Is it time to retire cholesterol tests?

The next time you go in for a medical checkup, your doctor will probably make a mistake that could endanger your life, contends cardiologist Allan Sniderman of McGill University in Montreal, Canada. Most physicians order what he considers the wrong test to gauge heart disease risk: a standard cholesterol readout, which may indicate levels of low-density lipoprotein (LDL) or non-high density lipoprotein (non-HDL) cholesterol. What they should request instead, Sniderman argues, is an inexpensive assay for a blood protein known as apolipoprotein B (apoB).

 Measuring cardiovascular disease risk and the importance of apoB

Millions of Americans schedule an annual physical health examination. During their visit, many can expect to get their blood drawn for a standard lipid panel, which ultimately provides the patient with a readout of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TGs). What virtually nobody among them will get is an apolipoprotein B (apoB) test. Yet this is considered the ideal, if not essential, measurement to assess lipoprotein-related atherosclerotic cardiovascular disease (ASCVD) risk

Apolipoprotein B (apoB)

Several studies have shown that apoB may be a better predictor of cardiovascular disease risk than LDL-C.

Lipoprotein(a)

Those with a family history of early heart disease not only need to get tested for the usual risk factors of high cholesterol, high blood pressure, diabetes and smoking but also must make sure they know if their Lp(a) is high and get their children tested as well.

VLDL – The Role of Triglyceride-Rich Lipoproteins and Remnant Cholesterol

Lipoproteins are important biochemical substances whose main purpose is to carry lipids from one tissue to another. VLDL is produced by liver cells and is an important carrier of triglycerides (TGs) and to a lesser extent cholesterol. Once in the circulation, VLDL is broken down in capillary beds by an enzyme called lipoprotein lipase, releasing lipids, mainly TGs, for energy utilization by cells or storage in adipose tissue.

HDL, LDL, WTF: Cholesterol?

No, this is not the new “must know” texting lingo; it’s the response I get from many of my patients who struggle with hyperlipidemia. Dealing with an abnormally high concentration of fats or lipids in the blood can be frightening and perplexing — just what do those numbers mean and why do they matter? Well, let’s start with the basics

Triglycerides

Yes, cholesterol is important, but there's another fat—triglycerides—you need to keep tabs on - Arthur Agatston

What is the difference between LDL and VLDL?

LDL and VLDL are both "lipoprotein packages" in your blood. Both are considered "bad" types of cholesterol. They differ in what each package carries. LDL cholesterol carries mostly cholesterol, some protein, and minimal triglycerides throughout your circulation. LDL should be less than 130 mg/dl, and ideally less than 100 mg/dl. VLDL cholesterol contains minimal protein and mainly transports triglycerides. VLDL should be less than 40 mg/dL.

Cholesterol Conundrum

Changing HDL and LDL levels does not always alter heart disease or stroke risk.

Making sense of cholesterol tests

The pros and cons of total cholesterol, HDL, LDL, and triglyceride testing.

The Sneakiest Heart Risk

Yes, cholesterol is important, but there's another fat—triglycerides—you need to keep tabs on. Here's how to get it under control.

"Advanced" cholesterol testing: Is it for you?

For most people, there is no advantage to tests that measure cholesterol and triglyceride particle size.

Ask Well: Should You Fast Before a Cholesterol Test?

Current cholesterol testing guidelines in the United States stipulate that fasting before a cholesterol test is “preferred.” But repeated studies have found no clinically significant differences between results from cholesterol tests done on a full stomach and those done after fasting.

Cholesterol levels predict if under-45s will ever have heart disease

A person’s cholesterol levels before the age of 45 can predict their lifetime risk of developing cardiovascular disease. The finding has prompted debate about whether younger people should be recommended preventative measures, such as taking statins.

End the War on Fat

The foundation for the "fat is bad" mantra comes from the following logic: Since saturated fat is known to increase blood levels of "bad" LDL cholesterol, and people with high LDL cholesterol are more likely to develop heart disease, saturated fat must increase heart disease risk. If A equals B and B equals C, then A must equal C. Well, no. With this extrapolation, scientists and policymakers made a grave miscalculation.

Getting Your Cholesterol Checked? Why You Don't Have To Fast

The next time you have blood drawn to check your cholesterol level, you may have a smile on your face. The reason? You don't have to fast overnight and skip breakfast before your blood draw.

Lipids and Coronary Heart Disease

Cardiovascular disease, or coronary heart disease, is the most common cause of morbidity and mortality in the developed world; over the course of this century it will assume this dubious distinction in the developing world as well. Many factors contribute to heart disease, including age, gender, family history, hypertension, and diabetes: hyperlipidemia figures especially prominently as such a risk factor.