“So, what’s my cholesterol looking like, doc?”
As I sit down to chat about the lab results with my patients, that’s one of the first questions they often have. Of course, cholesterol is part of what’s called a lipid panel. And then there are all the specific parts of that panel, and there are more advanced lipid panels that have even more parts to them. Let’s take a quick fly-over look at what they mean and what we do with them — a practical rather than an overly technical view.
First there’s total cholesterol, the sum of the main lipid entities in the blood. It doesn’t mean an awful lot without the rest of the breakdown into so-called “good” and “bad” cholesterol along with triglycerides. HDL (high density lipoprotein) is often called, good cholesterol, because, in general, higher levels of it are associated with better heart outcomes. It has a strong genetic set point, but it can be improved with significant increases in aerobic exercise (like 150 minutes per week getting your heart rate up with brisk walking, biking, mowing (with a walk-behind mower) or whatever your cardio exercise of choice might be), weight loss, and increasing fiber intake, including nuts and seeds.
Next, and considered generally more important to heart health, is the LDL (low density lipoprotein) often called, bad cholesterol, because higher levels of it are associated with increased likelihood of plaque formation on arteries leading to heart attacks and strokes. It is somewhat affected by diet, exercise, and weight, but in most people, about 80% of the level is genetically set. As a rule, we like to see it under 100, and in our folks with known plaque or heart disease, we like to see it down around 50-70. Although diet and exercise are encouraged and can help some, substantial improvement often needs a little help from a cholesterol med (and that’s a whole other conversation).
Before we get too excited about someone’s cholesterol level, we like to get a coronary calcium score and/or a carotid intimal medial thickness test (rather inexpensive, non-invasive looks at the arteries to the heart and brain to see if the cholesterol is actually forming plaque (blockages) or not). If we see the beginnings of plaque, we like to get aggressive with preventing further build-up. Aggressive prevention sure beats aggressive bypasses and stents and cardiac resuscitation later.
The third main number on a standard lipid panel is the triglycerides (TG’s). It is another fatty substance, similar to cholesterol. If it’s too high for too long it is associated with increased heart attack and stroke. Even though it is a fatty substance, it is driven by carbohydrates (carbs), the sugary and starchy parts of our diet. Cardio exercise and a low carb diet can substantially lower TG’s. Ideally, we like to see TG’s below 100.
Beyond a basic lipid panel, there are advanced lipid panels that have numbers like ApoB that is an even better marker for the amount of plaque-forming particles we have in our blood stream, or LPa that is a marker for those who are genetically prone to plaque formation. And the list goes on.
There are lots of tools these days to assess our health, and the lipid panel, along with all the add-ons to it, is a useful one. Of course, the numbers are only helpful if they trigger us toward healthier lifestyles and interventions that help head off trouble before it silently sneaks up on us down the road.