LDL vs. HDL vs. Triglycerides ~ Which of These Tests ACTUALLY Show Heart Disease Risk?
Updated: Mar 24
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 are ACTUALLY going to predict heart disease and which you can skip. Warning: this article is going to dive DEEP into the research and science, so make sure you snuggle up with a hot cup of Keto Coffee and get comfortable... it's time to nerd out on Nutrition!🤓
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.
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 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.
Most doctors do not test for LDL-P as it is more expensive and difficult to test. However it is the only form of LDL that is showing a promising predictive value of heart disease risk, according to research. If you are looking for a real predictive marker of heart disease, ask your doctor about LDL-P testing, not LDL-C.
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.
I'll Keto Coffee cheers to that!☕️🤓
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 MOST predict cardiovascular disease. And from what current research is suggesting, it's NOT LDL-C - which is likely what your doctor is testing you for. Rather, we need to take a closer look at LDL-P (the size of the LDL), HDL, Triglycerides and Insulin.
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Autumn Elle Nutrition