Do you have high LDL or high total cholesterol? If you read my previous article about cheese, you may recall that these LDL or total cholesterol numbers alone are not reliable predictors of mortality from heart disease.
An NBC News piece went further to cite American science writer Gary Taubes who reported that the LDL and total cholesterol numbers have been such poor predictors of disease risk that early screening tests should have likely just tested for HDL and triglycerides and nothing else.
A 1977 NIH study — an early set of papers from the now legendary Framingham Heart Study — confirmed that high HDL is associated with a reduced risk of heart disease. It also confirmed that LDL and “total cholesterol” tells us little about the risk of having a heart attack, language that heart-disease authorities would downplay years later. Given this finding, as Gary Taubes writes in “Good Calories, Bad Calories,” we would have been better off to start testing for HDL — or even triglycerides — and nothing else.
A more nuanced view associates the risk of atherosclerosis and heart disease with the type of LDL particles. There are two patterns (also referred to as “phenotypes”) of LDL particles.
- Pattern A: large, fluffy LDL particles which are largely benign
- Pattern B: small, dense LDL particles which are more likely to oxidize and lodge themselves to arterial walls
Studies have long shown the impact of LDL particle size on disease risk. A 1988 study in the Journal of the American Medical Association documented the association between Pattern B (small, dense) particles and disease risk:
The LDL subclass pattern characterized by a preponderance of small, dense LDL particles was significantly associated with a threefold increased risk of myocardial infarction, independent of age, sex, and relative weight.
So why not test for LDL particle size? The tests are more expensive!
However, there is an answer. While testing for LDL particle size is more expensive today than commonly used cholesterol tests, a triglyceride / HDL ratio of 3.8 or higher can predict pattern B with high confidence. A 1997 Harvard Medical School study also confirmed the efficacy of triglyceride / HDL ratio to predict the risk of myocardial infarction.
Given the age of these studies, the use of HDL and triglycerides has become accepted practice in some circles, as described by Everyday Health.
According to Scott W. Shurmur, MD, the medical director of the cardiovascular center at Texas Tech University Health Sciences Center in Lubbock, Texas, the particle test should be used for people who have other risk factors for heart disease or stroke, such as a family history of heart disease at early ages. “At the same time, standard cholesterol tests like HDL and triglycerides provide similar information (and are less expensive), particularly if non-HDL cholesterol is incorporated into the assessment,” says Dr. Shurmur.
Unfortunately, there are no widely adopted standards today for metrics of triglyceride / HDL ratios in common clinical practice. Some researchers have provided guidelines, including Zone Diet creator Dr. Barry Sears who wrote:
How can you tell which type of LDL you have? All you have to do is determine your ratio of triglycerides to HDL cholesterol, which would be found as part of the results of your last cholesterol screening. If you ratio is less than 2, you have predominantly large, fluffy LDL particles that are not going to do you much harm. If your ratio is greater than 4, you have a lot of small, dense LDL particles that can accelerate the development of atherosclerotic plaques – regardless of your total cholesterol levels.
Still, patients who view their standard lab test results will notice that standard lab results list other ratios including Total Cholesterol / HDL and LDL / HDL ratios, but they do not list Triglyceride / HDL ratios.
(TG/HDL = 138/83 = 1.7)
So why aren’t Triglyceride / HDL ratios more in use, or why aren’t LDL particle sizes discussed more often in the doctor’s office? After all, most of the research cited in this blog article is decades old!
Frequent readers of this blog know my skepticism around a lot of Western Medicine. Most continuing education for doctors is sponsored by pharmaceutical companies who have commercial interests in promoting use of lab numbers that their drugs can lower! According to an academic paper titled “Statins Do Not Decrease Small, Dense Low-Density Lipoprotein:”
Our study suggests that statin therapy—whether or not recipients have coronary artery disease—does not decrease the proportion of small, dense LDL among total LDL particles, but in fact increases it, while predictably reducing total LDL cholesterol, absolute amounts of small, dense LDL, and absolute amounts of large, buoyant LDL.
In other words, drug companies likely suppress the information about LDL particle sizes because their drugs preferentially target the benign “Pattern A” particles over the more harmful “Pattern B” particles!
My opinion: Before going on cholesterol lowering drugs, take a look at your triglyceride / HDL ratio. You may have “Pattern A” LDL particles and be at lower risk of heart disease than your LDL or total cholesterol numbers suggest.
Thanks, very interesting.
So, if my triglyceride level is 123 and my HDL is at 49 , the ratio is around 2.5— which is okay? Even though my LDL is at 192 ?
Your triglycerides are normal, and so are your HDLs. I think most doctors would recommend your taking a test for lipid subfractionalization by ion mobility. I did this in Germany, and my results showed “pattern A” with a high relative number of larger “fluffy” particles, and a small relative number of smaller “dense” LDL particles. The tests are offered in the US, too.
https://www.questdiagnostics.com/home/physicians/testing-services/condition/cardiovascular/cardio-iq-ion-mobility.html
The most recent Cleveland Heart Lab Cardio IQ test panel has my triglycerides at 103 and my HDL at 49, a ratio of about 2.1-1. Unfortunately it also shows I have far too many small lipid particles. Both LDL and HDL particles are too small according to the test results. I had 1909 LDL particles which is far too high according to their test. Small LDL, and medium LDL were both at 490, far above the maximums considered satisfactory. Large HDL came back with a number of 3881, which is far too low according to their test.
