Looking Beyond Lowering LDL Cholesterol

The risk of developing cardiovascular diseases is typically assessed based on a standard cholesterol test measuring LDL (low-density lipoprotein) and HDL (high-density lipoprotein) levels and then factoring advanced age, gender, family history of heart disease, high blood pressure, diabetes, and smoking. Taking these factors into account, LDL lowering targets can then be established, and a program of therapeutic changes in lifestyle and nutrition can be established. If these changes are unable to bring cholesterol levels in line, medications are routinely provided.

However, studies indicate that these risk factors can account for only a portion, perhaps 50%, of the incidence of coronary artery disease. The scientific community has continued its investigations, and is finding that a number of other risk factors can be identified through blood test. On its website, Berkeley Health Lab, a leading medical lab with an integrated program for cardiovascular treatment, identifies many of these important factors including:

Size of LDL Particles: Some LDLs Are Worse Than Others

• Small LDL particles can cause plaque build up to progress much faster because they can enter the artery wall easier than large LDL particles
• Too many small LDL particles can increase your risk for a heart attack beyond any other risk factors you may have, such as smoking, high blood pressure, diabetes, etc.
• Certain medications, proper nutrition, and regular exercise can help your body produce fewer small LDL particles

Size of HDL Particles: Some HDLS Are Better Than Others

• HDL helps to protect against progression of plaque build-up in the artery wall
• HDL2b is the workhorse of all of the HDL particle types. It has the ability to pick up and remove cholesterol
• Certain medications, improved nutrition, loss of body fat, stopping tobacco use, and increased physical activity are some ways that HDL-C and HDL2b can be improved

Apolipoprotein B: Accurate LDL Particle Number

• ApoB is a direct measurement of the amount of LDL ("bad" cholesterol) particles
• A high apoB number indicates increased risk for heart disease
• Improved eating habits, increased physical activity, and loss of body fat are some lifestyle changes that improve apoB
• Your physician uses apoB to determine if certain medications are needed and to monitor their effectiveness

C-Reactive Protein-hs (CRP)

• High levels of CRP indicate inflammation within the body due to infection or tissue injury; it can also predict heart disease risk levels
  Certain medications may help reduce this risk
  Certain foods have anti-inflammatory benefits

ApoE Genotype

• ApoE is a genetic test that plays a role in helping to identify how people respond to different amounts of dietary fat. Your body's response to dietary fat impacts the formation of small or large LDL particles
• There are 3 types of apoE genotypes: apoE2, apoE3 and apoE4
• People with an apoE4 have a greater risk for heart disease
• ApoE can be used to help guide the right nutrition plan for you

Other risk factors measurable through blood tests also are discussed on this site.

Overall, most of us typically receive the standard test for cholesterol, with these more thorough tests reserved for those individuals at high risk. Yet, for those of us interested in the information needed to optimize our long term health, this more complete assessment can be very useful. Check with you healthcare provider about obtaining these more extensive blood test to better direct your unique course for optimizing your health.