Cholesterol - Do I need to worry or not? Depends...know YOUR risk

    • There is probably no more misunderstood substance in our bodies than cholesterol. 
    • Your annual cholesterol test actually tells you very little about your heart attack risk.
    • There are tests that are significantly more predictive of your danger, that cardiologists rarely use.
    • You can get these tests done on your own at reasonable cost.
    • Finally know your real risk...put worries to rest, or get to work!

Cholesterol is a waxy, fat-like substance found in all cells of the body, produced by the liver to help perform thousands of bodily functions. We need some cholesterol to produce important things like hormones, vitamin D, and substances like bile acids that help us digest certain foods. Without it, we wouldn’t be able to maintain adequate levels of Testosterone, Estrogen, Progesterone, Pregnenolone, DHEA and Cortisol. An organic molecule, cholesterol also assists in the production and stability of cell membranes and the covering of nerve sheaths. Cholesterol itself is carried around the bloodstream in a complex molecule called a lipoprotein.

There are two major classes of lipoprotein...

LDL = Low Density Lipoprotein - takes cholesterol into bloodstream

HDL = High Density Lipoprotein - removes cholesterol from bloodstream

*Remember this fact...LDL & HDL are actually just the carriers of cholesterol.

LDL takes cholesterol from the liver, where it is produced, to all corners of the body for use in vital functions. Much of it therefore is used up, but what remains is picked up by the HDL and transported back to the liver for recycling. The relative balance of this cycle determines how much cholesterol remains in the bloodstream.

Cholesterol cycle

Beginning with the Framingham study in 1971, the association between high cholesterol and heart disease has been in focus. This study determined, among many things, that higher levels of cholesterol were connected with higher risks of cardiac events. Even though following studies on this relationship were broad and inconclusive, with the introduction of statins in 1987 doctors began aggressively prescribing them to lower cholesterol levels, and assumedly heart attack and stroke risk. It is curious then, that heart disease was our number one killer when statins were introduced 30 years ago, yet it is still our number one killer after billions of statin prescriptions.

What are cardiologists missing?

We now know after decades of diverse, continuing studies, that if you have not had a heart attack, starting to take a statin barely reduces the risk of having a heart attack or stroke...from 3% to just 2% after 10 years on a statin! That is only in men. What about women? If you are a woman with no evidence of heart disease there is absolutely NO data that shows a statin will protect you. 

Now if you have had a prior heart attack or stroke...statins are effective in preventing a recurrence. But for the average person...preventively taking a statin to lower your cholesterol hardly protects you.

So is it really your cholesterol level that is the problem? 

Well definitely not your total cholesterol number. That tells you absolutely nothing. Why? Because that number includes both "good" (HDL), and "bad" (LDL).

For example: A total cholesterol number of 200 could mean two totally different things. (Remember the HDL removes the bad from the arteries).

Total CHOL - 200

Person A: includes 170 LDL (bad) and 30 HDL (good) - Very high risk.

Person B: includes 130 LDL (bad) and 70 HDL (good) - Very low risk.

Remember having more HDL removes excess cholesterol from your bloodstream.

Neither is it so much your LDL number either, as a multitude of long term studies have shown little correlation to cardiac risk in those who have not had a heart attack.

There is much more important information available to you, that can truly tell you how much you need to be concerned about heart attack and stroke.

1. Your particle count and size of those particles

2. If you have high levels of Lipoprotein (a) which is genetic and dangerous

3. Your level of arterial inflammation, which leads to plaque formation

4. The stability of the plaque in your arteries. 

These four crucial factors can all be tested. That would be very important, risk predictive, and actionable information. You can actually test the levels of inflammation in your arteries! Let's talk about each factor, and how it impacts your cardiovascular risk.

1. Particle Count:

Remember at the start of this article when I said that what we commonly think of as good and bad cholesterol, HDL and LDL, are not actually cholesterol themselves but are actually lipoproteins, or a protein/fat molecule that carries around cholesterol? This means that they can contain many particles of cholesterol each. A LDL lipoprotein with 10 molecules of cholesterol is more problematic than one with 3. So your real measure of cholesterol levels needs to be how many particles of cholesterol there are total carried by all your LDL lipoproteins, not just how many lipoproteins (LDL).


LDL 120 (not bad) --- but your particle count is 1800 = high risk

LDL 120 (not bad) --- but your particle count is 900 = low risk

Knowing your particle count could tell you if you even need to worry about a 120 LDL cholesterol, or perhaps even 150.

Second, this same test will tell you the average size of these particles. This is very important information because small particles are much more likely to penetrate the endothelial cells that line your arteries, become inflamed, and start the cascade to plaque build up. Whereas larger sized particles are unable to penetrate the endothelium.

Particle count

The NMR® LipoProfile is this are the two discussed ranges...

NMR test results LDL Particle Count:

Low Risk < 1000

Moderate 1000 - 1299

Borderline-High 1300 - 1599

High 1600 - 2000

Very High > 2000

NMR test results LDL Size:

LDL Size large pattern A (safer) 23.0-20.6

LDL Size small pattern B (dangerous) 20.5-19.00

You will also get these results with it in addition:

• Small LDL particle number (small LDL-P)
• HDL particle number (HDL-P)
• A standard cholesterol test (LDL-C, HDL-C, triglycerides and total cholesterol)
• LP-IR (Insulin Resistance)

You can ask your doctor to run this important test, just make sure your insurance covers it...otherwise I recommend you get it from our friends at Life Extension. It is currently on sale for $74.25

Order the NMR LipoProfile here 


Lp(a) is a small, dense lipoprotein that is a combination of fats, proteins and cholesterol that is very dangerous and genetic. Yet it is rarely tested, even by cardiologists. High levels increase the risk for atherosclerosis and calcification in the arteries of your heart, legs, brain and even heart valves. A high level increases the risk of heart attack, stroke, and valve blockages. It is the strongest inherited risk factor for heart blockages and aortic stenosis and clots, so it is a very important molecule to get tested to know your levels. High levels may raise the risk of heart disease by 200–400%.