Lipoprotein(a) was a bright spot. I was only at 15 nmol/L according their test, much lower than the maximum of 75 considered optimal. What exactly should I make of these results?
You are a pattern B. For a complete picture I would suggest doing an inflammation panel by Cleveland heart labs. Also 9p21 and Apo B test.
No. Ratio is better the further under 2.0 preferably 1.0 or lower.
My LDL=184, HDL=69, Trig=82, Trig/HDL=1.19. (Oxidiertes LDL = 82ng/ml, ApoB = 55 mg/dl).
That seems to me OK.
My Doctor had a fit! I must start immediately on strong Statin to get LDL below 70.
What should I do?
Grateful for any advice. (75 year old male)
My LDL=184, HDL=69, Trig=82, Trig/HDL=1.19. (Oxidiertes LDL = 82ng/ml, ApoB = 55 mg/dl).
That seems to me OK.
My Doctor had a fit! I must start immediately on strong Statin to get LDL below 70.
What should I do?
Grateful for any advice. (75 year old male)
It’s my understanding from research I’ve seen, that pattern B LDL has free cholesterol bound to the outside of its ‘shell’ but when that cholesterol becomes esterified, it gets drawn into the shell, swelling the pattern B LDL to become large fluffy pattern A.
IF this is so, the question in my mind is how to deliberately trigger that esterification?
I recently ran an expensive Cardio IQ test and discovered that I have a huge problem with small, dense LDL. The same test showed very low levels of Lipoprotein (a). The results of recent cardiac calcium scoring tests and Lp-PLA2 blood tests show I need to be very concerned because of increasing arterial inflammation and greatly increased calcium deposits. I am currently running HDL numbers in the low to mid forties and triglycerides in the 170-200 range with total LDL usually over 200.
I would suggest finding a provider that is associated with the BaleDoneen method. Look at their website. They have been treating this condition for the last 15 years with huge success. Their specialty.
Second that on the Baledoneen method. Their forte.
With an HDL of 97 and triglycerides of 50, I guess a forumula determined LDL of 161 should not be too worrisome?
I would be more concerned with the number and size of LDL particles. If you have large numbers of small LDL particles, that would be of concern. If they are mostly large particles, I wouldn’t be concerned at all. Cleveland Heart Lab’s lipoprotein fractionation tests or Labcorp’s NMR lipoprofile test panel would tell you about the number and size of LDL particles.
Cholesterol levels are the wrong thing to test for. You can be harmed by having too many LDL particles, too many small LDL particles in particular, or too many oxidized particles.
Thank you!
According to my recent lab results , Cardio IQ, I have LDL pattern B. LDL small and medium lipoprotein fractionation, ion mobility are both in the moderate risk category while HDL large is well within the high risk category. Can you direct me to any articles or information on what I can do to lower my risk?
Can a person have both pattern A and pattern B LDL’s?
I’m looking more deeply than just whether they classify me as pattern A or pattern B. They use somewhat arbitrary dividing lines for classification. I’m still overweight but less than I used to be. My apolipoprotein B levels are still too high. My Lp-PLA2 levels remain too high. Just getting labeled by Cleveland Heart Lab as pattern A isn’t good enough.
The answer is no. You’re either a patter A or B
Hi, My latest test (19th Jan) shows LDL= 239, HDL= 74, Triglyceride=80, Total Cholesterol=329. My doctor wants to immediately put me on statins (Lipitor). I tried to argue that a) my TG:HDL ratio at 1.08 was ideal and b) I believe statins do more harm than good. To no avail – I was told not to believe what I read in tabloid newspapers – although I have done quite a bit of serious research. Am I or my doctor right/wrong. If I am right then do I need to take any action at all?
Have you ever been to the YouTube website of cardiologist Dr. Ford Brewer? He would argue that conventional doctors prescribe the wrong statins for the wrong reasons and in doses that are much higher than what is often needed. According to him, Crestor and Livalo are better choices that Lipitor. He says that statins should be prescribed to reduce arterial inflammation which is the real issue, not cholesterol numbers.
Most conventional doctors do not run tests for LDL particle numbers or Lp(a). Neither do they run tests for inflammation markers such as LP-PLA2. Such tests provide far better information than just running a cholesterol panel.
Statins are poison. They not only block your liver from producing cholesterol, but the same pathway also makes Coenzyme Q10, Which is vital for heart health. Low cholesterol leads to higher all cause mortality and can have cognitive affects as well. Don’t listen to your doctor on this. He probably hasn’t read any research for 30 years, and has a stake in Lipitor. I like the book The Great Cholesterol Myth. It goes over statins in detail, also how you can affect your heart health by diet.
If you’re not testing for the correct information in regards to CVD and you are only looking at the routine way 90%+ providers evaluate cholesterol, then I agree; dont give a statin.
I have a total cholesterol level or 237 with 123 triglycerides and 70 hdl and 142 ldl. So using that triglycerides/hdl ratio formula I got <2 so it means I have type A?
No, you need a fractionation test.
