Lipids are naturally occurring substances found in your body. Lipids include triglycerides (fats) and cholesterol. Testing for various lipids can help assess your risk of having cardiovascular diseases, including atherosclerosis. Atherosclerosis is characterized by clogged and stiffened arteries and is one of the principal causes of heart disease. Remember: You’re aiming for flexible arteries that are free from blockage. These biomarkers will tell you whether you are at risk of developing atherosclerosis.
The biomarkers to test for cardiovascular health are:
- Total Cholesterol
- LDL-c
- LDL-P
- ApoB
- % sdLDL
- HDL-c
- Triglycerides
Total Cholesterol
Lipoproteins (a word that combines “proteins” with the Greek word for fat, lipos) are spherical particles composed of lipids and proteins. If they weren’t packaged into lipoproteins, lipids, a category that includes fats and cholesterol, couldn’t move freely in the bloodstream. (Lipids and blood, like oil and water, do not mix.) Proteins and other components make up the outer shell of the lipoprotein; cholesterol and fats are packed together inside.
There are two main types of lipoproteins in the blood that transport cholesterol: HDL (high-density lipoprotein) and LDL (low-density lipoprotein). A test for total cholesterol is a measure of the cholesterol carried by HDL as well as LDL particles. Recent research into the role of lipoproteins in atherosclerosis has indicated that cholesterol, in itself, does not cause atherosclerosis. Only when specific lipoproteins become trapped within the arterial wall does cholesterol become a part of the atherosclerotic process. For this reason, your total cholesterol number is not a very good predictor of cardiovascular health. It is, however, a standard test, with the following classifications:
Healthy
While cholesterol levels can vary widely among healthy individuals, total cholesterol levels below 200 mg/dL are considered most desirable.
Borderline
Total cholesterol levels between 200 mg/dL and 240 mg/dL may put people at risk for cardiovascular disease.
High
Total cholesterol levels of 240 mg/dL and higher may put people at high risk for cardiovascular disease.
Low-Density Lipoprotein Cholesterol (LDL-C)
There are two main types of cholesterol-carrying particles found in the bloodstream: high-density lipoprotein (HDL ) and low-density lipoprotein (LDL).
A test for low-density lipoprotein cholesterol (LDL-C) measures the amount of cholesterol being carried within all the low-density lipoprotein particles in your body. The cholesterol carried within LDL particles is often referred to as the "bad" cholesterol. LDL particles can become trapped inside the walls of arteries and contribute to the formation of hard deposits called plaques. Plaques may continue to accumulate until they restrict blood flow. They can also rupture and cause blood clots to form. The clots may break off and travel to other parts of the body, where they can cause heart attack or stroke.
Healthy
LDL levels under 100 mg/dL are considerable optimal, and levels from 100-129 mg/dL are considered relatively low risk.
Borderline
LDL levels from 130-160 mg/dL increase an individual's risk for cardiovascular disease.
High
LDL levels over 160 mg/dL put individuals at high risk for cardiovascular disease. Conditions related to high LDL-C levels include cardiovascular disease, type 2 diabetes, and pregnancy.
Low-Density Lipoprotein Particles (LDL-P)
While the low-density lipoprotein cholesterol (LDL-C) test measures the amount of cholesterol carried by all the low-density lipoprotein particles in your body, the low-density lipoprotein particles (LDL-P) test measures the number of low-density lipoprotein particles in your body. Studies indicate that the risk for atherosclerosis is related more to the number of LDL particles than to the total amount of cholesterol carried by these particles.
In fact, the LDL-P test is very accurate in predicting the risk of cardiovascular disease. A high LDL-P number raises the risk of heart attack.
Numerous studies have shown that it’s very common for LDL-C levels to be low while at the same time the LDL-P number is high. Because LDL-C is far more frequently tested than LDL-P, many people with low LDL-C are under the mistaken impression they are at low risk for heart attack.
How can LDL-C levels be low while LDL-P is high? It's possible because the amount of cholesterol in each LDL particle can vary greatly. An individual may have a large number of LDL particles, each of which contains relatively little cholesterol. That individual's LDL-C levels, when measured, will be low—but the individual's heart disease risk is actually high. Greater numbers of LDL particles in the blood mean greater amounts of LDL enter into arterial walls, resulting in arterial plaques. Plaques lead to atherosclerosis (hardened arteries), heart attack, and stroke.
Healthy
A LDL-P count of under 1200 nmol/L is considerable optimal.
Borderline
If your results fall into this range, you are at greater risk of developing cardiovascular disease in the future. Lifestyle changes, such as controlled diet and exercise, have been shown to reduce LDL-P levels.
High
The greater the number of LDL particles in the bloodstream, the more likely it is that they will enter into arterial walls and create inflammatory conditions, leading to atherosclerotic plaques. Changes in lifestyle and diet, sometimes in conjunction with medication, can lower LDL-P numbers. Conditions related to high levels of LDL particles include metabolic syndrome, type 2 diabetes, hypercholesterolemia, hyperlipidemia, heart disease, atherosclerosis, and stroke.
