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Cholesterol Testing: What You Really Need To Know

The common cholesterol panel (aka lipid panel) is a test that is done during routine follow-ups and physicals. Physicians often base treatment decisions on the results of these tests. The idea is that if we lower “bad” cholesterol, we reduce cardiovascular risk.

However, most standard cholesterol testing is not good enough, so it is highly likely that your primary care physician is ordering outdated tests that only give part of the story. The result of this limited data is a greater possibility of prescribing unnecessary statins or other cholesterol-reducing drugs.

The typical standard panel usually consists of these tests:

  • Total cholesterol (this is a calculation using HDL, LDL and a % of triglycerides)
  • LDL aka “bad cholesterol”
  • HDL aka “good cholesterol”
  • Triglycerides (a type of fat in the blood)
  • Total Cholesterol to HDL Ratio

These tests only tell part of the cholesterol story, are not good enough for most patients, and in general do not warrant many statin prescriptions.

We now know that your LDL cholesterol is made up of different components, some of it good, some of it perhaps, not so good. The fact is, there is a heck of a lot more to your cholesterol story than what a standard panel can reveal. We can easily get the full story by running what we call a “fractionated lipid panel”.

The Fractionated Lipid Panel: A More Accurate Measurement Of Cardiovascular Risk

A fractionated lipid panel measures sub-categories of LDL and HDL cholesterol. Sub-categories of LDL include small, dense particles as well as large, buoyant particles. Small dense particles are more prone to imbed into arterial walls where they play a role in plaque formation. The more small particles you have floating around in your bloodstream, the higher your actual risk. Large particles pose less risk, although if you have a high number of them floating around that is not great either. Essentially, in the fractionated lipid panel we ask two questions- What size are your particles? And How many particles do you have floating around? These questions are essential to knowing the reality of your cardiovascular disease risk.

A Wolf in Sheep’s Clothing?

It is common knowledge that up to 50% of people who have had a heart attack have “normal” cholesterol numbers.  This can be prevented by doing accurate testing with a fractionated lipid panel.

In this scenario, people have completely normal LDL cholesterol and are told by their physician that their numbers are good and not to worry. Up to 30% of these people actually have something called cholesterol-depleted LDL, where LDL is viewed on a standard panel as “normal” but when you measure the small particle numbers, they turn out to be very high. These people typically also have high triglycerides and low HDL. This is a wolf in sheep’s clothing because these people are actually at higher risk of cardiovascular disease yet it may actually be missed because their total number was within a standard normal range (usually under 200 mg/dL).

In my clinic, I run a fractionated lipid panel along with inflammatory markers, fasting insulin and fasting glucose as well as an Omega fatty acid check. The Omega Check examines the ratio of Omega-3 to Omega-6 fatty acid ratio in the blood. Using this full Cardiometabolic Panel by SpectraCell, we get a comprehensive look at what your personal cholesterol profile looks like and we can then take into consideration your individual risk factors for disease.

For example, Sally can have a cholesterol number of 125 mg/dL but she may have many small, dense particles floating around. Her physician runs a standard, non-fractionated panel and only sees the basic numbers. The doctor has not measured particle numbers and therefore cannot know Sally’s true risk. Sally is told her cholesterol is “great” and to keep up whatever she is doing. Sally leaves the doctors office not knowing her true risk and assuming all is well.

What Is Your Baseline?

If you are trying out a new dietary or lifestyle approach, you can get a fractionated lipid panel along with the full cardiometabolic panel at baseline and then retest periodically. I usually recommend every 3 months for several cycles. This gives you a great baseline and a more accurate picture of your individualized response to lifestyle and dietary changes as time goes on.

Let’s Do Better, Period.

The fact is, the standard cholesterol panel is outdated and rudimentary. It can lead to unnecessary prescriptions and misguided dietary protocols.  We can do better by running a test that gives a vastly more accurate picture of true and specific risk factors. If your healthcare provider is not up speed on the fractionated lipid panel, please ask them to update their testing policies to reflect a better and more accurate data set. This is your health! They work for you!

We offer fractionated lipid panels in our office. If you want to get a more sophisticated, individualized look at what your cholesterol is actually doing, make an appointment for a lab consultation today! We can run and review labs. If you have an old lab you want to go over, bring it in! If you want to run new, more sophisticated labs we will talk about your goals and order the right panel for you.

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