Do you know that roughly 75% of people who end up in the hospital due to a heart attack have altogether normal cholesterol levels? My father passed away at 69 from a massive heart attack after receiving a clean bill of health from his physician. His cholesterol levels were in the normal range.
It’s surprising but true, so the research says. And yet, your primary care physician is most likely still measuring your risk for a heart attack using the same ol’ methods—ordering lipid panels and keeping track of your LDL (“bad”) cholesterol and total cholesterol levels. These methods don’t capture the whole picture, as several factors indicate your risk for heart attack and cardiovascular disease—and all these factors need to be taken into account and tested properly.
You can’t change (or predict) what you can’t measure. Modern technologies have allowed us to go beyond “good” and “bad” cholesterol, and at INDUR we believe it’s time to equip you with a complete understanding of your cardiovascular risk.
What is Cholesterol?
First, let’s clear up this thing called cholesterol. Cholesterol is a kind of fat that’s found in our bloodstream, and it actually does a lot of good in our bodies We use it to make many of the hormones we need to stay healthy, sharp, and strong. High cholesterol can be dangerous, but so can low cholesterol.
We get cholesterol via our food—eggs, meats, cheese, butter, and milk all contain healthy amounts of cholesterol. And, our liver makes it as well. We need it—in proper amounts.
Though it’s true that having high LDL (“bad cholesterol”) and low HDL (“good cholesterol”) can increase your risk for developing heart disease (especially if you have a family history), not all HDL and LDL are created equal. Let’s take a quick look at some of the important factors to consider.
LDL Particle Size
Pop quiz: Which type of “bad” cholesterol is more likely to give you heart disease?
A. Big and fluffy particles of LDL cholesterol?
B. Small and dense particles of LDL cholesterol?
Most people assume that “big and fluffy” implies more likely to clog arteries. Simple physics, right? Actually, small dense LDL is more likely to create atherosclerotic plaques (the kind you don’t want) in your arteries because it is more likely to cause damage to the arteries themselves.
They’re also more likely to oxidize (think: turn to rust) within the bloodstream, and oxidized cholesterol is much more likely to increase your risk for coronary artery disease.
No matter whether you passed this pop quiz or not, you’ll want to know whether your body has chosen answer A or answer B.
LDL Particle Number
First, you need to know your LDL Particle Number . This is a measure of the number of LDL particles you have, rather than the total amount of cholesterol you have. This is a more realistic approximation of risk that may result from a high LDL.
HDL Size and Type
In addition to knowing the size of your LDL, it is helpful to know the size of your HDL particles. Interestingly, these are the ones that you want to be big and fluffy. The higher the level of the biggest, fluffiest HDL (called “α-1”) particles, the better. We can also measure some subparticles of HDL (specifically apoA-1, which provides structure to HDL), as every 1 mg/dL apoA-I increase in very large α-1 HDL is associated with a 26% decrease in heart disease risk.
Lp(a) and Advanced Inflammatory Markers
Cholesterol problems don’t develop overnight, and neither do the factors that cause them. One of the most important considerations is how much inflammation is going on inside your blood vessels. Luckily, we can test for some of these risk factors. Assessing blood levels of homocysteine and Omega 3s can tell us how likely we are to be inflamed. Meanwhile, assessing our hs-CRP, Fibrinogen, or Lp(a) tells us if we already are. The good news is that either way, lifestyle intervention (and sometimes appropriately prescribed and monitored medication and supplements) has the potential to improve these inflammatory markers and reduce your risk.
Next, there’s something called Apolipoprotein B. This is the part of the cholesterol molecule that give LDL its shape, and the amount we have is directly tied to the amount of dangerous LDL particles. a molecule that shows up in cholesterol, and it’s one you want to keep to a minimum. Why? For every truly risky LDL, we carry just one of these. The more of these, the more we’re at risk.
What we put into our bodies goes a long way toward impacting how likely we are to be inflamed. Research shows that those of us who are deficient in omega-3 fatty acids are at greater risk for heart disease. At INDUR, we check your omega-3 index—to make sure you’re getting proper amounts of healthy, anti-inflammatory fats from foods like salmon, sardines, and other cold-water fish. Some foods (red meat, white meat, cheese, dairy, eggs, and some fish) contain arachidonic acid, a pro-inflammatory omega-6 fatty acid . Your diet needs to strike a proper balance between omega-6 fatty acids and omega-3 fatty acids (a ratio of 4:1 has been shown to reduce risk of death by 70% compared to a Standard American Diet). Sadly, the average American has an Omega 6 to Omega 3 ratio of greater than 20 to 1. For this reason, we need to increase our consumption of omega-3 fatty acids, and decrease the omega-6 intake.
Though many of these risk factors that we can test for are impacted by your genetics (everyone knows the person who can eat a burger a day and keep the doctor away, after all!), there is a lot that you can do by making significant changes to your lifestyle. At INDUR, we believe that those changes should be both precise and personalized, and appropriate testing can go a long way in helping to develop the best recommendations for you. The Ultimate Testing package was designed for the individual who wants to know their risks so that they can begin to truly take charge of their health.