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Posted on: August 14, 2019 at 8:16 pm

For many years we have been told that cholesterol screenings are crucial for predicting and determining heart disease, as elevated LDLs can build up in your blood vessels and put you at risk for cardiovascular disease, stroke, and heart attack.

It’s common practice for your doctor to request lab work to determine your low-density lipoprotein (LDL) and triglyceride levels, however these two markers, according to some doctors,  are not enough when it comes to CVD. 

According to a 2017 Minneapolis Heart Institute study published in The Journal of the American Heart Association (JAHA), the majority of heart attacks actually occur in people with normal cholesterol [1]. Does this mean measuring cholesterol is useless? No, but what it seems to indicate is that there are clearly other variables that need to be considered. If your medical doctor is relying only on cholesterol lab work to determine your risk for developing heart disease, they may be missing some valuable information.

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Cholesterol screenings are beneficial, however, cholesterol isn’t always to blame when it comes to heart disease, and not all cholesterol is bad for your health. When it comes to heart health, there are three other important numbers on your lab work, which should be valued as a determinant of your health and well-being.

1. Fasting insulin: Maintaining healthy insulin levels should be an absolute priority. For many years we believed that the hardening of the arteries was only due to high cholesterol levels, however chronically high blood sugar levels also dramatically accelerate atherosclerosis, drive inflammation, and slow blood flow [2][3][5]. 

Controlling your insulin level isn’t always easy, but it is possible. Your fasting insulin results should be 5 or under. This, of course, is particularly important for diabetics. 

In order to maintain healthy levels, regular exercise is key, particularly strength training and moderate aerobic training like walking. It would also be beneficial to follow a diet that is low in refined sugars and flours, focusing on quality proteins and fats, with plenty of fibrous vegetables. Additionally, natural supplements such as milk thistle, fenugreek, Gymnema, ginger, and berberine may also be helpful. Talk to your healthcare practitioner before taking any new supplements or stopping any prescribed medications. 

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Being overweight puts you at risk for both CVD and diabetes, reaching and maintaining a healthy weight is absolutely essential for the prevention of disease and helping to control blood sugar levels [4]. 

2. Inflammation markers: How inflamed are you? Your level of inflammation can predict your short-term risk for a cardiac incidence, these are some of the traditional inflammation markers on your lab work [6]:

  • hsCRP: This measures your C-reactive protein which is produced in the liver when inflammation is present. 
  • GGT: to measure gamma-glutamyl transferase, an indicator of liver dysfunction. 
  • Ferritin: to measure serum ferritin. It’s not clear if elevated serum ferritin causes inflammation or is the result of it. 

There are several other inflammation markers, however, of them, these two are particularly important:

  1. Lp-PLA2: Measures lipoprotein-associated phospholipase A2, an enzyme that seems to play a role in inflammation and promotes atherosclerosis.
  2. MPO: to measure myeloperoxidase, an enzyme that’s released when blood vessels are inflamed.

3. LDL particle number: An LDL particle test is not the same as an LDL cholesterol screening. An LDL particle test will determine the number of LDL particles that you have and evaluates them for their size, density, and electrical charge. Whereas your LDL measurement in a cholesterol screening is more about determining the ratio of your LDL to HDL, triglycerides and total cholesterol [6].

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While your LDL cholesterol can appear as ‘perfect’ in a cholesterol screening when determining your ratio, you should be interested in the number and size of the LDL particles, as these trigger plaque development and increase longer-term risk [6].

If your testing for fasting insulin, inflammation markers, and/or LDL particle test renders abnormal results, a coronary calcium score may be the next step. This CT scan takes pictures of your arteries to determine your level of arterial plaque. This test may predict your 10-year cardiac mortality. If you score a 0 on this test, your arteries have no visible plaque and your heart attack risk is low [7]. 

Book an appointment with your medical doctor or primary care physician to consult about arterial tests. Remember that you have the right to good health, and you’re allowed to request these tests to determine your health.

Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis or treatment and is for information only. Always seek the advice of your physician or another qualified health provider with any questions about your medical condition and/or current medication. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.

  1. Statin Eligibility and Outpatient Care Prior to ST‐Segment Elevation Myocardial Infarction
    https://www.ahajournals.org/doi/10.1161/JAHA.116.005333
  2. How Diabetes Drives Atherosclerosis https://www.sciencedaily.com/releases/2008/03/080313124430.htm
  3. Insulin resistance and cardiovascular disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC380256/
  4. Diabetes and Exercise https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-and-exercise/art-20045697
  5. Association between insulin resistance and the development of cardiovascular disease https://cardiab.biomedcentral.com/articles/10.1186/s12933-018-0762-4
  6. Focus Less on Your Cholesterol Screening and More on These 3 Tests https://www.mdvip.com/about-mdvip/blog/focus-less-your-cholesterol-screening-and-more-these-3-tests
  7. Coronary Calcium Scoring (Heart Scan) https://www.umms.org/ummc/health-services/diagnostic-radiology-nuclear-medicine/divisions-sections/computed-tomography-ct/cardiac-calcium-scoring
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