What are optimal cholesterol numbers? Doesn’t this contradict the latest theory that cholesterol does NOT cause heart disease. The truth is that it is a “factor” but not the “cause”!
How do we establish what the optimal levels for LDL and HDL are? These are important questions because the idea that cholesterol specifically causes heart disease is so deeply ingrained in the average person (and most doctors as well).
This is a difficult question to answer definitively because the issue is just so complex. I can tell you what some of the guidelines are, and of course they vary from one source to another. There is a generally accepted “optimal range” for cholesterol numbers.
Here are the guidelines issued by the American Heart Association.
|Desirable||Borderline Risk||High Risk|
|Total Cholesterol||200 or less||200-239||240 and over|
|HDL||60 or higher||40-59||40 or less (men)|
|HDL||60 or higher||50-59||50 or less (women)|
|LDL||less than 100||130-159||160-189|
|Triglycerides||less than 150||150-199||200-499|
Keep in mind that these guidelines somewhat reflect the influence of the drug industry and their attempts to increase their market for cholesterol lowering drugs called “statins.”
The recommended cholesterol numbers keep being adjusted downward, in my opinion in order to get doctors to prescribe more statin drugs which of course boots revenues of the drug industry.
In addition, there are other tests which are called “inflammatory markers,” that have a direct bearing on your risk for developing heart disease, and these tests should also be used to more accurately determine what your overall risk of cardiovascular disease is.
Once you know your level of risk based on the latest tests and analysis of particle types, then you can target your lifestyle strategies (exercise, diet, and stress reduction) to protect your heart health. This should always be the end point of ANY testing…a program to address whatever risks the tests have identified.
What really DOES Causes Heart Disease?
Here’s a simplified explanation. Heart disease is caused by inflammation. That is what actually damages the lining of your arteries. As Dr. Stephen Sinatra likes to say “Cholesterol is found at the scene of the crime, but it’s not the perpetrator!”
When arteries are damaged, your body uses LDL to try and repair the damage, kind of like patching holes in a wall. Obviously the LDL did not cause the damage, but gets attached to the artery walls and accumulates eventually clogging the artery. This is called an “occlusion.”
When the LDL particles that stick to your arteries become oxidized and thus inflammatory, the process of arteriosclerosis begins. This is where the small highly inflammatory LDL particles called HP(a) come in.
So again, the cholesterol did not initiate the process of heart disease, but it IS an important factor in the progression of heart disease. With that out of the way, lets move on…
Focus on Particle Size and Type, Not Just Cholesterol Numbers
The real focus should be on the type and particle size NOT just the levels. According to Dr. Stephen Sinatra, an integrative cardiologist who is board certified by the American College of Cardiology, if your LDL particles are large and fluffy then you really don’t need to worry so much about your LDL levels.
However if the LDL’s are small dense highly inflammatory particles, then your risk is greatly elevated. There is a test that measures for these small inflammatory particles (HP(a)), called the Lipoprotein Particle Profile (LPP) test.
The LPP test measures the level of HP(a) which is a small dense LDL particle which is very toxic and inflammatory to the blood, potentially causing your blood to become “hyper-coagulated” which is another word for sticky and more likely to clot.
The takeaway message is that if you have this dangerous inflammatory LDL particle, then obviously the higher your total cholesterol numbers, the more of this dangerous particle you have, and the greater your risk. Simply stated, high levels matter when you have dangerous LDL particles in your blood.
So in closing, optimal cholesterol numbers are totally dependent on particle size and type. If your cholesterol particles are the small dense inflammatory type, then you need to make a greater effort to lower your levels.
If your LDL type is large and non-inflammatory, then your total levels are not something to be overly concerned about. You should take the time to consult with an integrative cardiologist to determine how best to manage your heart health.