A Cholesterol-Lowering Approach to Food and Exercise

Why You Should Ask For Advanced Lipid Testing

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Controversies in Cardiovascular Medicine is the intriguing title of a 2009 article in the American Heart Association’s Circulation publication.

Stop laughing – cholesterol research can be intriguing!  I’d label the situation frustrating more than intriguing, but here’s what is going on.

The controversy is essentially that advanced lipid testing (explained in Cholesterol Tests Your Doctor Hasn’t Told You About) has been around for 50 years and is a better predictor of cardiovascular disease risk than standard cholesterol blood tests, and yet these ‘advanced’ tests are still not widely prescribed.

In fact, the ‘standard’ cholesterol blood panels (total cholesterol,


ApoB and Cardiovascular Risk

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In Cholesterol Tests Your Doctor Hasn’t Told You About, I briefly describe a cholesterol blood test for Apolipoprotein B (ApoB).  This simple blood test measures the number and size of LDL (bad) cholesterol: it’s an important test if you have high LDL (bad) cholesterol or are at ‘high risk’ of cardiac disease, as it provides a more finely tuned assessment of cardiovascular risk.

In fact, it might be a critical test for those with low LDL (bad) cholesterol – because it can reveal hidden cardiac risk.

While studies show ApoB is a better predictor of cardiac risk,


Cholesterol Results 2014

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So I finally bucked up and got my cholesterol tested in November and the results were surprising.  First of all, my cholesterol – after a year of reasonably careful eating and a lot more exercise, but no Metamucil or Fish Oil pills – actually moved in the right direction.

Details in a second.

Not only that, my new cardiologist (again, more in a sec on why I needed to finally see a cardiologist) actually called my cholesterol results “enviable.”

Enviable, people.

This shocked me. Especially because I gave up on the fish oil pills which apparently now,


Non-HDL Cholesterol and The New Cholesterol Guidelines

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If non-HDL cholesterol was viewed as a key predictor of cardiac disease risk (on par with apoB or LDL particle testing), why was it abandoned in the new November 2013 cholesterol guidelines?

This is something I’ve been thinking about for a while.  Because for those with diabetes or high triglycerides, it was considered vital to know non-HDL cholesterol. (Do You Know Your Non-HDL Cholesterol? explains why, and how easy it is to calculate from just a standard cholesterol lipid blood test.)

Let me start with a brief, very non-technical definition (for more technical info click blog post link above).  


Cholesterol Tests Your Doctor Hasn’t Told You About

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A standard cholesterol lipid panel  provides four measures: Total Cholesterol, LDL Cholesterol, HDL Cholesterol and Triglycerides.  But did you know that there are two other blood tests — and one ratio that’s easy to calculate — that can better predict your risk of heart disease?  Which means that even with high cholesterol, you might not need a statin medication if these tests show low cardiac disease risk.

Or you might think you don’t need a statin … and in fact do.

And yet, your doctor probably has not told you about these tests.  So let me.