You Need This Test If You Have High Cholesterol
It’s likely that you’ve had your cholesterol levels checked by your doctor and continue to do so on a regular basis. If you haven’t, I highly recommend that you do so, but with at least one addition to the standard lipid panel!
A standard lipid panel consists of the following (recommended levels according to the American Heart Association) included:
- Total cholesterol: below 200 mg/dL
- High-density lipoprotein cholesterol (HDL or HDL-C): above 60 mg/dL
- Low-density lipoprotein cholesterol (LDL or LDL-C): below 100 mg/dL (for those with diabetes: below 70 mg/dL)
- Triglycerides: below 150 mg/dL.
Many people rely on these numbers to assess their risk for heart disease, so much so that many can rattle off their numbers without a second thought. HDL has become colloquially known as the “good” cholesterol, while LDL has been coined the “bad” cholesterol.
While this is generally true, there is more to the story! There is an additional marker that you should be aware of that has been shown to be a much better predictor of your risk of heart disease, yet most doctors don’t order it unless you ask.
That Marker Is Called LDL-P!
LDL-P (which stands for LDL particle number) measures the actual number of LDL particles circulating in your bloodstream. This differs from LDL-C (often simply referred to as LDL on your bloodwork), which estimates the total amount of cholesterol within the LDL molecules.
As a reminder, LDL molecules are the lipoproteins that carry and transport cholesterol. You can have varying amounts of cholesterol within a single LDL molecule.
In other words, LDL-C tells you the estimated amount of cholesterol, but it does not tell you how many LDL particles it is taking to carry that cholesterol, which turns out to be what matters more in terms of predicting heart disease risk.
Why Knowing Your LDL-P Number Is So Important…
While LDL-P is not the only predictor of heart disease, according to research, we do know that it is more strongly associated with risk of cardiovascular disease and atherosclerosis than LDL cholesterol. Additional research also showed that “LDL-P was related more strongly to future [cardiovascular disease] in both sexes than LDL-C or non-HDL-C.”
According to Dr. Chris Kresser and the Journal of Clinical Lipidology, “patients with high LDL cholesterol (LDL-C) and low LDL particle number (LDL-P) are not at high risk of heart disease.” In other words, knowing your LDL number may not be enough to assess your risk! Knowing your LDL-P number in addition to your LDL can help you glean more insight as to your true risk for cardiovascular disease.
According to Labcorp, LDL-P should be under 1000 nmol/L, and is considered very high if above 2000nmol/L. These numbers are based on the Multi-Ethnic Study of Atherosclerosis (MESA).
What Contributes to High LDL-P?
According to Dr. Chris Kresser (read his 4 part series for lots more info!), the following are some of the top contributors to undesirably high LDL-P levels:
- insulin resistance
- poor thyroid function
- bacterial or viral infections
- increased intestinal permeability (“leaky gut”)
If you are struggling with any of these contributing factors, check out my 12 Weeks to Well program where I can help you rebalance these underlying issues.
What to Do Next…
If you have never seen a marker for LDL-P on your bloodwork, you should consider asking your doctor to test for it. Another option is to order an NMR LipoProfile® Blood Test yourself through a website such as Life Extension.
Knowing your LDL-P can help you and your doctor decide if a statin is right for you. While statins are generally considered safe, taking a statin to lower cholesterol in someone who doesn’t actually have a high risk for heart disease can potentially do much more harm than good.
Knowing your LDL-P number can help you and your doctor make a more informed decision in regard to treatment and lifestyle changes.
Let’s Have a Conversation:
Have you ever heard of LDL-P? Have you ever had your LDL-P tested? Do you have high cholesterol? Do you take a statin to manage your cholesterol? What lifestyle changes have you made and did they improve your cholesterol numbers?
Tags Medical Conditions
I never heard of the lipid P thank you so much for this information I will be asking my Dr. for this test the next time .I just had my cholesterol checked My HDL is 5 points below the average & my tryglyverides is 46 points over my cholesterol is real good
I’m glad you found the article helpful, Judy!
I have had genetically high cholesterol my entire life. My total cholesterol is 290 down from 328 the previous year. I tried a statin and felt awful. I cleaned up my diet and started supplements that help to lower cholesterol and started walking daily. I have done a lot of research on cholesterol and the fact is there is a minuscule difference in cardiovascular events for people with high cholesterol and those with normal numbers. The risk increased for people with high cholesterol who also had high blood pressure, diabetes, etc. I’m just trying to lower my cholesterol with lifestyle little by little but I will not go on a medication for it ever again.
Thanks for sharing your experience Kim! I am so glad that you have found lifestyle changes that work for you and have been able to improve your numbers.
Very good information as my Dr. wants me to take statins which gave me severe pain once. My cholesterol is very borderline
If it’s just borderline, I would not take a statin.
Also keep in mind that when on a statin, you have to have blood tests to check your liver every 3-4 months. Statins can cause type 2 diabetes. When I was on statins, I was consistently pre-diabetic. My blood glucose and A1c are now normal. If you are on a statin, you also must supplement with COQ10 as the statins deplete those levels and we don’t get enough through our diet. It’s much more involved than just taking a pill.
Hi Paula! Get as much information as you can so that you are well informed, but ultimately make sure you have a conversation with your doctor to figure out what is best for you :) If you are willing to make lifestyle changes to see if your numbers improve, make sure your doctor knows that!
I have had high cholesterol since my 20’s and tried Statins once in my 50’s. The drug left me lame on crutches for several months. I will not go on them again. I have never heard of LDL-P but have heard that the size of your cholesterol indicating whether it is ‘fluffy’ or not indicates less risk of heart disease because the larger particles don’t stick. It therefore makes sense that if your LDL-P score is higher it is carrying more small particles that stick forming plaaue.
Am I on the right track here? My Dr wanted to do a calcium MRI to see if I had plaque buildup but I have declined it for now. This may be the best next step in my diagnostic journey.
Thank you for the informative article.
I had high cholesteral and I too could not find a statin I could tolerate. I recommend you do the calcium test. I did and had it done twice over a couple of years which showed an increase from the first test to the second. Per my insurance, that increase in calcium qualified me for Rapatha and/or Praluent which is an easy pen injection I do myself every 2 weeks. I started on Rapatha then after a while my doctor switched me to Praluent. I don’t remember why. I had zero problems on both of them and they work! So easy!
I highly recommend the calcium MRI test. I am a very healthy, active 63 year old and have had high cholesterol my entire life — even with healthy eating and exercise. I refuse statins. Had a calcium scan done and my levels showed ZERO plaque build up! My doctor was shocked that someone my age had such a good scan. Some people just naturally have more cholesterol in their bodies and it’s not always bad.
ME TOO! I had never heard of the test (I think its relatively new). A very sharp nurse practitioner suggested it, even though insurance wouldn’t cover it. It was 95.00 at the cardiologist’s office.
I have also had chronic high-ish cholesterol numbers for decades. My calcium score was zero. This can now factor in the jumbles of numbers that they put together to come up with a risk factor. The calcium score made a huge difference in my overall risk. No drugs.
However, still need exercise, weights, etc. to be strong and mobile.
I have high cholesterol genetically. I did the CT Calcium Scoring Test and it showed only a minimal amount of plaque. Medicare does not cover it but it only costs $75. so I paid out of pocket for piece of mind.
I wonder if the cardio lipid panel has that test included? I just did that one and will have to check. It has others that the regular lipid panel doesn’t include.