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Every year at the annual physical, I would order for my patients their cholesterol numbers and give them the “report card”. We would talk “good” HDL cholesterol and “bad” LDL cholesterol make clinical decisions based on those numbers. Perhaps we would factor in some other things, such as blood pressure and family history of heart disease, 10 year Framingham Risk Score………sometimes. Unfortunately, the standard lipid panel as a heart disease risk factor is just the tip of the iceberg and can be misleading. A person’s cardiovascular health is more than the sum of their numbers and we must pay attention to more than the standard numbers when trying to assess cardiovascular risk.
Again, we must dig deeper beneath the surface of the water to see the full extent of the cholesterol iceberg. These days, most labs offer advanced lipid panels to better assess cardiovascular risk for people. The standard lipid panel may give false reassurance or false concern that there is cardiovascular risk. At Sparkle, we take into account LDL particle number and size as well as other markers of dysfunctional lipid proteins and inflammatory markers.
What is your LDL particle number and size? We want to know, is your LDL (aka bad cholesterol) REALLY BAD or just pretending to be BAD. Ideally your LDL particles are large and fluffy, not oxidized small and sticky. You can only determine this by measuring. A patient can have a LDL of 120 and still be at high risk if the particle number is elevated and the average size of their LDL is small. Conversely, a patient can have an LDL of 180 and carry little risk based on this marker as their particle number is low and the size of their LDL particles are large.
Of course, risk is not only from cholesterol numbers. We look at body composition and where the fat accumulates on the body (visceral fat or apple body type), blood sugar biomarkers, and other factors such as family history and blood pressure. We pay attention to inflammation – as cardiovascular disease often comes down to inflammation, endothelial damage (the endothelium is the inner lining of the blood vessel) and immune system dysfunction at the root cause and not just an abundance of cholesterol in the blood.
When deciding about cholesterol and treating hyperlipidemia we must look at the individual and ALL of the other factors. If we just pay attention to the standard numbers we may miss underlying risks.
We will put together for you an individualized treatment plan that may include standard cholesterol therapies if indicated but always through shared decision making and with priority placed on improving lifestyle factors first and foremost. If alternative treatment options are desired, we will give you the most evidence based possible nutraceutical options to help get your LDL particle size and number to goal and pay attention to some of the other risk factors that may be present that contribute to the progression of heart disease.
Curr Atheroscler Rep. 2014 Mar;16(3):394. The role of advanced lipid testing in the prediction of cardiovascular disease
J Clin Lipidol. 2016 Jan-Feb;10 National Lipid Association Annual summary of Clinical Lipidology 2016.
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