Cholesterol has been demonized for years, often leading to misconceptions about its role in our health. While it’s true that high cholesterol levels can pose risks to heart health, it’s essential to understand the nuances of cholesterol testing and interpretation. If you are brand new to cholesterol, check out my blog here.
Despite its bad reputation, cholesterol plays crucial roles in the body, such as forming cell membranes, producing hormones, and aiding in the synthesis of vitamin D and bile acids. In optimal amounts, cholesterol is vital for maintaining good health. On the flip side of things, excessive cholesterol in the bloodstream can accumulate in the walls of arteries, leading to the formation of plaque. These plaques narrow the arteries, restricting blood flow and increasing the risk of heart disease, heart attacks, and strokes.
This ultimate guide will help you navigate through your cholesterol lab results and empower you to make informed decisions about your heart health.
Why We Test:
Regular cholesterol testing is so important because it allows healthcare providers to assess your risk of heart disease and to see your trends over time. It is so important to get this checked and watch your trends stay, or move in the right direction! However, just looking at total cholesterol does not give you the full picture.
Why You Need to Understand Your Labs:
Understanding your cholesterol lab results is more than just knowing if your numbers fall within the “normal” range. The optimal range for cholesterol levels can vary based on factors such as age, gender, and overall health. Also, what’s considered “normal” for one person may not be optimal for another.
Cholesterol labs are a key factor in assessing heart health, and knowing what your lab results mean can help you take better care of your heart. Let’s break down the main things to look at:
Cholesterol Types:
- LDL (Low-Density Lipoprotein) Cholesterol: This is often called the “bad” cholesterol. Having too much LDL can lead to clogged arteries, which raises the risk of heart problems like heart attacks and strokes. The ideal LDL level is below 100 mg/dL. If your LDL is considered high then you must look deeper into the size of your LDL particles. Specifically particle size testing listed below.
- HDL (High-Density Lipoprotein) Cholesterol: This is known as the “good” cholesterol. It helps remove excess LDL from your bloodstream, which lowers your risk of heart disease. Aim for an HDL level above 60 mg/dL.
- Triglycerides: These are a type of fat in your blood. Having high triglyceride levels can increase your risk of heart disease. The best range for triglycerides is below 100 mg/dL. The lower the better.
Additional Markers:
- APOB: TApolipoprotein B is a protein that helps carry cholesterol in your body. ApoB is important because it reflects the number of atherogenic particles (particles that can cause plaque buildup in arteries), and elevated levels are associated with an increased risk of cardiovascular disease. Keeping your APOB level below 60 mg/dL is good for your heart.
- Lp(a): Lipoprotein(a) is a type of cholesterol-carrying particle in the blood that is genetically determined and associated with an increased risk of heart disease, stroke, and aortic valve disease. Lp(a) is measured in nmol/L or mg/dL, depending on the lab. Ideal levels:
- Below 50 mg/dL (125 nmol/L) → Low risk
- 50-125 mg/dL (125-300 nmol/L) → Moderate risk
- Above 125 mg/dL (300+ nmol/L) → High risk
Cholesterol Particle Size: Why It Matters
It’s not just about how much cholesterol you have; the size of the cholesterol particles also matters. Smaller LDL particles are more likely to cause problems because they are dense and can easily get stuck in your arteries and cause blockages. Versus large fluffy LDL which are benign and have no impact positive or negative.
Testing Particle Size:
Doctors usually don’t test for cholesterol particle size during routine checkups. But if you have certain health issues, like diabetes or heart disease, or your cholesterol is elevated then they should do more detailed tests. These tests can tell you about the size of your LDL particles, the size of your HDL particles, and your APOB levels. If your blood test shows that your LDL is over 100 mg/dl, ask your doctor to run an NMR profile to determine your LDL particle size. Big, fluffy LDL is typically not harmful. Small, dense LDL, which more easily clogs arteries, can be harmful.
Here are some optimal ranges to consider when interpreting your cholesterol lab results:
- APOB: Less than 60 mg
- Total Cholesterol: Less than 200 mg/dL
- LDL (Low-Density Lipoprotein): Less than 100 mg/dL
- HDL (High-Density Lipoprotein): Greater than 60 mg/dL
- Triglycerides: Less than 100 mg/dL is ideal
- Triglyceride to HDL Ratio (Tri/HDL): shown below
- Total Cholesterol to HDL Ratio: Abnormal is Greater than 3
How to Find Your Triglyceride and HDL Ratio
A simple blood test can show how much LDL and HDL you have, as well as your triglycerides. Adults over age 20 should get a blood test to check their cholesterol levels at least every 2 years if they do not have risk factors such as familial history of heart disease.
Once you know these numbers, then you should be able to determine your Triglyceride to HDL ratio. Do this by taking your fasting triglyceride number and dividing it by your fasting HDL number.
For example:
Triglycerides = 150 and HDL= 60
150/60 = a ratio of 2.5:1
A normal ratio falls between 1 and 1.9:1. A ratio of 2:1 or higher indicates significant insulin resistance and a higher risk of cardiovascular disease. So the example above would show insulin resistance and a higher risk of cardiovascular disease. Lifestyle changes should be made. This is important to look at because there are many people that will have a normal total cholesterol value yet have a poor ratio. The biggest myth about heart disease is that low or normal total cholesterol equals a healthy heart!
Bottom Line:
Lifestyle modifications play a crucial role in managing cholesterol levels. Simple changes such as staying hydrated, consuming whole foods, engaging in regular physical activity, and prioritizing quality sleep can positively impact cholesterol levels and overall heart health. Understanding your cholesterol lab results, including both the basic numbers and details like particle size, is really important for looking after your heart!
These extra tests might cost more out of pocket expense, but they can give you and your doctor important information about your heart health!
If you are serious about improving your cholesterol numbers and your health health, LEAN is the program for you! I will develop a specific macro nutrients plan to meet your goals, evaluate your labs to discuss changes we need to make and what we want to see and then hold your hand and give you daily support and accountability to stay on track! New session starts soon!