Eventhough I am clearly a Pattern A patient, I would like to know If having an increasing pattern in LDL levels should be of concern (or at what point should having fluffy and few ldl particles is not enough).
In a Lab Corp test done in Sept 2020 I had total cholesterol at 280, LDL-P at 1669, LDL -C at 171 and HDL-C at 75. Luckily small LDL -P is 101 and LDL size is 22.6. However, in a regular lipid study Ldl-C increased from to 207.
my recent lab corp results have my total cholesterol at 190, Triglycerides at 58, HDL at 55, vLDL at 11, LDL at 124. o my triglycerides to HDL is almost 1. Would it be a fair assumption that my LDL could be mostly type A ??
So for the past three years I’ve been eating healthier and healthier, I have an active job, I exercise for fun. I’m normal weight with perfect glucose numbers but still my LDL is going up!
My doctor wants me on Lipitor and says I may have Familia Hyperlipidemia but according to this and other sources I may be very very low risk.
My most recent test on 2/24/21 is as follows.
Total: 268
HDL: 55
Triglycerides: 66
LDL: 196
If my math is right 66/55 is only 1.2
I’m a lil skeptical but scared at the same time. I’m going to schedule a CAS soon to see where I’m at, bit what other tests are recommend?
Thanks for the blog!
You need to get a fractionation test from Cleveland heart lab. That will pretty much break down everything.
Hello,
my LDL was always high, no matter how healthy my life was and how much time I spend with cardio and in the gym. In the past months I changed my life from healthy to super healthy… even more cardio, even less alcohol, walking 25 kms each week alone to the office and back, no meal after 4 p.m., low carb, and lost another 10 pounds. Feel better and powerful – both physically and mentally than ever. My HDL raised by 10 %, but my LDL by more than 15! This starts to drive me crazy… expected declining or at least constant LDL.
Triglycerides/HDL ratio is 0.36, LDL/HDL ratio 2.6, age 54, 1.75 m, 86 kg, lots of muscles due to weight lifting three times a week
Any comments on these facts/numbers? Am I a medical miracle at the end of the day?
TIA for any feedback!
0.36 is good… maybe too good… this is based on mmol/l. But the scales of cholesterol and triglycerides are different. In mg/dl ist should be around 0.8, which is still good..
Your triglycerides are in the basement or you have unusually high HDL with that kind of ratio. Have you ever run Lp-PLA2? That test measures arterial inflammation.
both of your statements are true. I believe the trig. are low due to low carb diet, combined with interval diet. HDL may be high due to lot of cardio activity. Thx for the hint on Lp-PLA. Will do some research on this. Later
Ekki: Most of your numbers are genetic . Of course what you eat and lifestyle influence your number a bit. But gotta look at you family. Get genetic testing from Cleveland heart lab for more information.
I have not had genetic testing done thru Cleveland Heart Lab. For me I have noticed that I have a big problem with excessive numbers of small dense LDL particles. My last test for high-sensitivity C-reactive protein had me at 0.5 which is very good, but I have never gotten my Lp-PLA2 down to 123. According to that test I’m high risk. A few years ago my Hemoglobin A1C was 5.8 which is too high. The most recent test has me at 5.3 which is far better.
A few years ago, my blood pressure averaged something in the ballpark of 135/82. Today the average is about 120/72. I’m 68 years old and male. I have made good progress in some areas but not others. I do not take any prescription drugs. I have had some success reducing my weight thru time-restricted eating but it really takes a lot of discipline to maintain it. I have removed liquid calories from my diet.
My Lipid panel read this way on the following dates
2/2020 total cholesterol 203, hdl 55, try 48, LDL 138. Try/Hdl =0.87
11/2020 total cholesterol 248, hdl 89, try 56, LDL 150 Try/ Hdl=0.62
It appears have pattern A. There was an increase in LDL and HDL in part due to dietary changes, supplements and workouts.
Good afternoon – My recent blood results are shown below – are you able to tell me if I am pattern A or B please? Many thanks in advance.
Serum cholesterol level 5.7 mmol/L
Serum triglyceride levels 2.47 mmol/L [0.3 – 1.8]
Above high reference limit
Serum HDL cholesterol level 1.21 mmol/L
Serum LDL cholesterol level 3.36 mmol/L
Serum cholesterol/HDL ratio 4.7
Serum non high density lipoprotein cholesterol level 4.49 mmol/L
To me getting classified as either pattern A or pattern B is somewhat arbitrary because it can depend on where the boundary gets drawn. With respect to LDL I would worry a lot more about the number of particles than how much LDL cholesterol is being transported. That takes a more expensive lipoprotein fractionation test to determine that. Also have you ever been tested for Lp(a)? Most conventional doctors fail to run this very important test. It’s largely dictated by genetics. If you have high levels on Lp(a) you are at a huge disadvantage compared with those who don’t. Many people who have high levels of Lp(a) have very early heart attacks. It’s sad but true. This condition can be treated but thanks to the ignorance and improper training of most conventional doctors, it often goes undiscovered until it’s too late.
I recently had an advanced lipid panel, cardio IQ test from quest diagnostics. Trying to better understand the results. Any help/information would be greatly appreciated. Majority of my numbers are high risk on reference range, but still pattern A. Not sure if I’m reading these results correctly. Should I be concerned?
