Our attempts to eliminate cardiovascular disease and atherosclerosis have not been successful, despite a very rigorous methodology of measuring cholesterol levels in the blood.
One of the most perplexing revelations has been continuing to see patients who have a cardiovascular event (i.e., a heart attack) come back with normal cholesterol levels in their blood. How is this possible? What are we missing?
It turns out that cholesterol itself is not what initiates the process of atherosclerosis (a hardening of the arterial walls). Rather, it is the particles that carry cholesterol and fats. While it is true that cholesterol does become oxidized and is a component of the plaque in the arterial wall, it must first get there by traveling within these particles. To learn more about cholesterol, its role in the body and how it contributes to cardiovascular risk, visit the first blog in our series, “Cholesterol: Friend or Foe”.
Since the late 1990s we have known that it isn’t the amount of cholesterol in the particle but rather the number of particles that is responsible for increasing the risk of atherosclerosis and a future cardiovascular event. It is a concentration-driven process: the more particles there are, the likelier it is that more particles can get trapped in the vessel wall, resulting in a higher risk of atherosclerosis.
Here’s What We Know About Particles
We know that cholesterol and fats need to be delivered to the appropriate places in the body where they are necessary to perform many functions via LDL-P (low-density lipoprotein particles) and HDL-P (high-density lipoprotein particles). We also know the size of the particle can change, from larger to smaller, depending on genetics or preexisting conditions, such as insulin resistance (link to insulin resistance blog). Therefore, at any given level of cholesterol, the number of LDL-P can vary from patient to patient as can the risk of cardiovascular disease.
What’s the Bottom Line?
The number of LDL-P is far more important than measuring the amount of cholesterol in each particle. A normal lipid panel showing cholesterol content can be deceiving. In some cases, an individual may have small particles, therefore requiring a higher number to carry a given amount of cholesterol. In others, an individual with a high triglyceride level, whose particles will be cholesterol depleted, may need more particles to carry cholesterol and fats.
In short, LDL-C is not an accurate measure of risk; the LDL-P number is more predictive of your risk for a future cardiovascular event. In other words, measuring only cholesterol content and finding a normal LDL-C can result in missing an abnormal LDL-P number and a missed cardiovascular risk.
What We Offer
At Absolute Health, we perform a full cardiovascular risk assessment with advanced testing that utilizes nuclear magnetic resonance (NMR) technology to measure lipoprotein particle concentrations, as well as immunoassays to measure apoproteins (the protein portion that forms the lipoproteins). Through our advanced cardiometabolic testing, our providers will be able to determine the root cause of your high particle number. You may:
- Have insulin resistance and therefore smaller particles
- Make too much cholesterol
- Reabsorb too much cholesterol
- Have hypothyroidism
- Have a high triglyceride count
Following an assessment, you will work with a team of providers to create a customized treatment plan tailored to your individual needs for a happier, healthier you.
For more information or to schedule a consultation, contact us today.