The standard of lipid testing, a basic cholesterol profile, has become obsolete. Traditionally, this profile consisted of cholesterol, LDL (‘bad’ cholesterol), HDL (‘good’ cholesterol), and triglycerides. Today, advanced lipid profiles are available that measure the particle sizes and numbers of both the good and bad cholesterol. It is possible to have an LDL of, say, 115 and have it be more dangerous than an LDL of 140, all based on the particle distribution.

LDL and HDL cholesterol particles can exist in a broad range of particle sizes. It turns out that the larger the particles are, the less pathogenic (harmful) they will be. The smaller particles are more pathogenic because they tend to exist in larger and more concentrated numbers, are more dense than their larger counterparts, and their small size more easily diffuses into the arterial walls.

There are also isolated, specific particles that are known to be highly athrogenic (cause arteries to become clogged). These include small, dense LDL particles that break into specific subtypes, such as remnant lipoproteins and the type III and IV LDL’s. Lp(a) is another dangerous sub-particle that is not routinely measured, but should be followed in anyone with elevated cholesterol or a family history of heart disease. Elevated levels of these particular subtypes are associated with increased athrogenicity and increased cardiovascular disease risk. By quantifying the presence of these subtypes, we can identify people at higher risk and tailor their treatment to lower the specific subtype.

There are pharmaceuticals that can be used specifically to alter the numbers and ratios of these various particles, and there are certain supplements and vitamins, such as fish oil and niacin, that can have a significant balancing impact. It is important to be aggressive in individuals who have multiple risk factors, especially if their lipid profiling reveals a particularly dangerous type of sub-particle.

An advanced lipid test should be given to anyone who has an elevated cholesterol level, an LDL level over 100, or a known family history of cardiovascular disease. Currently, approximately 40% of deaths in the United States are due to heart disease, and this test is one of the more accurate ways to determine risk.