Total 242. HDL 62. Triglycerides 53. LDL 165.
Chol/HDLC ratio 3.9
Non HDL cholesterol 180
LDL particle number 2050. LDL small 248. LDL medium 409. HDL large 5664.
LDL pattern A
LDL peak size 224.2 Angstrom
Apolipoprotein B 125
Lipoprotein (a) 142
There are two things I quickly noticed that I would be concerned about if I were you. Your LDL particle number is too high. Your Lp(a) is also too high. Lp(a) is largely dictated by genetics. To some extent the levels can be modified. But no matter what you do, the bad gene that you probably have will always create an added additional risk for heart attacks and strokes that you would not have if too many LDL particles were the only major issue. If at all possible try to get on a prescription drug or whatever is needed to bring your Lp(a) levels down to a much better number. I hate to tell this, but in general elevated Lp(a) is a far worse problem than too many LDL particles, although both contribute to problems.
Thanks for the information Kelly. Much appreciated. Any suggestions on diet? Should I take an aspirin to lower LP(a) or any other method that will help lower the LP(a) number?
I honestly don’t know which method is best. I have seen different sources touting vitamin C, niacin, and certain prescription drugs. I have heard that high intake of animal protein may increase Lp(a) levels. I honestly don’t know which method of control is best. Unlike you I have very good genes with respect to Lp(a) and can just ignore it. The highest number I have ever had on a Lp(a) test is only 29. The lowest is 11.
Many people who have high levels of Lp(a) suffer deadly heart attacks in their 40s or 50s. One person that might be able to help you is Dr. Ford Brewer who has a Youtube website.
Thanks. I will look into that
I’ve been treating Lp(a) for years. The most successful treatment I’ve found is
EXTENDED RELEASE Niacin – Niaspan (rx). This is NOT the same as SLOW RELEASE.
Have your PCP or cardiologist prescribe this for you. They might say it does not work due to a paper put out by JAMA about a drug that a pharmaceutical company tried to develop by attaching another molecule to the Niacin so people would not flush, and it did not work. So the conclusion was the niacin does not work. But they failed to mention that changing the molecule did not work.
Thanks for the response. All this is information is so helpful. I know dr brewer is a big fan of niacin as well. I will have to reach out to my pcp to prescribe some. Either of you ever hear of a CIMT test? Thoughts on it if you have. Is it worth it for possible blockage detection, etc…
I have never actually had a CIMT test done. Lifeline Screening has a mediocre version of this type of test which focuses on blood flow issues rather than focusing on how thick the arterial deposits are. I have previously had the mediocre Lifeline Screening test done. One problem lies in the fact that many people who suffer deadly heart attacks or strokes don’t have a blood flow problem but they have sufficient arterial deposits to cause inflammation. One problem with the CIMT test lies with its limited availability and higher cost. It’s definitely better than the mediocre Lifeline Screening version as far as the information it provides.
One type of test that I have had run several times is a cardiac calcium scoring test. While it’s true that it only detects hardened calcified deposits and can’t see soft deposits, it’s usually a good bet that if you have substantial hardened deposits you also have substantial soft deposits. The soft deposits are what most often cause heart attacks and strokes.
Yes, the CIMT is not done by every radiology company . Most will tell you if you have “plaque” in the arteries. They do not comment on the soft plaque. Soft plaques is very important.
wondering how much advanced lipid panel test cost, with/without insurance?
Thanks
I use Walk-In Lab. Check their prices and also find out where Quest or Labcorp drawing locations are in your geographic area. Finding out how many LDL particles you have is a much better approximation of your risk than finding out how much LDL cholesterol you have. Also do not overlook Lp(a). It’s heavily influenced by genetics. If your Lp)a) is high it adds huge amounts of additional risk. If it’s very low you can just ignore it.
Any suggest which test to get? I found 91604 and 92500. I found I can order the tests myself from ultalabtests for $49 and $97 and they offered me a 20% discount code. It looks like they are just a billing org as the lab the recommended was my local quest lab (gawd – I hate quest!).
The first one is LDL particle details (size, pattern) while 92500 includes HDL details and VLDL info.
I did a lot of intermintent fasting, yoga 3+ times a week and reduced my total cholesterol from 240 untreated to 218 untreated. Statins give me headaches and definitely affect my short-term memory (Male 64 good shape, somewhat active).
Thanks so much. Awesome information and knowledge from both of you.
I did have a coronary artery calcium CAC test done a couple months back and it was 134 score. All in the LAD artery. Any thoughts on that? Good, bad etc.. considering how high my LP a score was does that mean I’m in a better spot with a 134 CAC score for overall heart problems?
The LAD artery is usually the one most affected. That artery is often called the “widow-maker” artery because it’s the one that most often causes fatal heart attacks. Calcification is actually a body defense mechanism against arterial inflammation. It’s been a little over a year since my last calcium scoring test. I was at 172 with most but not all of the calcium in the LAD artery.
The Youtube website of Ivor Cummins is a very strong advocate of the calcium scoring test. There are advantages and drawbacks to all kinds of tests. In my particular case it’s all roses when you run the C-reactive protein test but the situation is less favorable when you run the Lp-PLA2 test. I have never been able to get my Lp-LPA2 down to the level Quest considers optimal, but C-reactive protein is a different story.
