When evaluating your risk for conditions such as heart disease or heart attack, your physician generally orders a lipid panel as part of a cardiovascular risk assessment.
What are lipids, exactly?
Lipids are fat and fat-like substances in the body that play an imperative role in cell production and body energy. When a lipid profile is done, the profile measures the levels of certain lipids in the bloodstream. Two important lipids, cholesterol and triglycerides, are transported through the body via the bloodstream by lipoprotein particles (made up of apoprotein, cholesterol and phospholipid molecules). These particles are measured by their density in the blood as high-density lipoproteins (HDL), low-density lipoproteins (LDL) and very low-density lipoproteins (VLDL).
A lipid profile will normally include:
- Total cholesterol: A total cholesterol test measures all of the cholesterol in the lipoprotein particles and one-fifth (20 percent) of your triglyceride levels.
- High-density lipoprotein cholesterol (HDL-C): Commonly labeled as “good cholesterol” because this is the cholesterol carried back to the liver.
- Low-density lipoprotein (LDL-C): Commonly labeled as “bad cholesterol” because it’s the cholesterol that deposits on the walls of the blood vessels. This can lead to conditions such as atherosclerosis, a hardening of the artery walls.
- Triglycerides: Triglycerides are the most common type of fat in the body and a source of energy. The primary triglyceride transporting lipoproteins are VLDLs.
New evidence suggests it may not be as simple as “good and bad cholesterol”. Cholesterol itself is not “bad”, it’s a crucial building block in the body, but if it ends up in the walls of your arteries then it becomes part of othe problem.
So, what is your lipid panel telling you? — Not enough!
LDL-C and HDL-C are giving you the cholesterol content of those particles. But what you need to know is the number of particles, not the amount of cholesterol in each one. When LDL-C is very high, it’s more likely your particle number is elevated. Therefore, a traditional lipid panel can give us clues, but it does not provide the whole picture (and it is when the LDL-C is normal that it can be misleading).
While oxidized cholesterol does form part of the plaques that lead to atherosclerosis, the cholesterol must travel to the walls of the arteries inside lipoproteins (specifically apolipoprotein B (apoB) particles, the vast majority of which are LDL). Therefore, the important number to know is your LDL-P (particle) count NOT LDL-C (cholesterol content). The more particles traveling in your blood, the higher the likelihood more will get trapped inside the arterial walls. The plaque forming process that leads to atherosclerosis and increases your risk for a cardiovascular event (e.g. heart attack, stroke, peripheral vascular disease, etc.) will then begin.
This is why 50 percent of patients who suffer a heart attack claim they were at low risk due to a “normal cholesterol” level, but the reality was that while the cholesterol content was normal (LDL-C), the particle count (LDL-P) was likely elevated.
What’s the Bottom Line?
The key initiating process in atherosclerosis is the apoB-containing lipoprotein particles (the majority are LDLs) getting trapped inside the wall of your arteries, they then undergo oxidation and initiate a chronic inflammatory process. Entry of these lipoproteins is driven by a high particle concentration. Therefore, knowing your lipoprotein particle number (i.e. LDL-P, apoB) is more crucial than knowing the cholesterol content of your lipoprotein particles (LDL-C).
Advanced Testing and What We Can Do for You
At Absolute Health, we perform a full cardiovascular risk assessment with advanced testing that utilizes nuclear magnetic resonance (NMR) technology to measure the number of lipoprotein particles that carry your cholesterol and triglycerides in the bloodstream, and immunoassays to measure apoproteins.
Our specialists will educate you on the results and what can be done to improve your overall health and well-being. We will then work with you to create a personalized treatment plan to fit your individual needs. This plan will reduce and manage your risk of conditions so that we can be proactive about your health!
For more information or to schedule a consultation, contact us today.