For quite awhile now, I've been encouraging you to look at more than just your standard cholesterol panel to assess your risk for heart disease. I'm going to share the findings of an expert panel that supports this need.
In the Journal of Clinical Lipidology a panel of specialists concluded that patients considered at intermediate risk for heart disease be tested for C-reactive protein. It's likely this applies to a majority of the U.S. population since overweight and obesity is rampant. Family history, diet, exercise, and tobacco use also factor into determining if you are at intermediate risk.
Just evaluating total cholesterol, LDL cholesterol, and HDL cholesterol does not work well for predicting heart attack and stroke risk, especially for patients with metabolic syndrome or diabetes. It's even more difficult to evaluate risk if a patient is using cholesterol lowering statin medications.
C-Reactive protein is a marker for inflammation and is associated with plaque build up in blood vessel walls. The plaque build up in coronary arteries leads to narrow arteries, which can cause chest pain. If these arteries rupture you are dealing with a heart attack or stroke.
Studies, such as the Women's Health Study, have found C-reactive protein to be a better predictor of heart attacks compared to LDL cholesterol, HDL cholesterol, total cholesterol, or the cholesterol ratios.
The panel of specialists I initially referenced above, also indicated it'd be reasonable to include blood tests measuring LDL particle sizes, not just LDL cholesterol levels. LDL particles carry cholesterol to blood vessels, but different LDL particles carry different levels of cholesterol.
The type of LDL particles influences risk, such as high levels of small, dense LDL particles is associated with increased risk. Even if your LDL cholesterol number is within normal limits, you may still have high levels of unhealthy LDL particles.
The panel goes on to say individuals with high levels of LDL particles may be good candidates for statin lowering medication. I wouldn't necessarily recommend you turn to medication first. Medication comes with it's own list of pros/cons. Your first line of defense should be diet and lifestyle changes to bring levels within desired limits.
What should you do?
I recommend discussing a more comprehensive lipid profile with your doctor at your next appointment. Maybe you can establish a plan that includes routine cholesterol screenings combined with periodic more "in-depth" assessments (i.e. comprehensive lipid profiles).
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