LDL vs. HDL vs. Triglycerides ~ Which of These Tests ACTUALLY Show Heart Disease Risk?

Autumn Bates, CCN, MS, BS, CPT
Jan 17, 2020
4 min read

Updated: Jan 15, 2024

If heart disease runs in your family or you're simply looking to be proactive about your health, you're probably considering a blood test to assess your risk. But before you schedule your appointment, make sure you familiarize yourself with which tests can help to predict heart disease. In this article, I'm sharing the current research on various blood markers so you can discuss with your doctor which test is right for you and your health history.

DISCLAIMER: I am NOT a doctor. What I am about to share with you in this article is from years of clinical application and my own research of current studies. Always speak with your doctor and nutritionist before making dietary changes for your health and wellness goals.

LDL Cholesterol

Low density lipoprotein cholesterol, or as we know it LDL-C, is the most iconic test that we associate with heart disease. An honorable mention would also be "total cholesterol". However, back in the 1980s, total cholesterol amount was found to have no association with heart disease risk. This is where scientists started to focus on the individual cholesterol carriers such as LDL-C. A recent 2018 expert review of the literature found that even our traditional LDL-C test for assessing heart disease risk is not predictive of heart disease.

If your levels of LDL-C were predictive of heart disease, as the authors stated, then this would mean that those with low levels of LDL-C should NOT have heart disease. And yet this is not the case. Those with high, low and "normal" levels of LDL-C are still getting heart disease. And in some studies, those with the lowest amount of LDL-C are at the highest risk. In fact, in a large cohort study with 68,000 elderly people found that those with "the highest level of LDL-C lived even longer than those on statin [cholesterol lowering medication] treatment".

The one predictive factor that is useful when it comes to LDL is a certain type of LDL. This is called LDL particle testing or LDL-P. Within LDL-P, there are small and dense vs. large and fluffy LDL. Ironically, the small and sense LDL particles are the most atherogenic (heart disease indicating). The large and fluffy LDL are NOT associated with heart disease.

QUICK RECAP: Small, dense LDL = increased heart disease risk. Large, fluffy = relatively harmless. LDL-C = not currently shown to be predictive of heart disease.

LDL-C does not differentiate between these two types of LDL, which can be misleading. For example, you can have "high" LDL-C, but if it is entirely made up of the harmless fluffy LDL, then this isn't necessarily a problem. However, you can also have "low" LDL-C and think you are in the clear for heart disease - and yet, the entirety of your LDL-C could be made up of the heart disease associated small and dense particles. This could explain why someone can have low LDL-C and yet still die of a heart attack, while someone with high LDL-C never does.

A lot of doctors aren't currently testing LDL-P, so it could be a good one to ask about and possibly add to your usual testing.

HDL Cholesterol

HDL has strong ties to cardiovascular risks back to the 1950s when heart disease research was in it's infancy. Further studies have found that low levels of HDL is a strong indicator of heart disease risk. To top it off, decreases in HDL is often associated with increases in triglycerides - another important risk factor for heart disease. Studies have found that the combination of low HDL with high triglycerides is a strong predictor of heart disease risk.

QUICK RECAP: Low HDL = increased heart disease risk. High triglycerides = increased heart disease risk.

Pssst - guess what is one of the only foods that significantly raises HDL cholesterol? Saturated fat. Not only does saturated fat increase your HDL cholesterol, which is something that is strongly associated with improved CVD risk, it also has been found (in THIS, THIS and THIS study) to convert the dangerous, small LDL particles into the harmless large and fluffy LDL particles.

Although, there are some genetic variations for how each person responds to saturated fat, so it's important to consider your individual health history as well.

Another tool that has been shown to help raise HDL cholesterol is regular exercise.

ldl vs. hdl vs. triglycerides and heart disease — Click here to get the recipe for your first cup of fat burning Keto Coffee!

The Overlooked Test ~ Insulin

Often times, insulin is only ever viewed in terms of diabetes. However, as research progresses in the field of heart disease, the strong ties between insulin and cardiovascular disease are becoming more and more difficult to ignore. As we discussed in the previous section, low HDL and high triglycerides are strongly linked to heart disease. It turns out that insulin has a big role in this imbalance. As one review stated:

Insulin plays an important role in lipid metabolism, and IR, together with hyperglycemia [high blood sugar], may lead to dyslipidemia [imbalance between HDL and triglycerides] associated with ASCVD [heart disease] in type 2 diabetes.

An important takeaway is to look at the factors that have been shown to predict cardiovascular disease. In addition to the usual blood test markers (total cholesterol, LDL-C, etc), you might want to discuss adding a few additional tests with your doctor as well.