I recently got my lipids tested. Unfortunately I do not have access to detailed subfraction tests so I was only able to get the high level numbers.
I’ve been low-carbing for quite a while now. I’ve generally had good cholesterol figures so this would be telling for the increased consumption of fat in my diet.
The results, however, were a bit confusing:
Total cholesterol
LDL
HDL
Triglycerides
229 – high
154
64
54 – low
My total cholesterol number has climbed significantly over the past 2 years (it was ~170 before) which is a concern. However the low triglycerides with the high cholesterol figure gives contradictory risk indications for heart disease.
Now I’m aware that not all LDL are created equal but I wanted some definitive advice on this point (it wasn’t coming from my doctor who didn’t even remark on the triglyceride number).
In my searching, I found this interesting and succinct comment on the subject here which I am reprinting as it addresses my question directly:
LDL cholesterol can be broken down into two kinds, pattern A and pattern B. LDL pattern A is large fluffy particles that are less dense than pattern B and not easily oxidized. LDL pattern A is essentially benign with respect to heart disease. LDL pattern B on the other hand is small dense particles that are easily oxidized and more closely associated with heart disease. It has been theorized that the harm to the arteries is associated with oxidized cholesterol. Ok, enough about that. To summarize, LDL pattern B (think small dense BBs) is bad, LDL pattern A (light and fluffy) is not a problem.
Now you would think that the lab actually measured your LDL, but they likely didn’t. Most labs just calculate LDL from the following equation:
LDL = Total Cholesterol – HDL – triglycerides/5
So from this, you don’t know if you are predominately LDL pattern A (no big deal) or predominately LDL pattern B (much more risk). Some labs do have the capability to measure the LDL gradient and can determine your predominate LDL pattern type. However, there is another way. Studies have shown that there is a strong correlation between a low triglyceride/high HDL level and LDL pattern A (the non risky kind), and conversely, a high triglyceride/low HDL level is strongly associated with LDL pattern B (the harmful kind). This is one reason that high triglycerides alone are an independent risk factor for heart diease.
Ok, where am I going with this with respect to your situation. Other studies have shown that a high triglyceride/HDL ratio is the best indicator for heart disease risk (approximately 8x better at predicting heart disease risk than high total cholesterol alone). A triglyeride/HDL ratio of 5.0 is moderate risk and the higher the number, the higher the risk, while a ratio of <2.0 is very low risk.
From what I have just described, you can see that with your very low triglyceride level (<100) and moderately high HDL level (>50) you are at very low risk of heart disease. Also, your very low triglyceride level indicates that your LDL is predominately pattern A, the harmless kind. If you are still concerned, you can have your LDL gradient measured to determine your LDL pattern type.
I wouldn’t even remotely consider cholesterol lowering medications without knowing your LDL pattern type to see if there is any risk associated with your lipid levels because there are potential significant side effects (muscle damage, neurological damage, liver damage, even death – i.e. the Baycol recall) associated with many cholesterol lowering medications (statins in particular).
Oh, and I think that your low sugar, lower carbohydrate diet is the way to go to lower your risk of heart disease because of the positive effects it has on triglycerides and HDL.
Alan
Unfortunately the mystery man Alan does not provide any references however this is broadly in line with what I have read elsewhere. My triglyerides/HDL = 1.18 which suggests, according to Alan, that I am very low risk for heart disease.
I will, however, get my LDL gradient tested at the first opportunity.
Related:
- What Your Cholesterol Levels Mean
- Triglycerides: What is normal?
- Triglycerides: Mother of Meddlesome Particles
8 responses so far ↓
kensm // April 15, 2009 at 6:37 am |
I am in a very similar situation with very low triglycerides, high total cholesterol and LDL, high HDL, very good ratios. My doctor wants me on Zocor, and doesn’t much care about anything but the high total and LDL. I’ve read about the subcategories of LDL, and would be interested in whether anybody here has has test results. Next week, I’m going for the Life Line Screening to see what if any damage has been done.
On another note, you should all know that a friend of mine, who has never measured above 190 total cholesterol, went through the screening 5 years ago just to be sure all was well and was found to have 4 times the blockage of a normal person of his age, and this was verified later by his doctor. There are other factors involved, obviously.
missbossy // April 15, 2009 at 10:29 am |
Let us know how the screening goes.
Your friend’s experience underlies the point that cholesterol is a very rough indication of risk of plaque. The key is to find out the small LDL particle number.
This is exactly your friend’s story in a nutshell…
Why average cholesterol values can be so bad: http://ow.ly/2Tni
missbossy // April 20, 2009 at 12:31 pm |
By the way, Dr. Davis JUST did a post on this very same phenomenon…
http://ow.ly/3ij3
My fish oils give me a total of 1680 mg EPA and DHA per day, and my vitamin D levels since last year have varied between 50 ng/ml and 80 ng/ml. However, my lipid profile is not like either John’s or Sam’s:
LDL cholesterol 154 mg/dl
HDL cholesterol 93 mg/dl
Triglycerides 36 mg/dl
Total cholesterol 255 mg/dl
My cardiologist and endocrinologist are happy with my profile because they say the ratios are good, no one is asking me to take a statin. My calcium score is 0.
Ian Shaw // May 10, 2009 at 6:29 am |
I’m pretty sure that low triglycerides and high HDL are the God gene. I’m a 57 yr old male with 185 TC
76 HDL
103.5 LDL
29.3 Triglycerides
BP 106/60
resting pulse 48
This is similar to my entire family. My maternal grandfather died at 104, my maternal grandmother died at 92, my paternal grandfather died at 94 and my paternal grandmother died at 101. Both parents are alive and healthy at 87.
Raven // July 17, 2009 at 1:00 pm |
Cheap Labs use something I call it the Phizer Formula.
LDL = (Total Cholesteral) – (HDL) – (triglycerides * .2)
It pretty much ensures that anyone who eats their fish and vegetables and exercises and has a doctor that doesn’t read medical journals once a decade gets put on a statin drug
Explanation:
LDL is expensive to determine. But total cholesterol is easy and so is HDL. HDL is fluffy and stuff, so it’s easier to separate out. Anyway for the OP:
LDL = (Total Cholesterol) – (HDL) – (triglycerides * .2)
in your case that’s
229 – 64 – 11 = 154! surprise
If you wanted to decrease your LDL and thus total cholesteral, you could simply raise your triglycerides. Lets say your triglycerides were 200. Then:
229 – 64 – 40 = 125! Much better! You should work your triglycerides up to 400.
It is Phizers chewbaca defense. In order to lower your cholesterol, you must increase your triglycerides. It makes no sense. So why not just accept the $100 a month statin your doctor is pushing on you? Pharmaceuticals helped pay for his school, show some sensitivity you insensitive clod.
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missbossy // November 20, 2009 at 10:45 am |
OK here’s my follow up test (Nov’09):
LDL 144
HDL 67
Tri 39
Tot 218
Positive trends. I’m happy with this.