Approximately 25% of people have high levels of Lp(a). Most all of them are unaware because they don't get tested for it. I use a fairly simple question to help people identify if they potentially could have high Lp(a) since it is genetic.

  • Do you have a family member with early heart disease, who had a heart attack or stroke at a young age (men younger than 55 years of age and women less than 65 years of age)?

If so, it is highly likely that it was Lp(a), not LDL cholesterol that caused it, and statins do not lower Lp(a). You could be on a statin, keeping your LDL cholesterol levels low, and think you are safe. But hidden elevated Lp(a) levels could mean you are at great risk of a unexpected cardiovascular crisis. If your Lp(a) numbers come back can put this test aside and forget about your risk from it. 

LP-(a) test results

Desirable: < 14 mg/dL (< 35 nmol/l)
Borderline risk: 14 – 30 mg/dL (35 – 75 nmol/l)
High risk: 31 – 50 mg/dL (75 – 125 nmol/l)
Very high risk: > 50 mg/dL (> 125 nmol/l)

You can ask your doctor to run this important test, just make sure your insurance covers it...otherwise I recommend you get it from our friends at Life Extension. It is currently on sale for $29.25

Order the Lipoprotein (a) here 

3. Arterial Inflammation

Next let's move on to inflammation in your arteries, because that is what drives progressing heart disease and plaque build up. When small cholesterol particles penetrate the endothelium, that delicate one cell lining of your arteries, nearby cells send off inflammatory cytokines alerting the immune cells to this problem. Immune cells called Macrophages (big eaters in greek), enter the endothelium and gobble up the oxidized cholesterol. They become lodged there and become what is know as a foam cell. These foam cells release Myeloperoxidase (MPO), an enzyme that aggravates this process. This cascade of events results in inflammation linked to plaque formation in your artery wall. This destructive process causes the body to "patch" this problem with plaque (fats, cholesterol and calcium). 

Foam cells MPO

Myeloperoxidase (MPO) is a vascular specific marker that measures your body's response to damage in your artery walls and the subsequent formation of vulnerable plaque which is prone to rupture. Myeloperoxidase also activates enzymes that are linked to plaque vulnerability and rupture. This combination of detrimental effects shows that MPO is actively involved in both the initiation and progression of atherosclerosis, a chronic inflammatory disease of the arterial wall.

  • Individuals with elevated MPO levels are more than twice as likely to experience cardiovascular mortality.
  • Elevated MPO levels predict the risk of heart disease in subgroups otherwise associated with low risk.
  • MPO levels are not likely to be elevated due to chronic infections or rheumatologic disorders (likely possible in the popular inflammation test C-Reactive Protein) due to the fact that MPO in the blood is a specific marker of vascular inflammation and vulnerable plaque.

So by measuring your levels of Myeloperoxidase, you can understand how much inflammation is driving plaque build up in your arteries.

Goal: <400 pmol/L
Low risk: 400 - 480 pmol/L
High risk: ≥480 pmol/L

You can ask your doctor to run this important test, just make sure your insurance covers it...otherwise I recommend you get it from our friends at Life Extension. It is currently on sale for $90.00

Order the Myeloperoxidase test here 

plaque progression

4. Plaque Stability

We all have some plaque in our arteries, and levels increase as we age. Unfortunately, for most people, the first sign of heart disease is a heart attack or stroke since they are mainly caused by plaque rupture, not narrowing of the arteries. Hard plaque is actually less dangerous, it has what we could call a "hard cap" that cements it in place. But soft, unstable plaque is prone to break away and cause the clots and blockages that cause heart attacks and stroke. What makes plaque soft and rupture prone? 

An enzyme called Phospholipase A2 breaks down fats in the artery. Since arterial plaque is made up mostly of fats, the danger is this enzyme will break down the "hard cap" that covers the plaque, degrading the structure and causing it to rupture and break loose, lodging in smaller vessels and causing a blockage.

So a blood test that can tell us how "unstable and dangerous" our plaque is would be very crucial and potentially life saving information.

The PLAC® Test for Lp-PLA2 Activity measures the levels of the phospholipase enzyme in the artery wall— a vascular-specific inflammatory marker critical in the formation of rupture-prone plaque.

  • Lp- PLA2 activity is a novel risk predictor in people with no prior history of cardiovascular events with a prognostic value independent of standard lipid profile testing. 
  • The greater the Lp-PLA2 Activity, the greater the risk of fatal and non-fatal CHD events. PLAC Activity above 225 nmol/min/mL identifies people at increased risk of CHD events. 
  • An absolute risk of CHD events is 2.1 times greater with a PLAC test result over 225 and is associated with high risk for a first time myocardial infarction, cardiac revascularization and cardiac death.
You want your test results under 200

You can ask your doctor to run this important test, just make sure your insurance covers it...otherwise I recommend you get it from our friends at Life Extension. It is currently on sale for $93.75

Order the Lp-PLA2 test here 


If you have cardiovascular disease, have it in your family history, or just want to finally know if you need to keep worrying about those annual cholesterol numbers, consider these 4 blood tests. These blood tests are rarely run, and they give you a much, much more complete picture of your cardiovascular health, heart attack and stroke risk. The information they provide could end a lifetime of unnecessary worry, or get you vigilant and serious about taking measures to lower your risk. 


Note: Optimal Health Knowledge receives no compensation referring you to Life Extension, we just think they offer the most advanced tests you can order on your own, without needing a doctor or insurance company to approve. 


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