If you’re sitting in a doctor’s office and hearing words like “lipoprotein (a)” or “familial hypercholesterolemia” and feeling completely lost, you’re not alone. These terms can be confusing, but managing your cholesterol can actually be quite simple.
Tryon Medical Partners cardiology specialist Dr. Thompson is here to save the day, sharing all about cholesterol, including target levels, risk factors, and strategies for maintaining healthy numbers. Understanding cholesterol, including emerging risk factors like lipoprotein (a), is crucial for assessing and reducing your risk of heart disease and stroke.
What is cholesterol?
Dr. Thompson describes cholesterol as a type of fat that circulates in our bloodstream. It is a product of both our dietary intake and our genetic ability to metabolize what we eat. For some individuals, cholesterol levels are entirely dependent on their diet; if they maintain a perfect eating regimen (a nutrient-rich, whole-food diet with moderate fat intake), their cholesterol levels will remain low. However, for others, even with impeccable dietary habits, they may still experience high cholesterol due to their genetics.
In terms of cholesterol numbers you should be aiming for:
- Total cholesterol – Less than 170 mg/dL
- LDL (“bad” cholesterol) – Less than 110 mg/dL
- HDL (“good” cholesterol) – 35 mg/dL or higher
- Triglycerides – Less than 150 mg/dL
“You can think of cholesterol as the substance that can potentially clog up our blood vessels and arteries,” Dr. Thomspon explains. “Over time, it can accumulate on artery walls, forming plaque. This buildup of plaque can lead to serious cardiac events.”
To combat high cholesterol, statins are often prescribed. These medications work by lowering the amount of fat circulating in the bloodstream and also by creating a protective seal over existing plaque, effectively hiding it from the body’s immune response.
What is LDL particle count?
In certain cases, your health care clinician may find it helpful to order a LDL and/or HDL particle count test.
LDL particle count: LDL (low-density lipoprotein) particle count measures the number of LDL particles circulating in your bloodstream. A higher number of LDL particles generally indicates a higher risk for heart disease, even if the total LDL cholesterol level is normal.
Dr. Thompson shares some key points about LDL particle count:
- Unlike standard LDL cholesterol tests that measure the amount of cholesterol within LDL particles, this test quantifies the actual number of particles.
- It’s particularly useful for people with diabetes, metabolic syndrome, or a family history of early heart disease.
- The test can differentiate between large, buoyant LDL particles and small, dense ones. The small, dense particles are considered more harmful as they can more easily penetrate artery walls.
HDL particle count: HDL (high-density lipoprotein) particle count measures the number of HDL particles in your blood. A higher number of HDL particles is generally associated with better cardiovascular health.
Dr. Thompson provides some key facts about HDL particle count:
- Like with LDL, this test goes beyond measuring just the amount of cholesterol within HDL particles.
- HDL particles vary in size and functionality. Larger HDL particles are typically more effective at removing cholesterol from arteries.
- This measurement can be especially useful in cases where HDL cholesterol levels are normal, but cardiovascular risk remains elevated.
“Both LDL and HDL particle counts are typically measured using advanced techniques like nuclear magnetic resonance (NMR) spectroscopy,” Dr. Thompson explains. “These tests offer a more nuanced view of cholesterol-related cardiovascular risk than standard lipid panels.”
What are lipoprotein (a) and apolipoprotein B? How do they relate to cholesterol?
Lipoprotein (a) and apolipoprotein B are different types of cholesterol-related particles that clinicians can now measure thanks to advancements in medical technology. While most people are familiar with LDL, HDL, and triglycerides, these newer markers provide additional insight into cardiovascular health.
During years of studying cholesterol panels, researchers have established that high LDL and low HDL levels increase the risk of heart attacks. However, the scientific community has discovered other factors that contribute to cardiovascular risk. For instance, even when LDL levels don’t appear particularly concerning, certain inflammatory particles, such as lipoprotein (a) and apolipoprotein B in the body can still elevate the risk of heart attacks.
“Unfortunately, there aren’t medications yet that specifically target lipoprotein (a) or apolipoprotein B levels,” Dr. Thompson clarifies. “Nevertheless, elevated levels of these particles serve as important indicators for healthcare clinicians, like me, signaling that a patient may be at higher risk for cardiovascular events.”
What is familial hypercholesterolemia? What does it have to do with cholesterol?
Familial hypercholesterolemia (FH) is a significant genetic condition that affects how the body metabolizes cholesterol. It represents an error in metabolism, resulting in naturally high LDL levels, typically exceeding 200 mg/dL, regardless of dietary habits. This condition is caused by a change in DNA that alters how the body processes cholesterol.
“Individuals with FH face a significantly elevated risk of heart attacks and strokes,” Dr. Thompson warns. “As it’s a congenital condition, it requires treatment with medication to manage effectively.”
What about coronary calcium scoring? How does it work and what does the scoring mean?
Coronary calcium scoring is a calcium test for heart disease used to assess cardiovascular risk. The test often causes anxiety among patients who may misinterpret the results, mistaking minor findings for immediate health threats.
This scoring system was developed as part of efforts to reduce heart attack incidence. Initially, statins were widely prescribed, but concerns about side effects led to a more targeted approach. Coronary calcium scoring helps determine who might benefit most from cholesterol-lowering medications.
The test involves a low-dose CT scan without contrast, which can detect and quantify calcium deposits in the coronary arteries. Calcium appears bright white on these scans. By following patients over a decade, researchers have established risk categories based on the calcium scores:
- A score of 0 indicates a 0.0% chance of heart attack or stroke over the next 10 years.
- Scores between 0-100 still represent a very low risk.
- Scores of 100-400 indicate intermediate risk, warranting a discussion about treatment options.
- Scores over 400 suggest a high enough risk to justify cholesterol medication, with the goal of lowering LDL to 70 mg/dL or below.
It’s important to note that this test is only approved for patients aged 40-75, as younger individuals may have non-calcified plaque, and those over 75 are likely to have some degree of calcification due to age. The results are compared across gender and age groups for context.
Crucially, the amount of calcium detected does not directly indicate the extent of artery blockage. Interpretation of these scores should be done by experienced clinicians, and patients should discuss their results with their doctors to understand the implications fully.
“No one treatment works for everyone,” Dr. Thompson notes. “While many people can manage their cholesterol through diet and exercise, others may require medication. Statins remain a common treatment, but newer options like PCSK9 inhibitors are now available, offering powerful cholesterol-lowering effects through injectable medications.”
If this cholesterol breakdown prompted a few more questions, use MedChat or call Tryon Medical Partners to meet with your trusted clinician today.