A healthy cholesterol level is more than your total cholesterol number; it must also take into account cholesterol fractions.
What Is a Healthy Cholesterol Level? TraWhat Is a Healthy Cholesterol Level? Transcript
Dr. Sinatra, what's a healthy level for cholesterol?
Oh boy! You know, I hear this question all the time because the media and the drug companies have done such a great job of brain-washing us in thinking that if our cholesterol is over 200, we have a problem. But, you know, nothing's farther from the truth. I mean, I can't tell you how many heart attacks I've taken care of in people with cholesterols of 150 and below. Now look, if you live on the island of Crete in the Mediterranean, the average cholesterol for an inhabitant of Crete is 200, but yet there hasn't been a heart attack on record for over a decade when I did the research after writing my book, "Heartbreak and Heart Disease."
Now, if you are a Frenchman, your average cholesterol is between 250 and 275, but you have the lowest coronary artery disease in Western Europe. Now, what's the problem? Well, the problem is is that it's not the cholesterol number that is the issue. What you really need to do when you see your doctor and your doctor wants to check your cholesterol is fractionate the cholesterol. We call it a LPP test or a VAP test where the cholesterol particle is divided up or it's fractionated and, when you fractionate it, we see where the problem is. For example, if you have a high LDL and it's unoxidized and it's fluffy and large-particle, who cares? Who cares? It's just a high cholesterol and a lot of people have that.
But now, let's think of the opposite. Suppose you have a high LDL and it's small-particle LDL, it's heavily oxidized, and you have a lot of LP(a) also. LP(a) is really the cholesterol story. LP(a) is a small-particle cholesterol, has a dulcified bridge, it's very inflammatory, it's very thrombotic; that means it enhances blood clotting and, if you have high LP(a), you're in handcuffs for coronary artery disease. There's great data to show that people with high LP(a)'s have clotting of the blood and also inflammation, which predisposes you to a heart attack or even a stroke for that matter. That's the real cholesterol story.
So, if your doctor says to you, "Well, we're going to get a total cholesterol, and an HDL, and a LDL, blood sugar, and triglycerides," that's okay, but it's kind of dinosaur medicine. I'd prefer you to have a LPP or VAP test and fractionate the cholesterol. Suppose you have dysfunctional HDL or suppose you have VLDL, which is highly inflammatory, and you can't determine that unless you fractionate your cholesterol. So, here's the key: Lots of small, dense particles and many particles, oxidized particles, and high LP(a); dangerous scenario. These are people where I wouldn't want to intervene and give them anti-inflammatory agents to lower that inflammatory risk of having this small-particle cholesterol, which if oxidized, is highly inflammatory. So, don't worry about the numbers so much. And when I see patients and doctors prescribe drugs that are treating numbers, to me, that's not smart medicine. I treat the patient, not the number.