Apolipoprotein (ApoB)
Certain proteins, along with other materials, make up the outer shell of lipoproteins. Apolipoprotein B (ApoB) is one such protein, and it is found exclusively in low-density lipoprotein (LDL) particles. Each LDL particle contains one ApoB protein. ApoB can therefore serve as a surrogate marker for LDL particle (LDL-P) number, meaning that an LDL particle count can also be done indirectly by counting ApoB. Elevated levels of ApoB signify high LDL-P numbers, a significant predictor of heart disease.
Healthy
There is considerable evidence that levels of ApoB and LDL-P are better indicators of heart disease risk than total cholesterol or LDL-C. An ApoB count of under 80 mg/dL is considerable optimal.
Borderline
If your results fall into this range, you are at greater risk of developing cardiovascular disease in the future.
High
High levels of ApoB can lead to the arterial plaques that create atherosclerosis (hardened arteries). Having a high level of ApoB indicates a high risk of developing atherosclerosis, coronary heart disease, stroke, peripheral vascular disease, hypertension, hyperlipidemia, and metabolic syndrome.
Percent Small Dense Low-Density Lipoprotein (%sdLDL)
Low-density lipoprotein (LDL) particles can sometimes become smaller and denser. These types of LDL particles are called small dense low-density lipoprotein (sdLDL). Because sdLDL particles are small, they can't carry as much cholesterol as their larger LDL counterparts. A greater number of them are necessary to do the job of a few larger ones. The greater the number of LDL particles (of any type) in the bloodstream, the more likely it is that those particles will enter into arterial walls and create inflammatory conditions, leading to atherosclerotic plaques. The sdLDL particles are especially dangerous because they can very easily penetrate into the arterial wall due to their small size. Having a high percentage of LDL as sdLDL is linked with an increased risk for cardiovascular disease.
Healthy
The healthy area on the reference range above indicates the ideal range for %sdLDL.
Borderline
If your results fall into this range, you are at greater risk of developing a large range of diseases, including atherosclerosis, coronary heart disease, and stroke.
High
A high percentage of %sdLDL particles is linked with coronary heart disease. Elevated levels increase the risk of developing coronary heart disease. They also accelerate the progression of existing disease. High levels of %sdLDL particles are usually accompanied by other disorders, including high triglyceride levels, reduced HDL-cholesterol levels, abdominal obesity, insulin resistance, and other forms of metabolic dysfunction. Elevated levels of %sdLDL increase the chances of developing atherosclerosis, coronary heart disease, stroke, peripheral vascular disease, hypertension, hyperlipidemia, and metabolic syndrome.
High-Density Lipoprotein Cholesterol (HDL-C)
High-density lipoprotein (HDL) is one of the two main types of lipoproteins, which transport fats and cholesterol in the bloodstream. (The other type is low-density lipoprotein, or LDL.) The cholesterol carried inside HDL is often referred to as the "good" cholesterol. HDL particles can pick up excess cholesterol from cells and carry it to the liver for disposal. In this way, higher levels of HDL can decrease a person`s risk of developing the artery-clogging plaques of atherosclerosis. Low HDL levels are not treated with medication, though drugs that lower LDL may raise HDL. Lifestyle changes, however, do boost HDL levels. Quitting a smoking habit and exercising regularly are both ways to increase HDL levels.
Low
HDL levels under 40 mg/dL for men and under 50 mg/dL for women are associated with an increased risk of heart disease.
Borderline
HDL levels from 40-50 mg/dL for men, and from 50-60 mg/dL for women, are associated with average risk of heart disease.
Healthy
HDL levels of 60 mg/dL or higher are considered optimal.
Triglycerides
Triglycerides are a large category of fats found in both plants and animals. Our bodies convert excess dietary calories into triglycerides and store them in our fat tissue. Triglycerides can then be released into the bloodstream as needed. Most triglycerides in the blood are packaged and carried in very low-density lipoproteins (VLDL). Smaller quantities are carried in low-density lipoproteins (LDL) and high-density lipoproteins (HDL). Elevated levels of triglycerides in the bloodstream can increase an individual`s risk of developing heart disease.
High triglyceride levels can be lowered a number of ways, including losing weight, eliminating or restricting sugars and refined carbohydrates, limiting alcohol intake, and exercising regularly. If lifestyle changes are not sufficient, medications may be prescribed. Typically the same medications used to lower LDL cholesterol are prescribed to lower triglycerides. These include niacin, statins, omega-3 fatty acid supplements, and fibrate medications such as fenofibrate and gemfibrozil.
Healthy
For adults, triglyceride levels under 150 mg/dL are considered most desirable.
Borderline
Triglycerides levels between 150 and 199 mg/dL are considered borderline.
High
Triglyceride levels between 200 and 499 mg/dL are considered high. Levels over 500 mg/dL are considered very high. Elevated levels of triglycerides can be caused by physical inactivity, obesity, smoking, alcohol abuse, type 2 diabetes, and kidney disease.