Cholesterol, Heart Disease, and that Test You’re Not Having
Doctors identified blood cholesterol as a risk factor for cardiovascular disease many years ago. But it’s not quite that simple, of course. Cholesterol comes in several forms, and our body makes proteins that transport these various forms of fat around in the circulation. Generally speaking, when your doctor asks you to have a blood test to assess your cholesterol levels (a blood lipids panel), he or she will be looking at several factors, which taken together help paint a picture of your relative risk for eventual heart disease.
We know, for instance, that a form of cholesterol/protein complex called low density lipoprotein-cholesterol (LDL-c) is linked to a higher risk of heart disease. Scientists think this form tends to stick to the specialized tissue lining our blood vessels (the endothelium), and may eventually lead to atherosclerosis. In some places, these collections of cholesterol and cellular debris may eventually form a clot, which could break off, travel to the heart, cause blood vessel blockage, and give you a life-threatening heart attack. If the clot travels to the brain, it could cause a stroke.
A second form of cholesterol/protein complex, called high density lipoprotein cholesterol (HDL-c) is actually viewed as beneficial. This form of cholesterol works to remove LDL from the circulation. When doctors look at your blood lipid profile, they’re looking for high levels of HDL, and low LDL. They’ll also look at a number called “total cholesterol,” and at a third form of fat (or “lipid”), called triglyceride. Triglyceride is often more or less ignored, but it’s actually a useful number, because it gives an indication of how much sugar and other simple carbohydrates you’ve been consuming. Triglycerides (“trigs”) are directly related to sugar intake and fat formation. They’re the intermediaries that facilitate the transformation of excess carbohydrates from the diet into fat for storage in your fat cells. If your trigs are high, you’re probably eating too many simple carbs, and you’re at risk for obesity, because all those excess trigs have to go somewhere.
Have you had a blood lipid panel done recently? Were you concerned about any of your numbers? Did your doctor recommend medications, such as a statin drug, to lower your levels of “bad” LDL-cholesterol? How about diet? Did your doctor recommend eating fewer cholesterol-rich foods? Check back tomorrow, for more on this important subject. I’ll tell you why advice to cut back on cholesterol-laden foods may be misguided, and talk about the one test you’re probably not having that you probably should.
Dallmeier D1, Koenig W2. Strategies for vascular disease prevention: the role of lipids and related markers including apolipoproteins, low-density lipoproteins (LDL)-particle size, high sensitivity C-reactive protein (hs-CRP), lipoprotein-associated phospholipase A2 (Lp-PLA₂) and lipoprotein(a) (Lp(a)). Best Pract Res Clin Endocrinol Metab. 2014 Jun;28(3):281-94. doi: 10.1016/j.beem.2014.01.003. Epub 2014 Jan 15.