C-reactive protein suffers from the problem that it measures inflammation anywhere regardless of what it’s related to. Lp-PLA2 is specific to the blood vessels and arteries. The latter actually measures a specific enzyme which the body produces to attack arterial deposits.
Do you suggest getting a Lp-LPA2 test considering how high my other numbers are on lp a and particle sizes ? Is it a good marker for cardiovascular risk/disease?
I know someone that had a 900 score on CAC test. They went to a cardiologist and did a stress test, echocardiogram etc… and cardiologist told the individual after all the running/tests they did that they were fine and nothing to worry about. I assume it all depends on the individual and what tests works best for them.
As Dr. Ford Brewer and others have correctly pointed out, stress tests are not reliable. The famous NBC News “Meet the Press” moderator, Tim Russert, passed a stress test a few days before suffering a fatal heart attack in 2008. He had taken a CAC a decade earlier which had him at a score of 210. Most likely it would have been much higher close to the day of his fatal heart attack but he didn’t get a repeat CAC test then. Lp-PLA2 is probably a far better test for measuring arterial inflammation than C-reactive protein. But there is no single test that is 100% correct all the time.
In general, high Lp(a) is something to really worry a lot about because of statistics on who most often gets early age heart attacks. There is something about that specific particle which makes it far more dangerous than a standard LDL particle. Although I do not have a problem with Lp(a), I have another issue I have to be concerned about: excessive numbers of small, dense LDL particles. We all have different issues, some of which are heavily influenced by our genes.
Thanks for the responses. Very informative. I’m going to take a couple different tests and see different cardiologists for multiple opinions.
A major problem with stress tests is they look for blood flow problems. While some people with heart disease do in fact have a blood flow problem, many others do not. Only inflammation in the arteries is necessary to be at high risk for a heart attack.
The clogged up artery theory of heart disease is very inaccurate. When the presence of arterial deposits (plaque) lead the immune system to start attacking the arterial deposits, that’s the mechanism for trouble.
Hi,
I have been on Previstatan for about a year. I had low grade headaches with Crestor. I’d like to be off med and exercise strenously about 5 time a week for 1+ hours. My fasting test results recently were:
Cholesterol 203 mg/dL
HDL Cholesterol 64 mg/dL
Triglycerides 94 mg/dL
LDL, Calculated 119 mg/dL (calc)
My Tri/LDL ratio is low, at 1.46 so I believe that puts me pattern A however I just noticed my LDL was calculated, not measured. Is that a concern? What is your suggestion?
One person I suggest you consider talking to is Dr. Ford Brewer who has a YouTube website. He disagrees with the way statin drugs are commonly used by mainstream doctors. In his opinion, the only statin drugs that should ever be considered are Livalo and Crestor. He thinks these drugs should be prescribed in much lower dosages than is common with mainstream doctors. He believes that the focus should be on reducing inflammation rather than trying to get certain numbers on a standardized lipid panel.
Standardized lipid panels omit a lot of very important information. They don’t tell you if you have issues with Lp(a) or excessive numbers of small, dense lipid particles. They also don’t tell you how much inflammation you have or how much in the way of arterial deposits has actually resulted.
There is a genetic test that you can have done by Cleveland heart lab that tells you the correct statin you should be using. Inflammation and genetics are the key. Have the panel from CHL done so you dont have to guess. Your Provide can ask any lab to do a direct LDL rather than a calculated one.
my dr wants to put me on medicine and i refuse. what would you suggest with my results below:
total choles is 348, hdl is 63 and trig are 172, ldl is 251 with non hdl at 285
ldl particle is 3035, small is 422, medium is 800 and large are 7783 pattern type a. ldl peak size 220.5
apolipoprotein b is 184 lipoprotein a is 18. lp pla2 is 152. what are your thoughts ?
thank you in advance
Your LDL particle count is way, way too high. That is one thing I would really be concerned about if I were you. Here are two things I think you should consider as possible culprits depending on your diet. How much sugar is in your diet? If it’s high, see if greatly reducing it helps. Soft drinks and fruit juice are among the biggest culprits. The effect of saturated fats can vary depending on your genetics. Find out if reducing saturated fats helps or does not help.
Hi, I am a bit confused after reading your article then reading all these replies. I hope you will read this and answer as to help provide a bit of clarity. First, these are my numbers cholesterol 190, triglycerides 67, LDL 90, HDH 77. I am a 62 yr old healthy, as far as I know, female. No weight issues 5’5” 115-117 lbs. on no drugs. No known medical problems. Excerise fairly regularly except when traveling. On no medications except taking progesterone as I do hormone replacement.
I read about Lipoprotein A and decided to ask my dr to check it. It was high 67.6. Yikes! What I don’t understand is when I run the numbers for all the ratios listed in the article above they are all excellent. Why is this? My numbers don’t say I’m at risk be certainly LPa says I am. My dr did suggest taking the extended release niacin. Any thoughts as to why these numbers do not coincide??? Thank you for your time in advance!
