many people work to reduce saturated fat and replace these calories with an increase in carbohydrates which for some can shift their LDL profile from safe to problematic.
The overwhelming majority of LDL tests done do not distinguish between large and small LDL particles. This is a huge issue because knowing the exact mix of Large Buoyant Vs Small Dense LDL can make all the difference between living to a ripe old age or dropping dead at your desk! The good news is that there are tests that do differentiate that are insurance approved that can tell you and your Doctor the whole story!
For example the VAP test: http://atherotech.com/healthcare-providers/vap-lipid-panel/ This test is approved by virtually all insurance carriers and done by all the major labs so easy enough to get. This test also includes testing levels of Lp(a) which is a major hereditary risk factor. High levels of Lp(a) basically make things very sticky and even with normal levels of cholesterol can cause serious artery blockages sometimes at a very young age. It also measures triglycerides which are another blood fat.
The other test to discuss with your physician is homocysteine. Homocysteine is an amino acid and breakdown product of protein metabolism that, when present in high concentrations, has been linked to an increased risk of heart attacks and strokes. Elevated homocysteine levels are thought to contribute to plaque formation by damaging arterial walls. High levels may also act on blood platelets and increase the risks of clot formation. There is a rare disorder of homocysteine metabolism that causes very high levels of homocysteine to accumulate and people with this disorder are at extremely high risk for heart disease even at a very young age. The good news is that this is simple to treat with B-Vitamins. It is important to note that this test is often not covered by insurance and problems with homocysteine are rare.
Long story short the VAP test (and possibly a homocysteine test) can give you and your physician a much more precise look at your risk. The great news is that if there are issues found there are highly effective treatments. In addition, these treatments can and should be customized based on your test results rather than a one size fits all approach. Different medications and dietary approaches are indicated based on the specifics of these test results. There are many physicians who do use this test and treat specifically rather than using one approach or one drug to treat every patient.
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