I’ve always been interested in answering the question: “how healthy am I?”
Two years ago, I began a process of assembling an extensive diagnostic panel that would highlight the various functional areas of my body in a “system biology” approach to my health. My first topic of choice: cardiovascular health.
In the past, total cholesterol was considered a measure of cardio health. In general, anything under 200 was considered healthy. However, it was always a confusing measurement for me. Total cholesterol is the combination of LDL “bad” cholesterol, HDL “good” cholesterol, and triglycerides (another “bad” blood fat), all lumped together. Total cholesterol is therefore a mixture of both good and bad factors and can yield to confusing, or misleading information. If, for instance, HDL goes way up (a good thing), so does total cholesterol (mislabeled as a bad thing).
Good Versus Bad Cholesterol:
To understand cholesterol we should overlook total cholesterol and instead look at the breakdowns. HDL is “good” and LDL is “bad” and now we can get those values as separate measurements.
HDL levels are considered very good indicators of cardiovascular risk. High HDL is protective and low HDL has a strong correlation with coronary heart disease.
The more complex LDL value is not actually measured, but calculated, from three other meausred values: total cholesterol, HDL, and triglycerides, by an equation known as the Friedewald equation. Calculated LDL is often 20-50% inaccurate. It can be higher, it can be lower, but you or your doctor can’t tell which just by looking at the calculated LDL.
Calculated LDL is increasingly seen as irrelevant. More recent analysis has suggested that the higher LDL cholesterol is the greater the risk for heart disease and many people with low LDL cholesterol can still have substantial risk. Furthermore, not all people with high LDL cholesterol do indeed face increased risk.
New sets of modern testing methods allow for the testing of more specific breakdowns of sub-particles of HDL and LDL that allow a greater degree of insight into what the actual risks are.
My Early Test Results:
When I began to intensively measure & manage my cardiac health, I started off with an LDL of 172, an HDL of 73, and Triglyceride count of 103. The HDL and Triglycerides were good enough but the LDL was bad.
I started to take niacin, B-complex vitamins, red yeast rice, and omega 3 fish oil to improve my LDL. I wanted to try nutritional strategies before resorting to more common drugs.
Four months later, my LDL was 120, HDL 78, Triglycerides 51. More importantly, my ratio of Total Cholesterol to HDL had gone from 3.6 to 2.7 — a very good result.
I decided to stay off prescription medications for the time being.
My Even More Modern Testing Strategy:
Recently I updated my results, but I used a far more modern testing approach to test the specific fractions of my LDL and HDL.
As shown below, it starts out with the standard measures. The LDL is cautionary but balanced by the high HDL which is seen as protective. So far, so good and staying the course.
This test also measures the specific fractions of my lipids and cholesterol.
It turns out that while my aggregate LDL was labeled a cautionary yellow, a deeper dive showed that my LDL fractions were high risk and cause for further action. The main power of the fractions is to actually highlight the dangerous aspects of my LDL when an aggregate score might actually mask what is really going on.
The good news for me was that I have a really favorable set of HDL fractions that are protective against coronary heart disease.
Now that I am aware of the landmines in my lipids, my action items with the new set of numbers has been to increase my niacin from 500 mg to 1,000 mg/day, my omega 3 fish oils upwards to 2,000 mg with a special concentration on EPA, triple my intake of B-complex vitamins, continue with red yeast rice, and lastly take a specialized activated version of folic acid. I plan to re-test in April to assess how my nutritional regimen is working. If I’m still high in bad cholesterol I may add an anti-cholesterol class of drugs known as statins to the mix.
I took all of the above actions working with my doctor, and a pharmacist/nutritionist.
With the caveat that I am not a doctor, just an informed consumer, a couple of observations:
- Total cholesterol is irrelevant as a measure and should be ignored.
- Calculated LDL cholesterol is fading as a measure in favor of more accurate approaches like measured LDL, apoprotein B, and LDL particle numbers and sizes.
- HDL and triglycerides are valuable measures that yield huge amounts of information about your eating habits, genetics, and future potential for heart disease.
- Markers indicative of systemic inflammation and high risk like homocysteine, CRP, MPO, Lp-PLA2, and Fibrogen will be increasingly considered as part of the equation of cardiovascular health.