Susan, thank you for your inquiry. It is important not to conflate LDL Pattern A (which is an subclass of LDL) and Lipoprotein(a), which is a particle similar to LDL and two proteins known as ApoB and Apo(a). The Apo(a) particle is a very sticky protein particle, thought to be involved in the clotting system, and its addition can be likened to adding a patch of Velcro on a normal LDL particle. As such, your LDL, HDL, and triglyceride numbers do look quite good, but an Lp(a) above 50mg/dl is associated with increased risks.
Unfortunately, my understanding is that high Lp(a) levels are linked to genetics rather than lifestyle or nutrition. If you read my own blog, I happen to be a proponent of trying to attack the causes of underlying problems rather than the symptoms. As such, I’d be a bigger proponent of your continuing to take steps in your life to minimize your risk of cardiovascular disease (through exercise, healthy weight, etc.) rather than to manage specifically to your Lp(a) numbers. I believe your doctor’s recommendation of niacin (also known as vitamin B3) was in that same spirit – really trying to espouse niacin’s overall health benefits rather than from any theory on his part that Lp(a) issues stem from a lack of niacin.
I hope that helps to set some context and to clear up the confusion. Again, LDL Pattern A might be somewhat related to Lp(a), but these are two different substances.
Thank you so much for your reply! I guess I have the bad gene and all I can do is as you said minimize the risk as best as I can. Would you recommend getting the coronary artery calcium score test? Then, I guess if my arteries have plaque, then I’ll know if I have a immediate issue. Thanks again! Have a good evening!
Lp(a) is heavily influenced by genetics. Your level is high enough that you need to be concerned about it and try to reduce it. Lp(a) is far more dangerous than regular LDL. Conventional lipid panels focus on the wrong issues. The number of LDL particles you have is far more important than the amount of cholesterol they transport. Have you ever gone to websites like Walk-In Lab and ordered your own blood and/or urine tests from a menu they furnish? I have done that many times because I don’t trust mainstream MDs to do what’s best for me. I have also driven out of town for calcium scoring tests without a doctor’s prescription. Same reason. You can’t trust most mainstream doctors. There is too much greed for money and too many conflicts of interest that most patients aren’t aware of.
Hi Susan, you’ve likely asked the wrong guy here, but I would personally recommend getting the test. I do know that insurance often doesn’t pay for getting the data, and you may end up paying hundreds of dollars for it. Still, making healthcare decisions for yourself often requires being armed with data, and I’ve personally made the decision to seek testing that insurance providers don’t often pay for.
Stephen thank you for your generosity! I am in tears that I have found a community of self-advocating individuals committed to not being treated simply as a medical statistic. My journey has been long so I will not go into the details. I’m female, 56, diabetic for 7 years (A1C 5.8-6.5). 20 lbs loss now 128 lbs. avg. BP 125/78. Diagnosed with high cholesterol and a heart calcification score of 2. No other arterial issues. Doctor has insisted on statins. But if a less than desirable lifestyle has gotten me here i feel it is diet and lifestyle that can get me out. Recently had what Dr. called Berkely test???
NMR LDL-P Very high 2,206
LDL-C 192
HDL-C 63
Triglycerides 99
TOTAL 272
NMR HDL-P 34.4
NMR Small LDL-P 556
NMR LDL Size 21.7
Doctor has not discussed with me. What does all this mean? And are statins invariably in my near future especially with the diabetes factor. I fear statins just as much as heart disease.
I’m 43yrs old I had a lipoprotein a test done 2 yrs ago, it was marked as 283 mmol, had calcium score done at 41 yrs old it was marked as 0 score, had lipid panel done 2 weeks ago total cholesterol 160 hdl 49 ldl 99 vldl 11 glucose 88
I’m 57 male , 5″11 & 194lbs. Just had an NMR Lipid on 12/22/21 after 3 months of diet change & no real cardio exercise due to back injury (losing 20lbs from 213lbs to 193lbs) and a bit confused by mixed results. Maybe someone can comment?
My 9/22/21 normal Lipid results: TC 247, TriG 56/HDL 52 for 1.07 ratio, LDL 186 (no NMR performed)
12/22/21 results w/ NMR:
Total C = 220 (down 27 from 247)
TriG 52 went down 4 & HDL 48 went down 4 even after eating more salmon, Omega 3 oil, avocado, etc. (1.08 ratio which is good)
T-LDL 163 (down 23 from 186)
HDL-P is 24.6 (new NMR test)
Total LDL-P is 2073, small is 814 w/ Pattern A size 21.3 (new test)
??what is the pattern of the remaining 1259 LDL-P (2073 – 814) or are they non relevant??
Should I be concerned w/ High LDL count w/ Pattern A especially since my TriG/HDL ratio is good??
Also, surprised my Trig & HDL went down when changing up diet to cut back on saturated fats quiet a bit and increase foods quite a bit that increase HDL and adding lots of veg & fruit, beans, etc.
Not sure how to interpret the results?? Any suggestions?
Have you ever had Lp (a) tested? Conventional doctors usually overlook the need to test it, but it’s huge. It’s clear that your LDL particle number is too high and your small LDL particle number is likewise too high. I would look carefully at the amount of sugar and fructose you are eating, including sugar-containing beverages. If your diet includes sugar-containing soft drinks or fruit juice you should cut them out. See if this helps with the high LDL particle counts. I would not assume that you are AOK just because an arbitrary cutoff point has you on the A side of the pattern A/pattern B boundary.
