What does this mean for us when we look at our cholesterol levels?
If you didn’t already know, February was Heart Health Month. I realize I’m a little late, but I wanted to bring you some tips about how to utilize cholesterol (lipid) testing to benefit your cardiovascular health. We’re going to go beyond the basic cholesterol panel, which doesn’t provide enough information to accurately assess our cardiovascular risk, which we generally think of as our risk for heart attack or stroke.
We tend to think of the standard lipid panel as the supreme and all-encompassing test to look at our cardiovascular health, but, of course, things are not that simple. While high cholesterol accounts for approximately for 20% to 30% of coronary artery disease, 50% of hospital admissions for acute coronary syndrome (ACS) have normal cholesterol. According to the American Heart Association, acute coronary syndrome is any heart condition resulting from decreased blood flow to the heart. This means that half of the hospital admissions for ACS do not have high cholesterol.
What does this mean for us when we look at our cholesterol levels? How can we utilize testing cholesterol so that it more accurately reflects cardiovascular risk? We have all been told that LDL is the “bad” cholesterol and that HDL is the “good” cholesterol, right? And we’ve been told that having an appropriate ratio of LDL:HDL is crucial to determining cardiovascular risk.
Well, there’s more to the story. The size and number of our lipid (cholesterol) particles matter more than the LDL:HDL ratio when it comes to cardiovascular health! Larger, “fluffier” LDL particles are less damaging than small, dense LDL particles. The small, dense LDL particles increase our cardiovascular risk because they can burrow into our arteries and become oxidized, causing cardiovascular damage.
Fortunately, it’s very simple to run lab testing for the number and size of our lipid particles. We can do this by using NMR testing or CardioIQ testing. NMR or CardioIQ are both tests that look at lipid particle size. Which test is run (NMR or CardioIQ0) depends on which lab we are using. This more detailed cholesterol panel is, by far, my preferred method of testing cholesterol along with a few other markers.
The other markers I like to assess include Lipoprotein(a), Apolipoprotein B and high sensitivity CRP (c-reactive protein). When we look at an NMR or CardioIQ test in addition to these markers, we get a much broader assessment of a patient’s cardiovascular risk.
Lipoprotein(a), also known as Lp(a), is an LDL-like cholesterol particle with a protein called apo(a) attached to it. Elevations of Lp(a) are associated with up to a five times greater risk of cardiovascular disease! For better or worse, your lipoprotein(a) is inherited but there are lifestyle modifications, medications and natural substances that can help reduce Lp(a).
Apolipoprotein B (ApoB) is another cardiovascular inflammatory marker that, if elevated, can double the risk of cardiovascular disease. ApoB is one of the lipoproteins that transports lipids through our bodies and most of our cells have ApoB receptors so that they can receive cholesterol for important functions. However, at high levels ApoB can indicate arterial plaque buildup, which we know isn’t a healthy process. Again, lifestyle modifications, medications and natural therapeutics can help bring down ApoB levels.
Finally, I want to address high sensitivity c-reactive protein (hsCRP) as a cardiovascular inflammatory marker. If hsCRP is elevated, it can double the risk of cardiovascular disease. However, hsCRP can be a tricky marker! If a person has an infection, an injury or other inflammatory process that’s active in their body, it can falsely elevate hsCRP. A simple conversation with your provider if you have had an infection or injury around the time of testing can take the mystery out of this hsCRP interpretation.
There is another, final, cardiovascular inflammatory marker that I wanted to bring up. I have recently started running a test called Lp-PLA2 for my patients. This marker is found when inflammation is active, including the inflammation in arterial plaques. If elevated, it can increase your risk of cardiovascular disease by at least two times (double) and may increase your risk of stroke by 11 times. That’s huge!
As you can see, utilizing a standard cholesterol panel as a way to assess risk of heart attack or stroke may be inadequate. We really do have a lot of other testing tools available to us so that we can put on a wider lens and assess our cardiovascular risk more accurately. FBN
Amber Belt, ND
Amber Belt, N.D. is a naturopathic physician and co-owner of Aspen Integrative Medical Center where she helps patients get healthy from the inside out. She is also co-owner of Sage Sirona, which focuses on natural first aid and education. Dr. Belt has been practicing naturopathic medicine for more than 15 years and can be contacted via aspenmedcenter.com or sagesirona.com. You can also call her office at 928-213-5828.