Why and How to Test Cholesterol Particle Size

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

In 2016, I learned that one of my top recommended heart tests—the VAP test for cholesterol particle size—was discontinued. The VAP was the first of a new generation of cholesterol tests that I began recommending over a decade ago. Fortunately, there are other cholesterol particle size tests that can shed light on your particular cholesterol subtype situation:

Any of these tests are good options for getting a more detailed look at the various types of cholesterol particles in your blood, and a more accurate picture of your cardiovascular risk.

Why Measure Cholesterol Particle Size?

As I often note, and documented in my book The Great Cholesterol Myth, focusing on the total amount of cholesterol in your blood—particularly the amount of LDL cholesterol—has gone the way of dinosaurs. A more current and effective way to manage your heart health is to have a cholesterol fractionation test (also sometimes called a cholesterol particle size test).

Cholesterol “fractions” are the subtypes of LDL and HDL; some are benign, and some are inflammatory and can raise cardiovascular risk. For example, LDL comes in two different sized particles: large and small. The large particles are buoyant and mostly harmless. The small particles, however, are considerably more risky.

Knowing which size cholesterol particles make up the majority of your LDL can help you and your doctor better identify and manage your overall risk for cardiovascular disease. The old-school tests would have only shown how much LDL was circulating in your blood. Too much, and you probably would have been prescribed a statin drug. But with the additional information about particle size, medication can be prescribed to those who genuinely need it and avoided by those who don’t.

Triglyceride-HDL Ratio Is the New Benchmark for Assessing Health

While we’re talking cholesterol, I want to remind you that the old rules for determining cardiovascular risk by looking at ratios of LDL to HDL, or HDL to total cholesterol, are also outdated.

The new benchmark ratio is triglycerides to HDL cholesterol. A study published in the journal Circulation found that people who had the highest triglyceride-to-HDL cholesterol ratios were 16 times more likely to develop heart disease than those with the lowest ratios.

What Are Triglycerides?

The ideal triglyceride-to-HDL ratio, in my opinion, is 2:1 or less. So if your triglycerides are 100 mg/dL, for example, you want your HDL cholesterol to be at least 50 mg/dL.

The top-end limit for me is 5:1 (for example, triglycerides = 250 mg/dL, HDL = 50 mg/dL). I really don’t like to see numbers exceed this because the risk becomes too great. Fortunately, there are several effective ways to lower triglycerides and raise HDL without prescription medication.

5 More Rules for Cholesterol Management

Finally, when measuring and evaluating your blood lipid results, bear in mind these rules:

1. Total cholesterol is irrelevant unless it exceeds 400 mg/dL.

While I never recommend treating total cholesterol simply for the sake of keeping it low, I do take note of it when levels rise higher than 400. At that level, the wax-like consistency of cholesterol can begin to thicken the blood, raising the risk that a clot will form. You should certainly step up efforts to lower your cholesterol if you receive a result like this. Losing weight and adding more fiber to your diet are two good places to start. In extreme cases, pharmaceutical intervention may also be necessary.

2. Cholesterol can be too low.

You’d never know it from listening to many conventional physicians, but low cholesterol levels can be even more problematic than high ones—which is why you should be wary of doctors who constantly push their patients to reduce their LDL levels. Cholesterol plays a vital role in brain health, immune health, the production of vitamin D and various hormones, and the body’s ability to preserve and repair cellular membranes. Without enough of it, you may experience memory problems and be more likely to suffer a hemorrhagic stroke, more susceptible to gastrointestinal issues, and more prone to infectious disease.

3. Cholesterol is only dangerous when it’s oxidized.

Oxidation can occur when cholesterol molecules come into contact with free radicals, toxins, and other inflammatory particles in the blood. Once oxidized, cholesterol particles can then damage the delicate endothelial lining of arteries. This is one reason why it’s so important to consistently eat an anti-inflammatory diet, keep stress levels low, avoid known toxins, and supplement with additional antioxidant support.

Clearing Up Cholesterol Confusion

4. Small-pattern LDL particles are more inflammatory than large ones.

As I noted, cholesterol particle size is much important than how much LDL cholesterol you have. If your test results show the majority of your particles are the small undesirable kind, then healthy lifestyle choices are non-negotiable. You must do everything in your power to offset the inflammation they can cause! People who have predominantly small LDL cholesterol particles also need to be more diligent about getting regular blood tests to monitor their levels.

5. Lp(a) is the most dangerous cholesterol particle of the bunch.

A form of LDL cholesterol, Lp(a) is the most inflammatory of all cholesterol particles. If your cholesterol fractions show that your Lp(a) level is higher than normal, then your overall risk for heart disease is higher than normal, too. Unfortunately, Lp(a) levels are closely tied to heredity, and there aren’t any prescription medications that can effectively address them. The best option is to offset the inflammatory nature of Lp(a) with a healthy diet; grounding; and nutritional supplements such as niacin, omega-3 oils, and nattokinase or lumbrokinase (Bolouke).

Most of all, remember that cholesterol is not the cause of heart disease. You will always find cholesterol where arterial damage and blockages occur, because the body uses cholesterol to repair the harm. The true culprit is the inflammatory agent that caused the damage in the first place.

Additional Reference:                                                                                              

© Stephen Sinatra, MD. All rights reserved.

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