Thanks for your response.
Haven’t had the Lp (a) but will look into it. I don’t drink soft drinks except maybe 3x per month max and some grape juice about the same amount. I have cut way back on sugar/fructose the last 3 months but will keep doing it more carefully. Maybe it takes longer than 3 months of the diet change to change the LDL’s more since I ate a lot of junk, etc. previously?
Could a thyroid issue cause elevated LDL particles? I’m not aware of any issues.
This was super helpful! My test results had me a little confused as I am active and nutrition focused.
My results were;
Total C 232
HDL 51
LDL 170
VLDL 11
Triglycerides 54
Non-HDL 181
total/HDL 4.5
tri/HDL 1.06
On a high fat diet the Total/HDL made sense to me since I consume a lot of healthy fats but the obscene 170 LDL had me worried. I was concerned but my ratio’s looked pretty healthy, spent the last hour down a rabbit hole picking apart Friedewald’s formula and new equations to see if I could find any answers. Thankfully I came across this article.
Would you recommend asking for a Direct LDL test?
Hi, thanks for this article. I knew a lot of things from it. I have a question, the information is :
age:37
Triglycerides : 71mg/dL
HDL: 60mg/dL
LDL: 212mg/dL
VDL: 11mg/DL
Is it too bad? I am wondering I got heart diseases. I feel really bad for this.
Hi Mahir, seems best to get another test with LDL particle size information.
I am so confused. So I got the NMR LipoProtein test through my doctor when he found I was on Keto. He sent me the results with a statin prescription. HDL-P was 1665 and Small LDL-P was 761 which by this measure indicates high levels of small dense LDL. I’ve been on Keto and intermittent fasting for 18 months too. BUT, there is another measure in the report – LDL Size. That came back as 21.1 which puts me in the Large (Pattern A) category. So I have a ton of small dense particles but then show my LDL is of the large fluffy kind? I guess I’ll go get it filled or maybe go back to my old high carb/low fat diet and gain back the 30 lbs. I’m just nervous that if I start eating carbs again, there goes IF because I ate crap all day long.
Any thoughts about these results? Great ratio and gets classified as LDL Pattern A. However, the LDL Small and Medium are both considered just into the high range.
Early 50s caucasian male. Eat a substantial percentage of home-cooked Japanese food. Too many sweets is one of my weaknesses.
Cholesterol, total 226
HDL Cholesterol 83
Triglycerides 87
LDL Cholesterol 124
Chol / HDLC Ratio 2.7
Non-HDL Cholesterol 143
LDL Particle Number 1943
LDL Small 246
LDL Medium 325
HDL Large 12233
LDL Pattern A
LDL Peak Size 226.7
Apolipoprotein B 95
Lipoprotein A <10
Looks very similar to mine – the only high numbers on LDL-P, also small and medium LDLs. I am wondering if low fat diet would be the way to correct them. Not going to agree on statins. I hope to see a reply from a knowledgeable person here
I would avoid statins. Too many side effects. You can take non-prescription sitosterol pills if you are worried about your lipids. But I wouldn’t be too worried. Your HDL is high. The statistics show that high LDL matters less than low HDL as far as risk. You can take a calcium scoring test to find out how much calcification is in your arteries.
I’m 43yrs old I had a lipoprotein a test done 2 yrs ago, it was marked as 283 mmol, had calcium score done at 41 yrs old it was marked as 0 score, had lipid panel done 2 weeks ago total cholesterol 160 hdl 49 ldl 99 vldl 11 glucose 88
I’m 26 yrs old. Recently received blood test and considering whether or not I should look into advanced lipid testing
Recent blood test showed-
Total cholesterol -220 mg/dl
Triglycerides- 47 mg/dl
HDL -71 mg/dl
VLDL – 8 mg/dl
LDL – 141 mg/dl
I do understand my total cholesterol is high, however, based on the Tri/HDL ratio, this would classify me as pattern A?
I’m curious to see what my Lipo (a) levels would be.
I’m 24 and have very similar numbers to you, the biggest difference being my LDL at 129. My dr. wants to put me on a statin but I’ve been hesitant. Curious to see what everyone thinks about your numbers!
If you’re not testing for the correct information in regards to CVD and you are only looking at the routine way 90%+ providers evaluate cholesterol, then I agree; dont give a statin.
I hate to say this. But I think because of the way doctors are trained in medical school and because of greed you can’t trust them to always do the right thing. Medical schools are typically owned by special interests including the pharmaceutical industry and medical supply merchants. Medical schools tend to promote the an exaggerated picture of the benefits of both prescription drugs and surgeries and to greatly underestimate the risks.
I think if you will pull up the YouTube website of Dr. Ford Brewer, you will find someone who isn’t just after the money, or blindly doing it exactly the way they taught in medical school. Ford Brewer uses statins far more sparingly than conventional doctors and is very selective about which ones he prescribes. I am very distrustful of conventional doctors in particular because I think that greedy medical clinic and hospital administrators largely control what the doctors do along with questionable published treatment guidelines from the CDC and other government agencies which are likewise corrupted by selfish financial interests.
