Understanding Lipidology
(Long, yes, but easy read)
Yes, diet is a significant factor that can increase or decrease cholesterol and triglyceride in your blood – and since coronary heart disease is one of the leading causes of death in the world, many of us routinely get our lipid panel checked periodically. While some of the lab slips reach the doctor’s table, the rest of them that are self-assessed turn to dust.
To know more about your metabolic health it’s important to understand the four main elements in your cholesterol panel and what each one of them represent so that you pick up the subtle cues and don’t miss out on the early warning signs, if any.
Total Cholesterol
After the advancement in lipidology, this measurement is no longer considered a specific lipid marker to accurately evaluate a cardiovascular risk.
LDL Cholesterol
The second measurement is the “LDL-C” (bad one) with a risk ratio of 1:3 – that is, you have a 30% risk of having a heart attack when your levels are high. The medical profession places way too much significance on this test – only because we have a drug (statins) for it.
However, the ldl-c test has an inbuilt flaw. Because, when you measure your ldl you actually measure two kinds of ldls in one reading. One is the ‘small dense’ ldl particle (bad), and the other is the ‘large buoyant’ ldl particle (considered as cardiovascular-neutral). Interestingly, the bad one only accounts for 20% of the total ldl measured in the lab test. The remaining 80% is all neutral.
So if you have high ldl-c, how can you tell which one of the two is high – and which matters the most? And that’s what your doctor doesn’t know. For that, you need a special test – the “Particle Test” (LDL/P) which will accurately tell you if the ‘small dense’ ldl particles are dominant or not. This is a difficult test to perform and so it’s overlooked.
Triglycerides (TG)
That brings us to the 3rd piece of information in your lipid panel. When you measure TG in a fasting state you are actually looking at how your liver handles the carbohydrate (mainly sugar) in your diet. The liver turns sugar into fat and packages it as TG and VLDLs (very low density lipoproteins). These vldls offload in various tissues in the body and become the ‘small dense’ ldl particle (bad one) which are known to form plaque and blockages within the arteries.
Therefore triglyceride, as a marker, is much more indicative of a risk for heart attack than the ldl-c is. High TG has a risk ratio of 1.8 – that is, you have 80% risk of having a heart attack if you have a high number. Although this test is considered more relevant than ldl-c, it is neglected because we didn’t have a TG lowering drug (fibrates) until very recently.
HDL Cholesterol (good cholesterol)
The 4th piece of the puzzle is the HDL-C which is mostly protein based rather than lipid based. Studies have shown that higher the number, better is the recycling capability and therefore, lower the risk of heart disease. HDL carries excess cholesterol (small dense vlds) from the body’s tissues back to the liver (recycling) where it is broken down and removed. That’s why it’s called “good cholesterol”.
Triglyceride to HDL Ratio.
The last and the single most important lipid marker is the ratio between the two – TG divided by HDL. If you have a ratio of 1.5 or less you are good to go, and if you have a ratio of 2.5 or greater, then you have a problem – an analogy between Bad vs Good, and its final outcome.
That said, these molecules are the evolution of each other and by understanding what each one of these species are… you can look at the lab report and figure out what’s going wrong where.
Zareer Patell
