Cholesterol – It is more than just a number
Patient 1 has his blood work run and his total cholesterol is 182. Patient 2 has hers run and it is 232. We are told that total cholesterol should be less than 200. Who has healthier cholesterol levels and less risk for heart disease?
Trick question – without breaking down the total number into LDL, VLDL and HDL the number is useless.
HDL – high density lipoprotein. Considered to be protective against heart disease – often called the “good cholesterol.” The higher the number the better. Should be at least 45.
LDL – low density lipoprotein. Causes the formation of arterial plaque – the “bad cholesterol.” Should be less than 130, less than 100 is optimal.
VLDL – very low density lipoprotein. Considered even worse than LDL as a cardiac risk factor. Should be less than 29.
Back to the patients numbers:
Patient 1 HDL 12, LDL 135, VLDL 35 = Total Cholesterol 182
Patient 2 HDL 142 LDL 85, VLDL 5 = Total Cholesterol 232
Obviously Patient 2 has a much lower risk for heart disease even though her total cholesterol would be considered high. Interestingly, half of the people who have heart attacks have “normal” cholesterol levels.
There is more…
Trigylcerides, apolipoprotien, the size and the density of the LDL, remnant lipoprotein, homocysteine levels, c-reactive proteins, and insulin resistance all contribute to your risk of heart disease — even more so than VLDL and LDL. These factors indicate when the conditions are most conducive to creating arterial plaque.
So why do we need cholesterol? Cholesterol is the building block for our hormones – estrogen, progesterone, testosterone, aldosterone, and cortisol are all made from cholesterol. It is possible to have too little cholesterol especially through over supplementation/medication.
Bloodwork is available to test all these risk factors in addition to the HDL, LDL and Total cholesterol. These labs are a valuable tool since the strategy to reduce one risk factor is different for another. Diet and exercise should be the first line of therapy to reduce cardiac risk factors. As always, good medicine is not one supplement/drug fits all.
(These are my numbers. And yes I’ll work on my LDL.)