Component Results
Component Your Value Standard Range
Cholesterol 275 mg/dL 120 – 199 mg/dL
Triglycerides 35 mg/dL 50 – 150 mg/dL
HDL Cholesterol 88 mg/dL 35 – 55 mg/dL
Non-HDL Cholesterol 187 mg/dL 95 – 160 mg/dL
LDL, Calc 180 mg/dL <=99 mg/dL
Chol HDL Ratio 3 0 – 5
My doctor thinks that my LDL is too high and is saying that I need to go on a Statin drug if I can't lower it in the next 3 months. I had to see a nutritionist and she said my Triglycerides are too low, my HDL is too high, and my LDL is too high. However, my diet is excellent. After reading this article i think i am clearly pattern-A LDL and do not need to be on any cholesterol drug, but how do I convince my doctor? Can a get them to do a particle size test?
Definitely get the particle size test, Lorne. Don’t have the mindset of asking permission from someone superior, just plainly tell the doctor you require complete information before considering medication. If the doctor refuses, Quest and others will let you directly purchase tests in most states. Maybe it will cost $100 or so out of pocket, but a good investment. Or call around to other doctors in network and ask upfront about that.
Hi, Thanks for the information, this is the exact information I am looking for. This year my total cholesterol and LDL went up a lot, (total 290, LDL 202, HDL 89, Tri. 48), but my HDL is also high and my triglycerides is 48 (yes, I have been having this low number for many years), I have been running everyday, intake a lot of healthy diet including fruits, vegetables and fish, also one egg a day.
my questions:
1. should I be worried about this?
2. If I really want to test LDL particle size, any ideas usually how much does it cost without insurance?
many thanks
Hi, my TG/HDL ratio looks good at 1.8 but my fractionation confirmed pattern B (see below). Any advice on my next steps would be appreciated .
Lipid Panel
– TOTAL CHOLESTEROL: 199
– HDL CHOLESTEROL: 52
– TRIGLYCERIDES: 94
– LDL CHOLESTEROL
– TG/HDL = 138/83 = 1.8
Fractionation test:
– HDL Large 6423
– LDL Medium: 511
– LDL Particle number: 1762
– LDL Pattern: B
– LDL Peak size: 215.6
– LDL small: 388
Niaspan ER will help to change the LDL particle number and sizes. Also give up processed foods and go with more whole foods.
So with Triglyercides of 52 and HDL of 76 my ratio is at a .68
My LDL is a 143- 12 points higher from my test about a year ago and my HDL is 5 points higher. Total cholesterol is 229 up from 209
My ratio almost seems too low. Can you explain?
Doctor does not want to put me on medicine yet but wants me to watch diet. My diet is already pretty good and I exercise regularly.
Ask you doctor to run either a BOSTON HEART LAB OR CLEVELAND HEART LAB panel. CVD is more than cholesterol. There are genetic factors and oxidative LDL, ADMA, etc. About 9 different reason that we develop heart disease. Only looking at 1 factor is a not good enough.
I’m going to guess you are skinny as a rail.
Thank you for replying!!
Thank you for the information. I will look in to the other tests.
Yes, on being skinny – always have been unless pregnant.
Right now really at my highest weight at about 130 and 5 ft 6 with above average but not perfect diet and exercise, jogging and walking, getting many steps in each day.
I just got the Cardio IQ test and are completely confused by the results. Some items are great and some not.
Chol total = 215 HDL Chol = 86 Tri = 62 LDL – Chol = 115 Chol/HDLC ratio 2.5 Non- HDL Chol = 129.
LDL Particle Number = 1670 LDL Small = 303 LDL Medium = 372 HDL Large = 9058 LDL Pattern = A
LDL Peak size = 221.1
Apolipoprotein B = 90 Lipoprotein (A) <10 (with this one repeated twice per the notes)
On a ketovore diet/ lower body fat and exercise 6 days a week.
Have type B LDL. Post menopausal.
HDL 46.
Tri 128.
LDL 125.
LDL Particle # 2237.
LDL small 479.
LDL Med 491.
HDL Large 8583.
Obviously I have a genetic issue (Also have low Lactate Dehydrogenase # 106)- working on genetic test for glycogen storage disease XI
Insulin resistance also obvious.
Best type of diet to lower Type B LDL? What meds? How to reverse please. Recommendations would really be appreciated.
Confused! Please help me 🤞… should I resist statin recommendation
My LDL=132, HDL=71, Trig=79, Trig/HDL=1.11.
Cholesterol/HDL Ratio 3.1.
ApoB = 96 mg/dl; ApoA = 14.
LDL Particle Number 1,547.
LDL Small / Medium / Large = 219 small / 348 medium / 5,528 Large
LDL Pattern = A
LDL Peak Size = 221.1
Dr is recommending I consider statins.
51 yr old Male. Is it too early for me if I’m Low Risk?
I suspect that you may have a genetic condition that causes you make huge numbers of large LDL particles. I’m not a doctor so
I don’t know what treatment if any is best.
Thank you Kelly
I was looking into familial hypercholesterolemia, leaky gut and potential residual insulin resistance as possible contributors to discuss with my Dr at my next visit. My current risk is 2% of a coronary incident over the next 10 yrs which seemed a lesser risk for the benefits of statins and all their possible side effects ….forever!
I think I should also start a consultation with a functional medicine practitioner as a second path to find root cause.