Not Just Good vs. Bad—The Tests that Make Sense of Cholesterol’s Shades of Gray

As I’ve mentioned in my previous writings, different types of cholesterol particles influence your cardiovascular risk. While it’s common to hear generalizations such as “LDL is bad, and HDL is good,” the reality is that both LDL and HDL are far more complex. There are multiple subtypes of both, and some of those subtypes are good and some are bad.

I’ve found the standard test for cholesterol to be woefully inadequate when it comes to identifying how cholesterol affects your chance of having arterial disease. In fact, monitoring just the amount of total amount of cholesterol, HDL, and LDL in your body is only about 40 percent accurate in predicting heart attack risk. Fortunately, new tests are now available that can measure cholesterol subtypes. I’ll talk more about them as we go along, but for now, here’s a rundown on the key cholesterol components that you need to watch:

Your LDL Components

High levels of LDL are thought to increase the risk of heart attack. But LDL, up to a certain level, is really a good guy—a sheep slapped with a wolf’s reputation. Your most common type of cholesterol is LDL—a fatty substance produced in the liver and wrapped in a protein coating. It performs absolutely essential services in the body as a raw material. It’s converted by enzymes into vitamin D, steroid hormones (estrogen, progesterone, testosterone, and cortisol), and the bile acids that are critical for proper digestion. LDL is dangerous only when it becomes oxidized, or when it is made up mostly of small dense particles—rather than large, fluffy, and more “buoyant” particles.

Your Lp(a) Level

I consider a subtype of LDL called Lp(a) to be the most dangerous form of cholesterol. It’s highly inflammatory and thrombotic, which means it causes blood clots. When it increases abnormally in the bloodstream, it can increase your risk of heart attack up to 25 times. I’ve seen many patients with cardiovascular disease who have normal cholesterol levels but high Lp(a). The primary risk factor for high Lp(a) is genetic, so people with a family history of cardiovascular disease should have their Lp(a) level tested.

Your HDL Subtypes

A high level of HDL—the so-called good cholesterol—is generally associated with protection against heart attack. However, we now know that HDL can be further divided into subtypes HDL1 and HDL2. Both reduce cardiovascular risk, but HDL2 is far superior and provides more protection than HDL1.

IDL (Intermediate Density Lipoproteins)

IDL is a type of blood fat that represents an inherited independent risk factor for heart disease. I had never heard about this substance until recently, proving that even old watchdogs like me can learn new tricks.

Triglyceride Fractions

Previous blood tests gave you a total triglyceride level, and anything above 180 was considered a risk. Triglycerides are fat globules in the bloodstream. In a concentrated form, they create the fatty “love handles” around your midsection. As with LDL and HDL, there are different types of triglycerides, and advanced testing measures the levels of each. The one to be most concerned about is VLDL3, which is the most inflammatory triglyceride. It’s a prime indicator for the progression of coronary artery disease, insulin resistance, and type 2 diabetes.

What Advanced Testing Means for You

Here’s a real-life example of how knowing your cholesterol fractions can really make a difference in your health care. A while back, one of my nurses, Glenda, approached me at the clinic to ask for some advice regarding her cholesterol. Her family doctor had looked at her most recent blood work and wanted to give her a prescription for Lipitor.

Glenda’s total cholesterol was 271, and her LDL was 165—levels considered “very high” by standard measures. However, rather than accept the prescription for Lipitor, I suggested that she first take a new, more comprehensive lipid test to determine if her cholesterol levels truly warranted taking a statin drug. It’s called the VAP test—short for vertical auto profile.

For the most part, the VAP test gave Glenda passing marks. Her LDL was made up mostly of large, desirable particles. Her HDL fractions strongly favored the risk-reducing type. And her IDL level was low, in the range where you want it. However, the test showed her Lp(a) to be somewhat elevated. So, I recommended she take a natural approach with some niacin, nattokinase, and fish oil daily to help offset the effect of Lp(a) on the blood. Had Glenda taken a statin drug after her standard lipid test, it could have done her more harm than good. Statins not only deplete the body of CoQ10, they may also drive up Lp(a).

Another Testing Option: The LLP

Recently, a second test has emerged, and it’s even a notch better. It’s called the Lipoprotein Particle Profile (LPP), and it’s offered by SpectraCell Laboratories in Houston, Texas. The reasons I believe LPP has an advantage over VAP are because its methodology allows for more precise measurements, and because it can measure remnant lipoprotein (RLP). To date, no other test has been able to single out this type of cholesterol.

To understand why RLP is so important, you have to remember how arterial plaque forms. When LDL cholesterol penetrates the endothelial wall to make repairs, it can become oxidized. Once oxidized, it stokes the inflammatory process, calcifies, and eventually becomes part of plaque. RLP works the same way, except it doesn’t oxidize. It simply enters the endothelium and begins contributing to the inflammatory process.

How to Get the Tests

To find out what your cholesterol patterns are, ask your doctor for either a VAP or LPP test. Both tests are covered by Medicare and most insurance plans when ordered by a physician. For more information about them, visit their web sites at www.thevaptest.com and www.spectracell.com.