Dr. Rigobert Kefferputz

Patient Library / Cardiovascular Disease / Elevated Cholesterol

Elevated Cholesterol

Standard cholesterol testing tells you very little about actual cardiovascular risk — the full picture requires a different kind of assessment.

Total cholesterol and LDL-C are poor predictors of individual cardiovascular risk — yet they drive the majority of statin prescribing. What actually matters is LDL particle number, particle size, lipoprotein(a), ApoB, oxidized LDL, and the inflammatory environment these particles enter. A proper cardiovascular risk assessment changes who needs treatment and what that treatment should be.

LDL-C Is a Poor Proxy

Two people with identical LDL-C can have very different cardiovascular risk depending on particle size and number. Small, dense LDL particles are far more atherogenic than large, buoyant ones — and standard testing doesn't distinguish between them.

ApoB Is What Counts

ApoB measures the total number of atherogenic particles — a better single predictor of cardiovascular risk than LDL-C. Some patients with 'normal' LDL-C have high ApoB and significant risk; others with 'high' LDL-C have predominantly large particles and low risk.

Metabolic Drivers Come First

Insulin resistance shifts LDL toward small, dense particles and raises triglycerides. Hypothyroidism impairs LDL receptor clearance. Addressing these metabolic drivers often normalizes the lipid profile without targeted lipid-lowering interventions.

What You Need to Know

Frequently Asked Questions

How I Treat This

These are the services I most commonly draw on when working with elevated cholesterol.

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