A Closer Look At Cholesterol

Armen Hareyan's picture

Does testing for HDL and LDL give a complete picture of cholesterol levels and whether or not I am at risk for a heart attack?

Heart disease is the leading cause of death in the United States, and Coronary Artery Disease (CAD) is the most common form of heart disease. Unfortunately, half of all acute cardiac patients don't exhibit traditional warning signs of cardiovascular illness. But new tests give a more comprehensive assessment of an individual's risk factors. For cholesterol, this means analyzing more than just HDL ("good cholesterol") and LDL ("bad cholesterol") levels. We now know that within both LDL and HDL, there exist particles that vary in their characteristics and therefore in their risk (in the case of LDL) and protective (in the case of HDL) factors for CAD.


Cholesterol is a fat-like substance found in all body cells. LDL, a low-density lipoprotein found in the blood, is called a "bad" carrier of cholesterol because high levels of LDL may lead to the development of heart disease. It is now possible to measure LDL size and categorize it as "small LDL trait" or "large LDL trait." It's the small, dense LDL particles that increase CAD risk. That's because the small LDL particles slip between the cells of the artery's lining and tend to stick to artery walls. When these particles stick to artery walls, it causes formation of plaque. This is the process known as atherosclerosis, putting you at greater risk of a heart attack.

High levels of HDL in the blood are believed to lower your risk of heart disease. HDL is a high-density lipoprotein, and is considered a "good" carrier of cholesterol. That's because HDL particles carry cholesterol from your cells out of the arterial wall, via the circulation, back to your liver where it can be eliminated from your body. This process, which inhibits atherosclerosis, is known as reverse cholesterol transport. HDL 2B is the most active of all the HDL particles in such transport. The more HDL 2B you have, the more efficient the arterial cleansing process is. Low levels of HDL 2B increase cardiovascular risk. Through testing, it is now possible to single out and measure the level of heart-protective HDL 2B in your blood.

This more comprehensive approach can point to treatment that differs from traditional therapy. It allows your physician to develop a program for you that is more effective in slowing, halting, or reversing the progression of CAD.