If you really want to find out how much of a heart disease risk your current cholesterol and triglyceride levels represent, I’m here to tell you that you shouldn’t rely on a traditional blood lipid cholesterol testing to do the job. Such tests will measure total LDL, HDL and triglycerides, and they’re what most doctors will order—but they’re really relics from the Stone Age.
Granted, standard cholesterol testing is useful for determining whether your ratio of total HDL to LDL cholesterol is within a healthy range. But it won’t tell you about your HDL and LDL fractions (that is, whether you have predominantly small dense cholesterol particles, or large buoyant ones). Particle size is extraordinarily important, because new research shows that small dense LDL cholesterol is inflammatory and toxic to blood vessels. And even more troubling is a high level of lipoprotein(a), or Lp(a)—the most dangerous of the blood lipids. Lp(a) is a specific type of small LDL cholesterol particle, and it inflames the blood and makes it sticky—making it more prone to clotting.
As with cholesterol, there are also different types of triglycerides. The type to be most concerned about is VLDL3, which is the most inflammatory triglyceride. It’s a prime indicator for the progression of heart disease, insulin resistance, and type 2 diabetes.
Cholesterol Testing: Size and Subtype Matter
Since the size and type of your cholesterol and triglyceride particles, and the presence of Lp(a), are so important in assessing your risk of heart disease, you need to make sure that the cholesterol testing you get does indeed measure these different values. That’s why I recommend you talk to your doctor about having either the Vertical Auto Profile (VAP) test or the Lipoprotein Particle Profile (LPP) test.
Vertical Auto Profile (VAP) test. This test will analyze your LDL cholesterol and determine if it is made up of predominantly the small, dangerous particles or the larger, more benign particles. It will also tell you how much Lp(a) is circulating in your blood. In addition, the VAP test breaks out your HDL cholesterol subtypes, letting you know if you have more of the HDL2 subtype, which is most beneficial. It also measures the levels of each type of triglyceride. You can find out more about the VAP test.
Lipoprotein Particle Profile (LPP) test. The LPP test also measures the different triglyceride types and breaks cholesterol into fractions smaller than LDL and HDL and analyzes the particles comprising each of them, just like the VAP test. But I believe the LPP test has an advantage over the VAP test because its methodology allows for more precise measurements and because it can also measure remnant lipoprotein (RLP), which is a particularly threatening type of cholesterol. You can find out more about the LPP test.
Optimal Cholesterol & Triglyceride Levels Defined
Once you’ve had your cholesterol and triglyceride levels checked by either through cholesterol testing, there are certain ranges you want your scores to be in for a number of different categories. Here are my Sinatra Smart Zone recommendations for healthy cholesterol and triglyceride levels:
- Total Cholesterol: 180 to 250 mg/dL
- Total HDL Cholesterol: 40 to 120 mg/dL for women; 35 to 120 mg/dL for men
- HDL Cholesterol Subtypes: Greater than 25 mg/dL for HDL2; greater than 15 mg/dL for HDL3
- Total LDL Cholesterol: 80 to 140 mg/dL
- LDL Cholesterol Subtype Lp(a): less than 30 mg/dL for a standard blood test; less than 10 mg/dL for a VAP test
- Total Triglycerides: 50 to 150 mg/dL
- Triglycerides Subtype VLDL3: less than 10 mg/dL
In addition to the recommended ranges above, your doctor can review your cholesterol test results to see if your LDL cholesterol is mostly made up of large, fluffy particles that are not dangerous or small, dense particles (known as “LDL-pattern-B”) that are dangerous. If it turns out that your LDL cholesterol is mostly of the small, dense variety, you will want to address your cholesterol levels much more aggressively than if your LDL cholesterol is mostly the large, fluffy type.
More Dr. Sinatra Advice on Heart Disease Tests
What other heart disease tests should you consider? Get information on the array of heart disease tests I use when evaluating and treating my own patients.
Undergoing heart disease testing but unsure what your scores indicate? Get my Sinatra Smart Zone values for a wide array of heart health tests to ensure optimal heart health.
Want to read detailed questions and answers about different heart disease tests? Check out the Q&A section of my Heart Disease Tests Health Center.