What Is Cholesterol Fractionation?

Dr. Sinatra: This is a question from a newsletter subscriber. What is cholesterol fractionation?

Well, you know, we all hear about cholesterol on TV. We hear about the bad cholesterol, the good cholesterol, but that's a dinosaur. Folks, what you need to focus on, if your cholesterol is elevated, we have to know what type it is, so this is where cholesterol fractionation comes in. For example, if you have LDL and it's oxidized, we want to know how toxic that LDL is. We want to know if it's small particle, if it's fluffy, or if it's a combination of both, so we call it A size, B size, or AB. AB is a combination of a fluffy particle and also a small particle.

The problem is the more small particles you have, the more dense those particles, the more inflammatory cholesterol is. The more inflammatory cholesterol is, the more it can cause complications or inflammation in your blood vessels. Now, there's also the component of cholesterol called Lp(a). This is the most inflammatory and thrombotic, and what I mean by thrombotic, it causes clots. So, if you have high Lp(a), that's a problem; that's the real cholesterol story. So, high Lp(a) is something we have to worry about.

Now is all HDL protective? Not really. You can have dysfunctional HDL. When we fractionate cholesterol, we look at HDL subtypes. We call it HDL-2 and HDL-3. We also look at triglycerides. For example, we'll fractionate the triglycerides into VLDL. The higher the VLDL you have, very low density lipoprotein, the more inflammatory it is. So, if you go to your doctor and you get an HDL and a LDL and a total cholesterol and triglycerides, that's a start, but if you really want to look at your cholesterol picture, you must fractionate it. When you fractionate it, you can take steps to neutralize the bad portions and then you can really do something about it and that's what you want to do.